From the Department of Pediatrics, Division of Child Advocacy, Dayton Children's Hospital, Dayton.
Department of Pediatrics, Division of Child and Family Advocacy, Nationwide Children's Hospital, Columbus.
Pediatr Emerg Care. 2022 Jun 1;38(6):e1279-e1284. doi: 10.1097/PEC.0000000000002724. Epub 2022 May 3.
Six children's hospitals identified infants with an initial injury and recurrent injury over a 1-year period using 2 methods: (1) diagnostic code method - infants 6 months or younger presenting with at least 1 diagnostic code for injury were tracked for 12 months to determine the frequency of recurrent injury, and (2) consult method - all available medical records of children 18 months or younger seen for an inpatient consultation for suspected child abuse were reviewed to identify history of a first injury at 6 months or younger.
Using the diagnostic code method, 682 unique infants were identified with initial injuries, most commonly fractures (37.0%), bruising/ecchymosis (35.9%), and superficial injuries (28.3%). Forty-two infants (6.2%) returned with a second injury, and no demographic factors were significantly associated with the likelihood of a second injury. Using the consult method, 37 of 342 consults (10.8%) were identified as having a history of at least 1 initial injury. Of the initial injuries identified, the most common was bruising/ecchymosis (64.9%). The number of injuries identified with either method varied significantly across hospitals, as did completion of skeletal surveys for infants with bruising (range, 4.5%-71.1%; P < 0.001) and any injury (range, 4.4%-62.7%; P < 0.001).
Our study demonstrates that young infants who experience 1 injury often experience a second injury. There exists significant variability in the identification of injury and the completion of skeletal surveys across a network of 6 children's hospitals. A standardized quality improvement approach may improve identification of injury and reduce the variability in practice observed.
6 家儿童医院采用 2 种方法确定了在 1 年内发生初始损伤和再发损伤的婴儿：（1）诊断代码方法 - 将 6 个月或更小的患有至少 1 个损伤诊断代码的婴儿进行 12 个月的跟踪，以确定再发损伤的频率；（2）咨询方法 - 对 18 个月或更小的因疑似儿童虐待而接受住院咨询的所有儿童的病历进行审查，以确定 6 个月或更小时有首次损伤史。
使用诊断代码方法，确定了 682 名有初始损伤的独特婴儿，最常见的损伤是骨折（37.0%）、瘀伤/瘀斑（35.9%）和浅表损伤（28.3%）。42 名婴儿（6.2%）出现了第二次损伤，没有任何人口统计学因素与再次受伤的可能性显著相关。使用咨询方法，342 次咨询中有 37 次（10.8%）被确定为有至少 1 次初始损伤史。在确定的初始损伤中，最常见的是瘀伤/瘀斑（64.9%）。两种方法识别的损伤数量在各医院之间差异显著，接受瘀伤婴儿骨骼检查的完成情况（范围为 4.5%71.1%；P<0.001）和任何损伤（范围为 4.4%62.7%；P<0.001）也存在显著差异。
我们的研究表明，经历过 1 次损伤的幼儿经常会经历第 2 次损伤。在一个由 6 家儿童医院组成的网络中，损伤的识别和骨骼检查的完成存在显著的差异。标准化的质量改进方法可能会改善损伤的识别，并减少观察到的实践差异。
