General Pediatric Division, Seattle Children's Hospital & the University of Washington School of Medicine, Seattle, Washington, USA.
Child Protection Team, Boston Medical Center, Boston Medical Center, Pediatrics, Shrewsbury, Massachusetts, USA.
Arch Dis Child. 2014 Sep;99(9):817-23. doi: 10.1136/archdischild-2013-304701. Epub 2014 Apr 19.
To determine the frequency of non-cutaneous mimics identified in a large, multicentre cohort of children evaluated for physical abuse.
Prospectively planned, secondary analysis of 2890 physical abuse consultations from the Examining Siblings To Recognize Abuse (ExSTRA) research network. Data for each enrolled subject were entered at the child abuse physician's diagnostic disposition. Physicians prospectively documented whether or not a 'mimic' was identified and the perceived likelihood of abuse. Mimics were divided into 3 categories: (1) strictly cutaneous mimics, (2) strictly non-cutaneous mimics and (3) cutaneous and non-cutaneous mimics. Perceived likelihood of abuse was described for each child on a 7-point scale (7=definite abuse).
Among 2890 children who were evaluated for physical abuse, 137 (4.7%) had mimics identified; 81 mimics (59.1% of mimics and 2.8% of the whole cohort) included non-cutaneous components. Six subjects (7.4%) were assigned a high level of abuse concern and 17 (20.1%) an intermediate level despite the identification of a mimic. Among the identified mimics, 28% were classified as metabolic bone disease, 20% haematologic/vascular, 16% infectious, 10% skeletal dysplasia, 9% neurologic, 5% oncologic, 2% gastrointestinal and 10% other. Osteomalacia/osteoporosis was the most common non-cutaneous mimic followed by vitamin D deficiency.
A wide variety of mimics exist affecting most disease categories. Paediatric care providers need to be familiar with these conditions to avoid pitfalls in the diagnosis of physical abuse. Identification of a mimic does not exclude concurrent abuse.
确定在一个大型多中心儿童虐待评估队列中发现的非皮肤性模仿的频率。
对 Examining Siblings To Recognize Abuse（ExSTRA）研究网络的 2890 例虐待性身体检查咨询进行前瞻性计划的二次分析。每个入组患者的数据都在儿童虐待医生的诊断处置中输入。医生前瞻性地记录是否识别出“模仿”以及虐待的可能性。模仿分为 3 类：（1）严格的皮肤性模仿，（2）严格的非皮肤性模仿，（3）皮肤性和非皮肤性模仿。对每个孩子的虐待可能性都使用 7 分制（7=明确虐待）进行描述。
在 2890 名接受身体虐待评估的儿童中，有 137 名（4.7%）识别出有模仿；81 种模仿（模仿的 59.1%和整个队列的 2.8%）包括非皮肤性成分。尽管识别出了模仿，但有 6 名儿童（7.4%）被归为高度虐待关注，17 名（20.1%）被归为中度关注。在识别出的模仿中，28%为代谢性骨病，20%为血液/血管，16%为感染，10%为骨骼发育不良，9%为神经，5%为肿瘤，2%为胃肠道，10%为其他。佝偻病/骨质疏松症是最常见的非皮肤性模仿，其次是维生素 D 缺乏症。
存在影响大多数疾病类别的各种模仿。儿科护理提供者需要熟悉这些疾病，以避免在身体虐待的诊断中出现错误。识别出模仿并不能排除同时存在的虐待。
