Cook Children's Medical Center, Fort Worth, TX, United States; Texas A&M University College of Medicine, Bryan, TX, United States.
Cook Children's Medical Center, Fort Worth, TX, United States.
Child Abuse Negl. 2019 Oct;96:104081. doi: 10.1016/j.chiabu.2019.104081. Epub 2019 Jul 22.
Drug endangerment is known to be associated with child maltreatment. However, even with the high association between physical abuse and drug endangerment there is no standard for screening in this population. Skeletal survey screening may facilitate the identification of children in this population who have also been physically abused.
Our objective was to determine the characteristics of drug endangered children and specifically the yield of skeletal survey screening.
The participants in this study were children referred by Child Protective Services (CPS) due to concerns of drug exposure. They were seen in a child abuse outpatient clinic by a child abuse pediatrician or pediatric nurse practitioner.
This study is a retrospective chart review of the Child Advocacy Resource and Evaluation (C.A.R.E.) Team records between January 1, 2011 and December 31, 2017. We measured the yield of toxicology, additional abuse endured, and skeletal survey findings.
Over the 6-year period, 1252 cases were referred to C.A.R.E. Team for drug endangerment. 1150 cases had hair toxicology performed with 595 cases (52%) testing positive for at least one illegal substance. The compound most frequently identified was methamphetamine followed by marijuana and cocaine. In addition to drug endangerment, other forms of abuse were identified in 162 cases including sexual, physical, and neglect. Using the American Academy of Pediatrics (AAP) and American College of Radiology (ACR) guidelines, 340 skeletal surveys were performed. Twelve cases (4%) had occult skeletal injuries none of which had cutaneous findings. Of those with skeletal injury, 11 cases out of 11 tested by hair toxicology were positive for at least one illegal substance.
The application of the AAP and ACR guidelines for skeletal survey screening to those children referred for drug endangerment is useful in identifying children with physical abuse.
已知药物危害与儿童虐待有关。然而，即使身体虐待和药物危害之间存在高度关联，在该人群中也没有筛查的标准。骨骼检查筛查可能有助于确定该人群中也遭受身体虐待的儿童。
我们的目的是确定药物危害儿童的特征，特别是骨骼检查筛查的效果。
本研究的参与者是因药物暴露问题而被儿童保护服务机构（CPS）转介的儿童。他们由儿童虐待儿科医生或儿科执业护士在儿童虐待门诊就诊。
本研究是对 2011 年 1 月 1 日至 2017 年 12 月 31 日期间儿童倡导资源和评估（C.A.R.E.）团队记录的回顾性图表审查。我们测量了毒理学检查、额外的虐待行为和骨骼检查结果的效果。
在 6 年期间，有 1252 例因药物危害被转介到 C.A.R.E. 团队。1150 例进行了毛发毒理学检查，其中 595 例（52%）至少检测出一种非法物质呈阳性。最常鉴定出的化合物是冰毒，其次是大麻和可卡因。除了药物危害，还在 162 例中发现了其他形式的虐待，包括性虐待、身体虐待和忽视。根据美国儿科学会（AAP）和美国放射学会（ACR）的指南，进行了 340 次骨骼检查。12 例（4%）有隐匿性骨骼损伤，均无皮肤表现。在有骨骼损伤的患者中，11 例经毛发毒理学检查均至少检测出一种非法物质呈阳性。
将 AAP 和 ACR 指南应用于因药物危害而转介的儿童的骨骼检查筛查有助于识别有身体虐待的儿童。
