Division of Trauma, Critical Care, Burns, and Emergency Surgery, The University of Arizona, Tucson, AZ.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Ann Surg. 2022 Sep 1;276(3):500-510. doi: 10.1097/SLA.0000000000005548. Epub 2022 Jun 28.
Child abuse is a major cause of childhood injury, morbidity, and death. There is a paucity of data on the practice of abuse interventions among this vulnerable population. The aim of our study was to identify the factors associated with interventions for child abuse on a national scale.
Retrospective analysis of 2017 to 2018 American College of Surgeons (ACS) Pediatric Trauma Quality Improvement Program (TQIP). All children presenting with suspected/confirmed child abuse and an abuse report filed were included. Patients with missing information regarding abuse interventions were excluded. Outcomes were abuse investigations initiated among those with abuse reports, and change of caregiver at discharge among survivors with an investigation initiated. Multivariable regression analyses were performed.
A total of 7774 child abuse victims with an abuse report were identified. The mean age was 5±5 years, 4221 (54%) patients were White, 2297 (30%) Black, 1543 (20%) Hispanic, and 5298 (68%) had government insurance. The most common mechanism was blunt (63%), followed by burns (10%) and penetrating (10%). The median Injury Severity Score was 5 (1-12). The most common form of abuse was physical (92%), followed by neglect (6%), sexual (3%), and psychological (0.1%). The most common perpetrator of abuse was a care provider/teacher (49.5%), followed by a member of the immediate family (30.5%), or a member of the extended/step/foster family (20.0%). Overall, 6377 (82%) abuse investigations were initiated for those with abuse reports. Of these, 1967 (33%) resulted in a change of caregiver. Black children were more likely to have abuse investigated, and Black and Hispanic children were more likely to experience change of caregiver after investigations, while privately insured children were less likely to experience both.
Significant racial, ethnic, and socioeconomic disparities exist in the nationwide management of child abuse. Further studies are strongly warranted to understand contributing factors and possible strategies to address them.
Level III-therapeutic/care management.
儿童虐待是儿童受伤、发病和死亡的一个主要原因。在这个弱势群体中，关于虐待干预实践的数据很少。我们的研究目的是确定与全国范围内儿童虐待干预相关的因素。
对美国外科医师学院（ACS）2017 年至 2018 年儿童创伤质量改进计划（TQIP）的回顾性分析。所有有疑似/确诊儿童虐待和提交虐待报告的儿童均包括在内。对于缺乏虐待干预信息的患者，予以排除。结果为对有虐待报告的患者进行的虐待调查的启动，以及幸存者中调查启动时看护者的变化。进行了多变量回归分析。
共确定了 7774 名有虐待报告的儿童虐待受害者。平均年龄为 5±5 岁，4221 名（54%）患者为白人，2297 名（30%）为黑人，1543 名（20%）为西班牙裔，5298 名（68%）有政府保险。最常见的机制是钝性（63%），其次是烧伤（10%）和穿透伤（10%）。损伤严重程度评分中位数为 5（1-12）。最常见的虐待形式是身体虐待（92%），其次是忽视（6%）、性虐待（3%）和心理虐待（0.1%）。最常见的虐待者是护理人员/教师（49.5%），其次是直系亲属（30.5%）或扩展/继父母（20.0%）。总体而言，6377 名（82%）有虐待报告的患者进行了虐待调查。其中，1967 名（33%）导致看护者变更。黑人儿童更有可能进行虐待调查，而黑人儿童和西班牙裔儿童在调查后更有可能更换看护者，而私人保险儿童则不太可能同时发生这两种情况。
在全国范围内对儿童虐待的管理中存在显著的种族、民族和社会经济差异。强烈需要进一步研究，以了解造成这些差异的因素和可能的解决策略。
三级——治疗/护理管理。
