1Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT. 2Pediatric Critical Care Medicine, Yale-New Haven Children's Hospital, New Haven, CT. 3Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, DC. 4UT Regional One Physicians, Trauma Surgery, Regional One Health, Memphis, TN. 5General Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA. 6Keck School of Medicine, University of Southern California, Los Angeles, CA. 7Department of Pharmacy and Therapeutics, University of Pittsburgh, School of Pharmacy, Pittsburgh, PA. 8VA Medical Center, Department of Emergency Medicine, Durham, NC.
Crit Care Med. 2015 Nov;43(11):2460-7. doi: 10.1097/CCM.0000000000001255.
This review provides an overview of what is known about violent injury requiring critical care, including child physical abuse, homicide, youth violence, intimate partner violence, self-directed injury, firearm-related injury, and elder physical abuse.
We searched PubMed, Scopus, Ovid Evidence-Based Medicine Reviews, and the National Guideline Clearinghouse. We also included surveillance data from the Centers for Disease Control and Prevention and National Trauma Data Bank.
Search criteria limited to articles in English and reports of humans, utilizing the following search terms: intentional violence, intentional harm, violence, crime victims, domestic violence, child abuse, elder abuse, geriatric abuse, nonaccidental injury, nonaccidental trauma, and intentional injury in combination with trauma centers, critical care, or emergency medicine. Additionally, we included relevant articles discovered during review of the articles identified through this search.
Two hundred one abstracts were reviewed for relevance, and 168 abstracts were selected and divided into eight categories (child physical abuse, homicide, youth violence, intimate partner violence, self-directed injury, firearm-related injury, and elder physical abuse) for complete review by pairs of authors. In our final review, we included 155 articles (139 articles selected from our search strategy, 16 additional highly relevant articles, many published after we conducted our formal search).
A minority of articles (7%) provided information specific to violent injury requiring critical care. Given what is known about violent injury in general, the burden of critical violent injury is likely substantial, yet little is known about violent injury requiring critical care.
Significant gaps in knowledge exist and must be addressed by meaningful, sustained tracking and study of the epidemiology, clinical care, outcomes, and costs of critical violent injury. Research must aim for not only information but also action, including effective interventions to prevent and mitigate the consequences of critical violent injury.
本综述概述了需要重症监护的暴力性损伤，包括儿童身体虐待、凶杀、青少年暴力、亲密伴侣暴力、自我伤害、与枪支相关的损伤以及老年人身体虐待。
我们在 PubMed、Scopus、Ovid 循证医学评论和国家指南清除库中进行了搜索。我们还纳入了疾病控制与预防中心和国家创伤数据库的监测数据。
搜索标准仅限于英文文章和人类报告，使用了以下搜索词：蓄意暴力、蓄意伤害、暴力、犯罪受害者、家庭暴力、儿童虐待、老年虐待、老年虐待、非意外损伤、非意外创伤以及创伤中心、重症监护或急诊医学相结合的蓄意伤害。此外，我们还纳入了在审查这些文章时发现的相关文章。
有 201 篇摘要被审查了相关性，其中 168 篇摘要被选中并分为八个类别（儿童身体虐待、凶杀、青少年暴力、亲密伴侣暴力、自我伤害、与枪支相关的损伤以及老年人身体虐待），由两位作者进行完整审查。在我们的最终审查中，我们纳入了 155 篇文章（139 篇来自我们的搜索策略，16 篇额外的高度相关文章，其中许多是在我们进行正式搜索后发表的）。
少数（7%）文章提供了特定于需要重症监护的暴力性损伤的信息。鉴于一般暴力性损伤的已知情况，重症暴力性损伤的负担很可能很大，但对于需要重症监护的暴力性损伤知之甚少。
知识存在显著差距，必须通过对重症暴力性损伤的流行病学、临床护理、结果和成本进行有意义的、持续的跟踪和研究来解决。研究必须不仅要提供信息，还要采取行动，包括采取有效干预措施，预防和减轻重症暴力性损伤的后果。
