General Pediatrics, Children's Hospital of Philadelphia, Department of Biostatistics, University of Pennsylvania School of Medicine, 3535 Market Street, Room 1517, Philadelphia, PA 19104, USA.
Pediatrics. 2010 Sep;126(3):408-14. doi: 10.1542/peds.2010-0031. Epub 2010 Aug 16.
To evaluate in a national database the association of race and socioeconomic status with radiographic evaluation and subsequent diagnosis of child abuse after traumatic brain injury (TBI) in infants.
We conducted a retrospective study of infants with non-motor vehicle-associated TBI who were admitted to 39 pediatric hospitals from January 2004 to June 2008. Logistic regression controlling for age, type, and severity of TBI and the presence of other injuries was performed to examine the association of race and socioeconomic status with the principal outcomes of radiographic evaluation for suspected abuse and diagnosis of abuse. Regression coefficients were transformed to probabilities.
After adjustment for type and severity of TBI, age, and other injuries, publicly insured/uninsured infants were more likely to have had skeletal surveys performed than were privately insured infants (81% vs 59%). The difference in skeletal survey performance for infants with public or no insurance versus private insurance was greater among white (82% vs 53%) infants than among black (85% vs 75%) or Hispanic (72% vs 55%) infants (P=.022). Although skeletal surveys were performed in a smaller proportion of white than black or Hispanic infants, the adjusted probability for diagnosis of abuse among infants evaluated with a skeletal survey was higher among white infants (61%) than among black (51%) or Hispanic (53%) infants (P=.009).
National data suggest continued biases in the evaluation for abusive head trauma. The conflicting observations of fewer skeletal surveys among white infants and higher rates of diagnosis among those screened elicit concern for overevaluation in some infants (black or publicly insured/uninsured) or underevaluation in others (white or privately insured).
在国家数据库中评估种族和社会经济地位与儿童创伤性脑损伤（TBI）后虐待性头部创伤的影像学评估和随后诊断的关系。
我们对 2004 年 1 月至 2008 年 6 月期间因非机动车相关 TBI 住院的 39 家儿科医院的婴儿进行了回顾性研究。进行了逻辑回归分析，控制了 TBI 的类型、严重程度和其他损伤的存在，以检查种族和社会经济地位与疑似虐待和虐待诊断的主要影像学评估结果的关系。回归系数被转换为概率。
在调整 TBI 的类型和严重程度、年龄和其他损伤后，公保/无保婴儿比私保婴儿更有可能接受骨骼扫描（81%比 59%）。在白种人（82%比 53%）婴儿中，公保/无保或私保婴儿与白种人（85%比 75%）或西班牙裔（72%比 55%）婴儿相比，进行骨骼扫描的差异更大（P=.022）。尽管白种人婴儿进行骨骼扫描的比例较小，但接受骨骼扫描评估的婴儿中诊断为虐待的调整后概率高于黑种人（51%）或西班牙裔（53%）婴儿（P=.009）。
全国数据表明，对虐待性头部创伤的评估仍存在持续的偏见。在白人婴儿中骨骼扫描的比例较低，而在接受筛查的婴儿中诊断率较高的观察结果相互矛盾，这引发了对某些婴儿（黑人或公保/无保）过度评估或对其他婴儿（白人或私保）评估不足的担忧。
