Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Int J Surg. 2017 Jul;43:137-144. doi: 10.1016/j.ijsu.2017.05.068. Epub 2017 May 31.
While assault is commonly reported or suspected in children with traumatic wounds, a recent overview of these injuries, especially those requiring trauma surgery consultation is lacking in the literature.
Explore the incidence, demographics and injury patterns of children presenting to trauma centers following an assault.
Retrospective review of the National Trauma Data Bank 2007 to 2011.
Subjects up to 18 years old with "assault" reported as the intent of injury. Patients were divided into infants (<2 years), young children (2-5 years), children (6-11 years), and adolescents (12-18 years).
Mechanism of injury, injury severity and mortality based on age groups and race.
Of 609,207 children, 58,299 (9.6%) were victims of an assault. The median age was 16 years and 81% were male, with a median injury severity score (ISS) of 8. The majority of patients were adolescents (76%), followed by infants (17%) and young children (4%). There was a stepwise increase in the proportion of assaulted Black children with increasing age (23.2% for infants and up to 46.7% for adolescents, trend p < 0.01, effect size: 0.175) while the opposite applied for White children (46.0% for infants and down to 19.5% for adolescents, trend p < 0.01, effect size: -0.230). With increasing age, White subjects had the highest trend of being assaulted during an unarmed fight or brawl (p < 0.01, effect size: 0.393), while for Black victims the highest trend was noted for assault with a firearm (p < 0.01, effect size: 0.323). Almost 2 out of 3 infants sustained severe head trauma (59%). The overall mortality was 8%, highest among young children, where it reached 16% (p < 0.01).
Up to 10% of children admitted following trauma are victims of assault with traumatic brain injuries predominant in infants and firearm injuries predominant in adolescents. Injury patterns largely correlate to age and race. Assault in children is associated with a high mortality risk. These data highlight the magnitude of the problem and calls for further involvement of trauma surgeons to improve outcomes, bring awareness and promote preventative strategies to eliminate assault in children.
虽然在创伤儿童中常见报告或怀疑有攻击行为，但文献中缺乏对这些伤害的综述，尤其是需要创伤外科咨询的伤害。
探讨在创伤中心就诊的被攻击儿童的发病率、人口统计学和损伤模式。
对 2007 年至 2011 年国家创伤数据银行的回顾性研究。
年龄在 18 岁以下，报告的受伤意图为“攻击”的患者。患者分为婴儿（<2 岁）、幼儿（2-5 岁）、儿童（6-11 岁）和青少年（12-18 岁）。
根据年龄组和种族，分析损伤机制、损伤严重程度和死亡率。
在 609207 名儿童中，有 58299 名（9.6%）是攻击的受害者。中位年龄为 16 岁，81%为男性，损伤严重程度评分（ISS）中位数为 8。大多数患者为青少年（76%），其次为婴儿（17%）和幼儿（4%）。黑人儿童中被攻击的比例随着年龄的增长呈阶梯式上升（婴儿为 23.2%，青少年为 46.7%，趋势 p<0.01，效应量：0.175），而白人儿童则相反（婴儿为 46.0%，青少年为 19.5%，趋势 p<0.01，效应量：-0.230）。随着年龄的增长，白人患者在徒手搏斗或斗殴中被攻击的趋势最高（p<0.01，效应量：0.393），而黑人受害者则以被枪支攻击为主（p<0.01，效应量：0.323）。近 2/3 的婴儿有严重的头部创伤（59%）。总体死亡率为 8%，幼儿中死亡率最高，为 16%（p<0.01）。
多达 10%的创伤后住院儿童是攻击的受害者，创伤性脑损伤在婴儿中占主导地位，而青少年中枪支伤占主导地位。损伤模式与年龄和种族密切相关。儿童受攻击与高死亡率风险相关。这些数据突出了问题的严重性，需要创伤外科医生进一步参与，以改善结局，提高认识，并推动预防策略，以消除儿童受攻击的现象。
