Isıyel Emel, Tekşam Özlem, Foto-Özdemir Dilşad, Özmert Elif, Tümer Ali Rıza, Kale Gülsev
Departments of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Departments of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Turk J Pediatr. 2018;60(6):625-632. doi: 10.24953/turkjped.2018.06.002.
Isıyel E, Tekşam Ö, Foto-Özdemir D, Özmert E, Tümer AR, Kale G. Home accident or physical abuse: Evaluation of younger children presenting with trauma, burn and poisoning in the Pediatric Emergency Department. Turk J Pediatr 2018; 60: 625-632. Most cases of physical abuse and neglect refer to pediatric emergency clinics, and these patients are diagnosed as only home accidents. Cases that cannot be diagnosed and managed correctly are again exposed to severe trauma and consequently, they may die. The aim of this study is to evaluate the physical abuse and neglect in children younger than three years of age, admitted to the pediatric emergency department with the complaints of trauma, burn, drug poisoning and/or caustic ingestion. This prospective study included 132 patients who were admitted to the pediatric emergency department. Children were classified into three groups as no abuse, suspected abuse and abused after being evaluated with a standard form. Additionally, suspected abuse and abused cases were evaluated once again by The Team of Child Abuse and Neglect Evaluation, Research and Treatment in Hacettepe University, İhsan Doğramacı Children's Hospital. The frequency of the suspected abuse or abused cases in all burn, trauma and poisoning cases was found to be 7.5%. It was noticed that 65 of the patients (49.2%) were physically neglected considering the mechanism of occurrence of events. Unplanned pregnancy, absence of prenatal follow-up, high number of siblings, previous physical abuse in the family, absence of witness during the event, and hospitalization were statistically significant differences between no abuse and suspected abuse or abused cases (p < 0.05). Moreover, age group and income were significant risk factors in the logistic regression model for the patients who were thought to be suspected abuse/abused in univariate analyses (age group: Odds ratio (OR) 0.279, 95% confidence interval (CI) 0.085-0.723, p=0.0049; income: OR 2.323, 95% CI 1.052-6.198, p=0.0345). In conclusion, most cases of physical abuse and neglect are referred to the pediatric emergency clinics, and these patients are misdiagnosed as home accidents. The physicians working in the emergency department should be informed and trained in recognizing the cases of abuse and neglect, making the differential diagnosis, identifying the high-risk families and appropriate physical and psychological treatment for the abused and neglected children.
伊西尔·E、特克萨姆·Ö、福托-厄兹德米尔·D、厄兹默特·E、图默尔·AR、卡莱·G。家庭意外还是身体虐待：对儿科急诊科中出现创伤、烧伤和中毒的年幼儿童的评估。《土耳其儿科学杂志》2018年；60：625 - 632。大多数身体虐待和忽视案例被送往儿科急诊诊所，而这些患者仅被诊断为家庭意外。无法正确诊断和处理的案例会再次遭受严重创伤，进而可能死亡。本研究的目的是评估因创伤、烧伤、药物中毒和/或腐蚀性物质摄入等主诉而入住儿科急诊科的3岁以下儿童的身体虐待和忽视情况。这项前瞻性研究纳入了132名入住儿科急诊科的患者。使用标准表格对儿童进行评估后，将其分为三组：“无虐待”、“疑似虐待”和“受虐待”。此外，疑似虐待和受虐待案例由哈杰泰佩大学伊哈桑·多格拉马奇儿童医院的“儿童虐待与忽视评估、研究和治疗团队”再次进行评估。在所有烧伤、创伤和中毒案例中，疑似虐待或受虐待案例的发生率为7.5%。从事件发生机制来看，发现65名患者（49.2%）存在身体忽视情况。意外怀孕、缺乏产前检查、兄弟姐妹数量多、家庭中曾有身体虐待、事件发生时无证人以及住院情况在无虐待组与疑似虐待或受虐待组之间存在统计学显著差异（p < 0.05）。此外，在单因素分析中被认为疑似虐待/受虐待的患者，年龄组和收入在逻辑回归模型中是显著的风险因素（年龄组：优势比（OR）0.279，95%置信区间（CI）0.085 - 0.723，p = 0.0049；收入：OR 2.323，95% CI 1.052 - 6.198，p = 0.0345）。总之，大多数身体虐待和忽视案例被送往儿科急诊诊所，而这些患者被误诊为家庭意外。急诊科的医生应了解并接受培训，以识别虐待和忽视案例、进行鉴别诊断、确定高危家庭以及为受虐待和被忽视儿童提供适当的身体和心理治疗。
