Prehosp Emerg Care. 2019 Sep-Oct;23(5):672-682. doi: 10.1080/10903127.2019.1573940. Epub 2019 Feb 22.
The objective of this study was to determine if neighborhood rates of pediatric Emergency Medical Services (EMS) encounters correlate with rates of child maltreatment reporting and if there are neighborhood-level risk factors for EMS encountering children with maltreatment reports. We conducted a retrospective cohort study using the electronic medical records of children ages <18 years who had Columbus Division of Fire EMS encounters between 2011 and 2015. We used Nationwide Children's Hospital electronic medical records to identify child maltreatment reports. The EMS scene addresses and home addresses associated with maltreatment reports were geocoded independently and rates for each Census tract were calculated. The maltreatment reports were matched to the EMS encounters using name, gender, and date of birth. Rates of EMS encounters with children that had a maltreatment report were calculated for each Census tract. Census tract demographic information was obtained from the American Community Survey. Bayesian conditional autoregressive Poisson models were used to calculate rate ratios for census tract variables to determine their relationship to EMS encountering children with maltreatment reports. A total of 44,002 EMS encounters and 4,298 maltreatment reports were included in the study. The Spearman correlation coefficient relating rates of EMS encounters to rates of maltreatment reports within census tracts was 0.72 (95% confidence interval, 0.65-0.77). Within the study period, a total of 1,134 EMS encounters were linked to 578 children with maltreatment reports. Poverty was the only independent risk factor for EMS encountering children with maltreatment reports. The multivariate analysis also identified protective factors, which included neighborhoods with higher proportions of residents who had bachelor's degrees, spoke a language other than English, and had the same residence the previous year. This study showed that in Franklin County, Ohio, neighborhoods with high EMS utilization had a strong positive correlation with areas that had high rates of child maltreatment reports. We also identified four neighborhood characteristics that were independently associated with EMS encountering children at risk for maltreatment (risk factor: poverty; protective factors: residents with college educations, non-English speaking households, and residents maintaining the same residence as the previous year).
本研究旨在确定儿科急诊医疗服务（EMS）的社区发生率是否与儿童虐待报告率相关，以及是否存在与 EMS 遇到有虐待报告儿童相关的社区水平风险因素。我们使用 2011 年至 2015 年期间 Columbus Division of Fire EMS 遭遇的年龄<18 岁的儿童的电子病历进行了回顾性队列研究。我们使用 Nationwide Children's Hospital 电子病历来识别儿童虐待报告。虐待报告的 EMS 现场地址和家庭地址被独立地理编码，并计算了每个普查区的发生率。使用姓名、性别和出生日期将虐待报告与 EMS 遭遇相匹配。为每个普查区计算了有虐待报告的儿童的 EMS 遭遇率。普查区人口统计信息从美国社区调查中获得。贝叶斯条件自回归泊松模型用于计算普查区变量的比率比，以确定它们与 EMS 遇到有虐待报告儿童的关系。共有 44002 次 EMS 遭遇和 4298 次虐待报告纳入研究。在普查区内，EMS 遭遇率与虐待报告率之间的斯皮尔曼相关系数为 0.72（95%置信区间，0.65-0.77）。在研究期间，共有 1134 次 EMS 遭遇与 578 名有虐待报告的儿童相关联。贫困是 EMS 遇到有虐待报告儿童的唯一独立风险因素。多变量分析还确定了保护因素，包括居民中拥有学士学位的比例较高、讲其他语言和去年居住同一住所的社区。本研究表明，在俄亥俄州富兰克林县，高 EMS 利用率的社区与儿童虐待报告率较高的地区存在很强的正相关。我们还确定了四个与 EMS 遇到有虐待风险的儿童相关的独立社区特征（风险因素：贫困；保护因素：受过大学教育的居民、非英语家庭和前一年居住在同一住所的居民）。
