Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, and Department of Surgery, University of California San Francisco, San Francisco, CA 94611, USA.
Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, 48201, USA.
Child Abuse Negl. 2021 Dec;122:105333. doi: 10.1016/j.chiabu.2021.105333. Epub 2021 Sep 25.
Children with abusive injuries have worse mortality, length-of-stay, complications, and healthcare costs compared to those sustaining an accidental injury. Long-term functional impairment is common in children with abusive head trauma but has not been examined in a cohort with heterogeneous body region injuries.
To assess for an independent association between child physical abuse and functional impairment at discharge and six-month follow-up.
Seriously injured children (<15 years) treated at seven pediatric trauma centers.
Functional status was compared between child physical abuse and accidental injury groups at discharge and six-month follow-up. Functional impairment was defined at discharge ("new domain morbidity") as a change from pre-injury ≥2 points in any of the six domains of the Functional Status Scale (FSS), and impairment at six-month follow-up as an abnormal total FSS score.
Children with abusive injuries accounted for 10.5% (n = 45) of the cohort. New domain morbidity was present in 17.8% (n = 8) of child physical abuse patients at discharge, with 10% (n = 3) of children having an abnormal FSS at six-months. There were no differences in new domain morbidity at hospital discharge between children injured by abuse and or accidental injury. However, children injured by physical abuse were 4.09 (2.15, 7.78) times more likely to have functional impairment at six months.
Child physical abuse is an independent risk factor for functional impairment at six-month follow-up. Functional status measurement for this high-risk group of children should be routinely measured and incorporated into trauma center quality assessments.
与意外受伤的儿童相比，遭受虐待性损伤的儿童死亡率、住院时间、并发症和医疗保健费用更高。儿童虐待性头部创伤后长期功能障碍很常见，但在具有异质身体区域损伤的队列中尚未进行检查。
评估儿童躯体虐待与出院时和 6 个月随访时的功能障碍之间是否存在独立关联。
在 7 个儿科创伤中心接受治疗的严重受伤儿童（<15 岁）。
在出院和 6 个月随访时，将儿童躯体虐待和意外损伤组的功能状态进行比较。功能障碍在出院时定义为（“新域发病率”）任何六个功能状态量表（FSS）域中从受伤前增加≥2 分，6 个月随访时定义为异常总 FSS 评分。
虐待性损伤患儿占队列的 10.5%（n=45）。出院时，躯体虐待患儿有 17.8%（n=8）存在新域发病率，有 10%（n=3）患儿 6 个月时 FSS 异常。躯体虐待组和非躯体虐待组患儿出院时新域发病率无差异。然而，躯体虐待受伤的儿童在 6 个月时发生功能障碍的可能性是躯体虐待受伤儿童的 4.09 倍（2.15，7.78）。
儿童躯体虐待是 6 个月随访时功能障碍的独立危险因素。应常规测量这一高风险儿童群体的功能状态，并将其纳入创伤中心质量评估。
