美国外科医师学会认证的儿科创伤中心儿童非意外创伤的患病率。
Prevalence of nonaccidental trauma among children at American College of Surgeons-verified pediatric trauma centers.
作者信息
Bogumil David D A, Demeter Natalie E, Kay Imagawa Karen, Upperman Jeffrey S, Burke Rita V
机构信息
From the Division of Pediatric Surgery (D.D.A.B., N.E.D., J.S.U., R.V.B.), Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics and Audrey Hepburn Child Advocacy, Response and Evaluation Services Center (K.K.I.), Children's Hospital Los Angeles, Los Angeles, California; and Keck School of Medicine (J.S.U., R.V.B., K.K.I), University of Southern California, Los Angeles, California.
出版信息
J Trauma Acute Care Surg. 2017 Nov;83(5):862-866. doi: 10.1097/TA.0000000000001629.
BACKGROUND
Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting. Extreme cases of child abuse, or nonaccidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians who have additional training and experience with pediatric trauma are better equipped to detect signs of NAT and have more experience reporting it. This additional training and experience can be measured by using the American College of Surgeons (ACS) Pediatric Trauma verification. It is hypothesized that ACS-verified pediatric trauma centers (vPTCs) have an increased prevalence of NAT because of this additional experience and training relative to non-ACS vPTCs.
METHODS
The National Trauma Data Bank, for the years 2007 to 2014, was utilized to compare the prevalence of NAT between ACS vPTCs relative to non-ACS vPTCs to produce both crude and Injury Severity Score adjusted prevalence ratio estimates.
RESULTS
The majority of NAT cases across all hospitals were male (58.3%). The mean age of the NAT cases was 2.3 years with a mean Injury Severity Score (ISS) of 11.1. The most common payment method was Medicaid (64.4%). The prevalence of NAT was 1.82 (1.74-1.90) times higher among ACS vPTCs and 1.81 (1.73-1.90) after adjusting for ISS.
CONCLUSIONS
The greater prevalence of NAT at vPTCs likely represents a more accurate measure of NAT among pediatric trauma patients, likely due to more experience and training of clinicians.
LEVEL OF EVIDENCE
Prognostic/Epidemiological, Level II.
背景
虐待儿童仍是一个全国性的问题，如果在临床环境中未被发现，会产生有害影响。极端的虐待儿童案例，即非意外创伤（NAT），由于治疗费用和虐待的长期影响，会带来巨大的经济负担。接受过儿科创伤额外培训和有相关经验的临床医生，更有能力发现NAT的迹象，也更有经验进行报告。这种额外的培训和经验可以通过美国外科医师学会（ACS）的儿科创伤认证来衡量。据推测，由于相对于非ACS认证的儿科创伤中心（vPTCs）有更多的经验和培训，ACS认证的vPTCs中NAT的患病率更高。
方法
利用2007年至2014年的国家创伤数据库，比较ACS认证的vPTCs与非ACS认证的vPTCs之间NAT的患病率，以得出粗略的和经损伤严重度评分调整后的患病率比值估计值。
结果
所有医院中，大多数NAT病例为男性（58.3%）。NAT病例的平均年龄为2.3岁，平均损伤严重度评分（ISS）为11.1。最常见的支付方式是医疗补助（64.4%）。在ACS认证的vPTCs中，NAT的患病率比非ACS认证的vPTCs高1.82（1.74 - 1.90）倍，经ISS调整后为1.81（1.73 - 1.90）倍。
结论
vPTCs中NAT患病率较高，可能代表了儿科创伤患者中NAT的测量更为准确，这可能是由于临床医生有更多的经验和培训。
证据级别
预后/流行病学，二级。
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