Letson Megan M, Cooper Jennifer N, Deans Katherine J, Scribano Philip V, Makoroff Kathi L, Feldman Kenneth W, Berger Rachel P
Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; The Ohio State University College of Medicine, 370 W. 9th Ave., Columbus, OH 43210, USA.
Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
Child Abuse Negl. 2016 Oct;60:36-45. doi: 10.1016/j.chiabu.2016.09.001. Epub 2016 Sep 25.
Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities. All AHT cases from 7/1/2009 to 12/31/2011 at four tertiary care children's hospitals were included. A prior opportunity was defined as prior evaluation by either a medical or child protective services (CPS) professional when the symptoms and/or referral could be consistent with abuse but the diagnosis was not made and/or an alternate explanation was given and accepted. Two-hundred-thirty-two children with AHT were identified; median age (IQR) was 5.40 (3.30, 14.60) months. Ten percent (22/232) died. Of the 232 patients diagnosed with AHT, 31% (n=73) had a total of 120 prior opportunities. Fifty-nine children (25%) had at least one prior opportunity to identify abuse in a medical setting, representing 98 prior opportunities. An additional 14 (6%) children had 22 prior opportunities through previous CPS involvement. There were no differences between those with and without a prior opportunity based on age, gender, race, insurance, mortality, or institution. Children with prior opportunities in a medical setting were more likely to have chronic subdural hemorrhage (48 vs. 17%, p<0.01) and healing fractures (31 vs. 19%, p=0.05). The most common prior opportunities included vomiting 31.6% (38/120), prior CPS contact 20% (24/120), and bruising 11.7% (14/120). Improvements in earlier recognition of AHT and subsequent intervention might prevent additional injuries and reduce mortality.
受轻微虐待性伤害的婴儿有遭受更严重虐待性伤害的风险，包括虐待性头部创伤（AHT）。我们的研究目的是确定患有AHT的儿童是否有过先前发现虐待行为的机会，并描述这些机会。纳入了2009年7月1日至2011年12月31日期间在四家三级儿童专科医院发生的所有AHT病例。先前机会被定义为当症状和/或转诊可能与虐待行为一致，但未做出诊断和/或给出并接受了另一种解释时，由医疗或儿童保护服务（CPS）专业人员进行的先前评估。共识别出232例患有AHT的儿童；中位年龄（四分位间距）为5.40（3.30，14.60）个月。10%（22/232）的患儿死亡。在232例被诊断为AHT的患者中，31%（n = 73）共有120次先前机会。59名儿童（25%）至少有一次在医疗环境中识别虐待行为的先前机会，共98次先前机会。另有14名（6%）儿童通过先前CPS的介入有22次先前机会。在年龄、性别、种族、保险、死亡率或机构方面，有先前机会和没有先前机会的儿童之间没有差异。在医疗环境中有先前机会的儿童更有可能患有慢性硬膜下出血（48%对17%，p<0.01）和愈合性骨折（31%对19%，p = 0.05）。最常见的先前机会包括呕吐31.6%（38/120）、先前与CPS接触20%（24/120）和瘀伤11.7%（14/120）。更早识别AHT并进行后续干预的改进措施可能会预防更多伤害并降低死亡率。
