Department of Orthopaedics, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC, Canada.
Clin Orthop Relat Res. 2011 Mar;469(3):759-67. doi: 10.1007/s11999-010-1565-4.
Abuse of children is abhorrent in Western society and, yet, is not uncommon. Nonaccidental trauma (NAT) is the result of a complex sociopathology. Not all of the causative factors of NAT are known, many are incompletely described, not all function in each case, and many are secondary to preexisting pathology in other areas.
QUESTIONS/PURPOSES: We therefore addressed the following questions in this review: (1) what is the general incidence of NAT; (2) what factors are intrinsic to the abused child, family, and society; and (3) what orthopaedic injuries are common in NAT?
We searched Medline, Medline In Process & Other Non-Indexed Citations, and Embase using OVID. Only one article fit our inclusion criteria; therefore, this is a descriptive generalized review of the epidemiology of NAT.
The general incidence of NAT ranges from 0.47 per 100,000 to 2000 per 100,000. Younger children are at greater risk of NAT than older children. Parents are often the perpetrators of the abuse. Rib fractures are highly indicative of NAT in young children.
It is important to consider child, family, and societal factors when confronted with suspicions of child abuse. Our review demonstrates the currently limited information on the true incidence of NAT. To determine a much more accurate incidence of NAT, there needs to be a population-based surveillance program conducted through primary care providers.
儿童虐待在西方社会是令人憎恶的，但却并不罕见。非故意伤害性创伤（NAT）是一种复杂的社会病理学的结果。并非所有 NAT 的致病因素都已知，许多因素描述得并不完整，并非所有因素在每种情况下都起作用，许多因素是其他领域先前存在的病理学的继发因素。
问题/目的：因此，我们在本次综述中提出了以下问题：（1）NAT 的一般发生率是多少；（2）受虐待儿童、家庭和社会的内在因素是什么；（3）NAT 中常见的骨科损伤有哪些？
我们使用 OVID 在 Medline、Medline In Process 和其他非索引引文以及 Embase 上进行了搜索。只有一篇文章符合我们的纳入标准；因此，这是对 NAT 流行病学的描述性综合综述。
NAT 的一般发生率从每 10 万人 0.47 例到每 10 万人 2000 例不等。年幼的儿童比年长的儿童面临更大的 NAT 风险。父母往往是虐待行为的施害者。肋骨骨折是幼儿 NAT 的高度提示性表现。
在面对儿童虐待的怀疑时，考虑儿童、家庭和社会因素很重要。我们的综述表明，目前关于 NAT 真实发生率的信息有限。为了确定更准确的 NAT 发生率，需要通过初级保健提供者进行基于人群的监测计划。
