Children's Health of Orange County, CHOC Hospital, 1201 W. La Veta Ave, Orange, CA, 92868, USA.
Department of Emergency Medicine, University of California, Irvine, 3800 W. Chapman Ave, Suite 3200, Orange, CA, 92868, USA.
BMC Pediatr. 2023 Mar 10;23(1):117. doi: 10.1186/s12887-023-03927-0.
Child maltreatment is distressingly prevalent yet remains under-recognized by healthcare providers. In 2015 the Ohio Children's Hospital Association developed the Timely Recognition of Abusive INjuries (TRAIN) collaborative in an effort to promote child physical abuse (CPA) screening. Our institution implemented the TRAIN initiative in 2019. The objective of this study was to examine the effects of the TRAIN initiative at this institution.
In this retrospective chart review we recorded the incidence of sentinel injuries (SIS) in children presenting to the Emergency Department (ED) of an independent level 2 pediatric trauma center. SIS were defined and identified by a diagnosis of ecchymosis, contusion, fracture, head injury, intracranial hemorrhage, abdominal trauma, open wound, laceration, abrasion, oropharyngeal injury, genital injury, intoxication, or burn in a child < 6.01 months of age. Patients were stratified into pre-TRAIN (PRE), 1/2017-9/2018, or post-TRAIN (POST), 10/2019-7/2020, periods. Repeat injury was defined as a subsequent visit for any of the previously mentioned diagnoses within 12 months of the initial visit. Demographics/visit characteristics were analyzed using Chi square analysis, Fischer's exact test, and student's paired t-test.
In the PRE period, 12,812 ED visits were made by children < 6.01 months old; 2.8% of these visits were made by patients with SIS. In the POST period there were 5,372 ED visits, 2.6% involved SIS (p = .4). The rate of skeletal surveys performed on patients with SIS increased from 17.1% in the PRE period to 27.2% in the POST period (p = .01). The positivity rate of skeletal surveys in the PRE versus POST period was 18.9% and 26.3% respectively (p = .45). Repeat injury rates did not differ significantly in patients with SIS pre- versus post-TRAIN (p = .44).
Implementation of TRAIN at this institution appears to be associated with increased skeletal survey rates.
儿童虐待令人痛心，但医疗保健提供者仍未充分认识到这一点。2015 年，俄亥俄州儿童医院协会成立了及时识别虐待性损伤（TRAIN）合作组织，以促进儿童身体虐待（CPA）筛查。本机构于 2019 年实施了 TRAIN 计划。本研究的目的是检查该机构实施 TRAIN 计划的效果。
在这项回顾性图表审查中，我们记录了在一家独立的 2 级儿科创伤中心的急诊科就诊的儿童中哨兵损伤（SIS）的发生率。SIS 通过在 6.01 个月以下的儿童中出现瘀伤、挫伤、骨折、头部损伤、颅内出血、腹部创伤、开放性伤口、撕裂伤、擦伤、口咽损伤、生殖器损伤、中毒或烧伤的诊断来定义和识别。患者分为 TRAIN 前（PRE）、2017 年 1 月至 2018 年 9 月或 TRAIN 后（POST）、2019 年 10 月至 2020 年 7 月。重复损伤是指在初次就诊后 12 个月内再次因上述任何一种诊断就诊。使用卡方分析、Fisher 精确检验和学生配对 t 检验分析人口统计学/就诊特征。
在 PRE 期间，12812 名 6.01 个月以下的儿童在急诊科就诊，其中 2.8%的就诊者有 SIS。在 POST 期间，有 5372 次 ED 就诊，其中 2.6%涉及 SIS（p=0.4）。在 PRE 期间，接受 SIS 患者的骨骼检查率从 17.1%上升到 POST 期间的 27.2%（p=0.01）。PRE 与 POST 期间骨骼检查的阳性率分别为 18.9%和 26.3%（p=0.45）。SIS 患者的重复损伤率在 TRAIN 前与 TRAIN 后无显著差异（p=0.44）。
本机构实施 TRAIN 计划似乎与骨骼检查率的增加有关。
