Department of Pediatrics, Division of Child Protection and Family Health, University of Utah, Salt Lake City, Utah 84115, United States; The Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, Utah 84115, United States.
Safe Place: The Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
Child Abuse Negl. 2021 Feb;112:104893. doi: 10.1016/j.chiabu.2020.104893. Epub 2020 Dec 26.
The 2016 Presidential Commission to Eliminate Child Abuse and Neglect Fatalities identified systematic review of all cases of near-fatal child maltreatment as a necessary step towards prevention of child maltreatment fatalities. A critical barrier to adoption of this recommendation is the lack of a standard definition of "near-fatality" in the context of suspected child maltreatment.
To develop a consensus definition of near-fatal child maltreatment to be used in practice, policy, and research.
A multidisciplinary expert panel of 23 individuals from across the U.S. including child abuse pediatricians, pediatric intensivists, pediatric emergency medicine physicians, child welfare administrators, child welfare researchers, and child injury/fatality researchers.
A modified Delphi process reflecting an iterative process of 3 rounds of surveys of expert opinion, statistical summary of survey response, and feedback of summary statistics. Consensus was defined as 75 % of panelists ranking an element as required (≥80 on a scale of 0-100) to meet a definition of near-fatality (75th% threshold).
Experts defined near-fatal child maltreatment as life-threatening cardiopulmonary dysfunction directly attributable to suspected abuse or neglect as evidenced by (a) respiratory insufficiency/failure requiring intubation and mechanical ventilation, (b) respiratory insufficiency/failure requiring medications to reverse effects of toxic ingestion, or (c) cardiac arrhythmia with/without cardiopulmonary resuscitation (CPR).
A consensus definition of near-fatal child maltreatment should be introduced in child protective services processes and in child fatality/near-fatality reviews to improve our ability to identify, review, and respond to trends in near-fatal child maltreatment at local, regional, and national levels.
2016 年消除儿童虐待和忽视致死问题总统委员会确定，对所有近乎致命的儿童虐待案件进行系统审查，是预防儿童虐待致死的必要步骤。采用这一建议的一个关键障碍是，在疑似儿童虐待的情况下，缺乏“近乎致死”的标准定义。
制定一个近乎致命的儿童虐待的共识定义，用于实践、政策和研究。
一个由来自美国各地的 23 名多学科专家组成的小组，包括儿童虐待儿科医生、儿科重症监护医生、儿科急诊医生、儿童福利管理人员、儿童福利研究人员和儿童伤害/死亡研究人员。
采用改良德尔菲法，反映了专家意见的 3 轮调查的迭代过程，对调查结果进行了统计总结，并反馈了总结统计数据。共识定义为 75%的小组成员将某个元素评为必需的（在 0-100 的范围内为≥80），以满足近乎致死的定义（75%阈值）。
专家将近乎致命的儿童虐待定义为直接归因于疑似虐待或忽视的危及生命的心肺功能障碍，表现为（a）呼吸功能不全/衰竭需要插管和机械通气，（b）需要药物逆转有毒物质摄入的影响的呼吸功能不全/衰竭，或（c）伴有/不伴有心肺复苏（CPR）的心律失常。
应在儿童保护服务流程中以及在儿童死亡/近乎致死审查中引入近乎致命的儿童虐待共识定义，以提高我们在地方、区域和国家各级识别、审查和应对近乎致命的儿童虐待趋势的能力。
