Wieldraaijer Femke, de Vries Tjalling W
Medisch Centrum Leeuwarden, Leeuwarden, Afd. Spoedeisende Hulp, the Netherlands.
Ned Tijdschr Geneeskd. 2011;155(28):A3001.
To determine whether there are any differences between children known to be maltreated and a control group, the goal being an earlier detection of maltreated children in the emergency department (ED).
Retrospective case control study.
Children in whom child abuse had been ascertained by the Dutch child protection services (Advies- en Meldpunt Kindermishandeling, AMK) in Friesland in 2008, were compared with matched control children from Leeuwarden Medical Centre. For each child we established the total number of ED visits and the number of hospitals visited in Friesland in the 3 years prior to registration at the AMK. For each ED visit we recorded the reason for the visit, type of injury, if applicable, length of delay before seeking medical attention, diagnosis, reason for admission, completeness of the screening questionnaire and registration, if applicable, at the AMK. For each ED visit we assessed in retrospect whether there was a possibility of child abuse, whereby assessors were not aware of the group each child was in.
In the group of maltreated children, 93 of the 676 children collectively visited the ED 129 times, compared with 61 of 676 children in the control group who visited 69 times (odds ratio (OR):1.61; 95% CI: 1.14-2.27). 24 (26%) of the maltreated children who visited the ED went more than once; in the control group 6 children visited the ED more than once (9.8%) (OR: 3.19; 95% CI: 1.22-8.35). In retrospect the researchers suspected 11 cases of child abuse in the group of maltreated children but not one in the control group. These results were all significantly different between both groups, the other variables showed no significant difference. For 3 of the 93 maltreated children (3%) contact had been made with the AMK at the time of the most recent ED visit.
Children who were maltreated visited the ED more frequently and were more likely to visit the ED several times over a period of 3 years. Child abuse was not sufficiently detected in the ED.
确定已知受虐待儿童与对照组儿童之间是否存在差异，目标是在急诊科（ED）更早地发现受虐待儿童。
回顾性病例对照研究。
将2008年荷兰弗里斯兰省儿童保护服务机构（儿童虐待咨询与报告中心，AMK）确定存在虐待情况的儿童与来自吕伐登医疗中心的匹配对照儿童进行比较。对于每个儿童，我们确定了在AMK登记前3年内在弗里斯兰省的急诊就诊总数和就诊医院数量。对于每次急诊就诊，我们记录了就诊原因、损伤类型（如适用）、寻求医疗救治前的延迟时间、诊断、入院原因、筛查问卷的完整性以及在AMK的登记情况（如适用）。对于每次急诊就诊，我们回顾性评估是否存在虐待儿童的可能性，评估人员不知道每个儿童所属的组别。
在受虐待儿童组中，676名儿童中的93名共急诊就诊129次，而对照组676名儿童中的61名就诊69次（优势比（OR）：1.61；95%置信区间：1.14 - 2.27）。在急诊就诊的受虐待儿童中有24名（26%）不止就诊一次；对照组中有6名儿童不止一次就诊（9.8%）（OR：3.19；95%置信区间：1.22 - 8.35）。回顾性分析中，研究人员怀疑受虐待儿童组中有11例虐待儿童情况，而对照组中无一例。两组之间这些结果均有显著差异，其他变量无显著差异。在93名受虐待儿童中有3名（3%）在最近一次急诊就诊时已与AMK取得联系。
受虐待儿童急诊就诊更频繁，且在3年期间内更有可能多次就诊。急诊科对虐待儿童情况的检测不足。
