College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Birmingham Community Healthcare NHS Trust, Birmingham, UK.
BMJ Open. 2021 Aug 5;11(8):e048689. doi: 10.1136/bmjopen-2021-048689.
To identify the common factors in serious case reviews (SCRs) where a child has died of a medical cause.
Qualitative thematic analysis.
SCRs take place when neglect or abuse results in children dying or being seriously harmed. Known key factors within SCRs include parental substance misuse, mental health problems and domestic abuse. To date, there has been no investigation of children who die of a medical cause where there are concerns about child maltreatment.
A list of SCRs relating to deaths through medical causes was provided from previous coded studies and accessed from the National Society for the Prevention of Cruelty to Children National Case Review Repository. Twenty-three SCRs with a medical cause of death from 1 April 2009 to 31 March 2017 were sourced.
20 children died of an acute condition and 12 of a chronic condition; 20 of the deaths were unexpected and maltreatment contributed to the deaths of 18 children. Most children were aged either <1 year or >16 years at the time of death. Many parents were caring for a child with additional vulnerabilities including behavioural issues (6/23), learning difficulties (6/23), mental health issues (5/23) or a chronic medical condition (12/23). Common parental experiences included domestic violence/abuse (13/23), drug/alcohol misuse (10/23), mental ill health or struggling to cope (7/23), criminal history (11/23) and caring for another vulnerable individual (8/23). Most children lived in a chaotic household characterised by missed medical appointments (18/23), poor school attendance (11/23), poor physical home environment (7/23) and disguised compliance (12/23). All 23 SCRs reported elements of abusive or neglectful parenting. In most, there was an evidence of cumulative harm, where multiple factors contributed to their premature death. At the time of death, 11 children were receiving social care support.
Although the underlying medical cause of the child's death was often incurable, the maltreatment that often exacerbated the medical issue could have been prevented.
确定儿童因医疗原因死亡的严重病例审查（SCR）中的常见因素。
定性主题分析。
当忽视或虐待导致儿童死亡或严重受伤时，会进行 SCR。SCR 中的已知关键因素包括父母的药物滥用、心理健康问题和家庭暴力。迄今为止，对于因虐待而导致儿童死亡的医疗原因，尚未进行调查。
从以前的编码研究中提供了一份与医疗原因导致死亡的 SCR 清单，并从全国防止虐待儿童协会国家案例审查资料库中获取。共检索到 2009 年 4 月 1 日至 2017 年 3 月 31 日期间因医疗原因死亡的 23 例 SCR。
20 名儿童死于急性疾病，12 名死于慢性疾病；18 名儿童的死亡是由于虐待造成的，其中 20 名儿童的死亡是意外的。大多数儿童死亡时的年龄要么小于 1 岁，要么大于 16 岁。许多父母在照顾一个有其他脆弱性的孩子，包括行为问题（23 分之 6）、学习困难（23 分之 6）、心理健康问题（23 分之 5）或慢性疾病（23 分之 12）。常见的父母经历包括家庭暴力/虐待（23 分之 13）、药物/酒精滥用（23 分之 10）、心理健康不佳或难以应对（23 分之 7）、犯罪史（23 分之 11）和照顾另一个脆弱的个体（23 分之 8）。大多数儿童生活在一个混乱的家庭中，表现为错过医疗预约（23 分之 18）、出勤率低（23 分之 11）、家庭环境差（23 分之 7）和伪装遵守（23 分之 12）。所有 23 例 SCR 都报告了虐待或忽视育儿的元素。在大多数情况下，都存在累积伤害的证据，即多个因素导致了他们的过早死亡。在死亡时，11 名儿童正在接受社会关怀支持。
尽管儿童死亡的潜在医疗原因通常是无法治愈的，但往往会加剧医疗问题的虐待行为是可以预防的。
