Castagnino Miriam, Paglino Alessandra, Berardi Carla, Riccioni Sara, Esposito Susanna
Department of Surgical and Biomedical Sciences, Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy.
Primary Care Pediatrician, Perugia, Italy.
Front Pediatr. 2020 Apr 21;8:183. doi: 10.3389/fped.2020.00183. eCollection 2020.
Skeletal fractures (SFs) are very common in pediatrics. In some cases, they are secondary to child abuse. Differentiation of accidental from non-accidental fractures (NAFs) is essential as in abused children risk of further injuries leading to severe clinical problems and death is significant. Main objectives of this study were to evaluate the characteristics of SFs of children ≤3 years of age presenting to the Emergency Room (ER) of a Children's Teaching Hospital over a 12-year period and the attention paid by ER physicians to the identification of the indicators that increase suspicion of NAF and that suggest referring of the patient to the child protection agencies. This is a descriptive, retrospective study of the medical records of all the pediatric patients ≤ 36 months of age admitted to the ER of the Azienda Ospedaliera Santa Maria della Misericordia, University of Perugia, Perugia, Italy, for radiological documented SFs between January 1, 2004, and March 31, 2016. Available information was used to evaluate whether indicators of possible child abuse were documented by the ER staff and whether diagnosis of potential abuse was followed by further screening or referral to child protection agencies. During the study period, 11,136 accesses of the ER by children younger than 36 months were documented, among whom 417 presented long bone or skull fractures. Skull fractures were significantly more common among children <12 months of age ( = 0.001), whereas radius/ulna and humerus fractures were diagnosed significantly more frequently in children 12-36 months of age ( = 0.036 and = 0.022, respectively). Recorded medical history was considered inadequate in 255 (61.2%) cases with no difference related to patient's age. Our study showed that the majority of charts in case of SFs were found to contain inadequate documentation to explain causes at the heart of the fractures and, therefore, to rule out any inflicted trauma. The development of specific referral guidelines, along with the continuous education and training of health professionals, as well as the preparation of structured medical forms, are essential measures to activate in order to improve the referral of children from the ER to child protection agencies.
骨骼骨折（SFs）在儿科中非常常见。在某些情况下，它们是虐待儿童的继发性后果。区分意外骨折和非意外骨折（NAFs）至关重要，因为在受虐待儿童中，进一步受伤导致严重临床问题和死亡的风险很大。本研究的主要目的是评估12年间在一家儿童医院急诊室（ER）就诊的3岁及以下儿童SFs的特征，以及急诊医生对识别增加NAF怀疑的指标和建议将患者转诊至儿童保护机构的指标的关注程度。这是一项对意大利佩鲁贾圣玛利亚慈悲医院大学附属医院急诊室收治的所有36个月及以下因放射学记录的SFs入院的儿科患者病历进行的描述性回顾性研究，时间跨度为2004年1月1日至2016年3月31日。利用可获得的信息评估急诊工作人员是否记录了可能存在虐待儿童的指标，以及潜在虐待诊断后是否进行了进一步筛查或转诊至儿童保护机构。在研究期间，记录了36个月以下儿童11136次急诊就诊情况，其中417例出现长骨或颅骨骨折。颅骨骨折在12个月以下儿童中明显更常见（=0.001），而桡骨/尺骨和肱骨骨折在12 - 36个月儿童中诊断频率明显更高（分别为=0.036和=0.022）。在255例（61.2%）病例中，记录的病史被认为不充分，与患者年龄无关。我们的研究表明，在SFs病例中，大多数病历被发现包含不足以解释骨折核心原因的记录，因此无法排除任何受虐创伤。制定具体的转诊指南，以及对卫生专业人员进行持续教育和培训，以及准备结构化的医疗表格，是为改善从急诊室将儿童转诊至儿童保护机构而必须采取的重要措施。
