Oral Resmiye, Bayman Levent, Assad Abraham, Wibbenmeyer Lucy, Buhrow Jakob, Austin Andrea, Bayman Emine O
Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Pediatr Emerg Care. 2011 Jun;27(6):490-5. doi: 10.1097/PEC.0b013e31821d860f.
Substantiation of drug exposure in cases with alleged maltreatment is important to provide proper treatment and services to these children and their families. A study performed at University of Iowa Hospitals and Clinics showed that 30% of pediatric patients with burn injuries, which were due to child maltreatment, were also exposed to illicit drugs.
The children presenting to the University of Iowa Hospitals and Clinics with alleged maltreatment have been tested for illicit substances since 2004. The objective of this study was to analyze the presence of illicit drug exposure in the pediatric subpopulation admitted to pediatric inpatient and outpatient units for an evaluation for abuse/neglect.
The study design is a retrospective chart review. Using hospital databases, every pediatric chart with a child abuse/neglect allegation was retrieved. The association between risk factors and clinical presentation and illicit drug test result was assessed. Excel and SAS were used for statistical analysis. Institutional review board approval was obtained to conduct this study.
Six hundred sixty-five charts met study inclusion criteria for child abuse/neglect allegation. Of those, 232 cases were tested for illicit drugs between 2004 and 2008 per the testing protocol. Thirty-four cases (14.7%) tested positive on a drug test. Positive test rates based on clinical presentation were 28.6% (18/63) in neglect cases, 16.1% (5/31) in cases with soft tissue injuries, 14.3% (4/28) in burn injuries, 10.0% (2/20) in cases with sexual abuse, 7.1% (2/28) in cases with fractures, and 4.8% (3/62) in abusive head trauma cases. There were long-term abuse findings in 129 children (55.6%). Logistic regression analysis revealed that positive drug testing was most significantly associated with clinical symptoms suggesting physical abuse or neglect versus sexual abuse (odds ratio [OR] = 6.70; 95% confidence interval [CI], 1.26-35.49; P = 0.026), no or public health insurance versus those with private insurance (OR = 4.49; 95% CI, 1.47-13.66; P = 0.008), history of parental drug abuse versus those without parental history of drug abuse (OR = 3.42; 95% CI, 1.38-8.46; P = 0.008), and history of domestic violence versus those without a history of domestic violence (OR = 2.81; 95% CI, 1.08-7.30; P = 0.034).
The results of this study showed that an illicit drug screening protocol used in the assessment of children evaluated for child abuse identified almost 15% of the population of allegedly abused and neglected children who were tested according to a protocol being exposed to illicit drugs. Thus, routine drug testing of at least children assessed for neglect and nonaccidental burn and soft tissue injuries, children with a history of either parental drug use or domestic violence is recommended.
在疑似虐待病例中证实药物暴露情况对于为这些儿童及其家庭提供恰当的治疗和服务至关重要。爱荷华大学医院及诊所进行的一项研究表明，因儿童虐待导致烧伤的儿科患者中，有30%还接触过非法药物。
自2004年以来，前往爱荷华大学医院及诊所就诊且疑似受到虐待的儿童都接受了非法物质检测。本研究的目的是分析入住儿科住院部和门诊部接受虐待/忽视评估的儿科亚人群中非法药物暴露情况。
本研究设计为回顾性病历审查。利用医院数据库，检索了每一份有儿童虐待/忽视指控的儿科病历。评估了风险因素与临床表现及非法药物检测结果之间的关联。使用Excel和SAS进行统计分析。本研究已获得机构审查委员会批准。
665份病历符合儿童虐待/忽视指控的研究纳入标准。其中，根据检测方案，2004年至2008年期间有232例接受了非法药物检测。34例（14.7%）药物检测呈阳性。基于临床表现的阳性检测率在忽视病例中为28.6%（18/63），软组织损伤病例中为16.1%（5/31），烧伤病例中为14.3%（4/28）,性虐待病例中为10.0%（2/20），骨折病例中为7.1%（2/28）,虐待性头部创伤病例中为4.8%（3/62）。129名儿童（55.6%）有长期虐待迹象逻辑回归分析显示,药物检测呈阳性与提示身体虐待或忽视而非性虐待（优势比[OR]=6.70；95%置信区间[CI]，1.26 - 35.49；P=0.026）、无保险或公共医疗保险与私人保险（OR=4.49；95%CI,1.47 - 13.66；P=0.008）、有父母药物滥用史与无父母药物滥用史（OR=3.42；95%CI，1.38 - 8.46；P=0.008）以及有家庭暴力史与无家庭暴力史（OR=2.81；95%CI，1.08 - 7.30；P=0.034）最为显著相关。
本研究结果表明，在对疑似受虐待儿童进行评估时使用的非法药物筛查方案，在按方案接受检测的疑似受虐待和被忽视儿童群体中，发现了近15%的儿童接触过非法药物。因此，建议至少对接受忽视、非意外烧伤和软组织损伤评估的儿童、有父母吸毒或家庭暴力史的儿童进行常规药物检测。
