Scribano Philip V, Makoroff Kathi L, Feldman Kenneth W, Berger Rachel P
The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., Philadelphia, PA 19104, USA.
Child Abuse Negl. 2013 Oct;37(10):771-7. doi: 10.1016/j.chiabu.2013.04.011. Epub 2013 Jun 2.
The diagnosis of abusive head trauma (AHT) remains a significant public health problem with limited prevention success. Providing protection from further harm is often challenged by the difficulty in identifying the alleged perpetrator (AP) responsible for this pediatric trauma. The objective of this study was to evaluate demographic and clinical characteristics of children with AHT and the relationship between APs and their victims in a large, multi-site sample. Understanding the AHT risks from various caregivers may help to inform current prevention strategies. A retrospective review of all cases of AHT diagnosed by child protection teams (CPT) from 1/1/04 to 6/30/09 at four children's hospitals was conducted. Clinical characteristics of children with AHT injured by non-parental perpetrators (NPP) were compared to parental perpetrators (PP). There were 459 children with AHT; 313 (68%) had an identified AP. The majority of the 313 children were <1 year of age (76%), Caucasian (63%), male (58%), receiving public assistance (80%), and presented without a history of trauma (62%); mortality was 19%. Overall, APs were: father (53%), parent partner (22%), mother (8%), babysitter (8%), other adult caregiver (5%); NPP accounted for 39% of APs. NPPs were more likely to cause AHT in children ≥ 1 year (77% vs. 23%, p<0.001) compared to PP. Independent associations to NPP included: older child, absence of a history of trauma, retinal hemorrhages, and male perpetrator gender. While fathers were the most common AP in AHT victims, there is a significant association for increased risk of AHT by NPPs in the older child, who presents with retinal hemorrhages, in the hands of a male AP. Further enhancement of current prevention strategies to address AHT risks of non-parental adults who provide care to children, especially in the post-infancy age seems warranted.
虐待性头部创伤（AHT）的诊断仍然是一个重大的公共卫生问题，预防成效有限。由于难以确定造成这种儿童创伤的所谓肇事者（AP），防止进一步伤害往往面临挑战。本研究的目的是在一个大型多地点样本中评估AHT患儿的人口统计学和临床特征，以及AP与其受害者之间的关系。了解来自不同照顾者的AHT风险可能有助于为当前的预防策略提供信息。对四家儿童医院儿童保护团队（CPT）在2004年1月1日至2009年6月30日期间诊断的所有AHT病例进行了回顾性研究。将非父母肇事者（NPP）造成AHT的患儿的临床特征与父母肇事者（PP）造成AHT的患儿进行了比较。共有459名AHT患儿；313名（68%）有确定的AP。在这313名患儿中，大多数年龄小于1岁（76%），为白种人（63%），男性（58%），接受公共援助（80%），且无创伤史（62%）；死亡率为19%。总体而言，AP为：父亲（53%）、父母伴侣（22%）、母亲（8%）、保姆（8%）、其他成年照顾者（5%）；NPP占AP的39%。与PP相比，NPP在1岁及以上儿童中更有可能导致AHT（77%对23%，p<0.001）。与NPP的独立关联包括：年龄较大的儿童、无创伤史、视网膜出血以及男性肇事者。虽然父亲是AHT受害者中最常见的AP，但在年龄较大、有视网膜出血、由男性AP造成伤害的儿童中，NPP导致AHT风险增加存在显著关联。似乎有必要进一步加强当前的预防策略，以应对为儿童提供照顾的非父母成年人的AHT风险，尤其是在婴儿期之后。
