From the Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
Division of Trauma and Acute Care Surgery, University of South Florida, Tampa, FL.
Pediatr Emerg Care. 2024 Feb 1;40(2):119-123. doi: 10.1097/PEC.0000000000002996. Epub 2023 Jun 12.
Children experiencing physical abuse may initially present to hospitals with underappreciated minor injuries, only to experience more severe injuries in the future. The objectives of this study were to 1) describe young children presenting with high-risk diagnoses for physical abuse, 2) characterize the hospitals to which they initially presented, and 3) evaluate associations of initial presenting-hospital type with subsequent admission for injury.
Patients aged younger than 6 years from the 2009-2014 Florida Agency for Healthcare Administration database with high-risk diagnoses (codes previously associated with >70% risk of child physical abuse) were included. Patients were categorized by the hospital type to which they initially presented: community hospital, adult/combined trauma center, or pediatric trauma center. Primary outcome was subsequent injury-related hospital admission within 1 year. Association of initial presenting-hospital type with outcome was evaluated with multivariable logistic regression, adjusting for demographics, socioeconomic status, preexisting comorbidities, and injury severity.
A total of 8626 high-risk children met inclusion criteria. Sixty-eight percent of high-risk children initially presented to community hospitals. At 1 year, 3% of high-risk children had experienced subsequent injury-related admission. On multivariable analysis, initial presentation to a community hospital was associated with higher risk of subsequent injury-related admission (odds ratio, 4.03 vs level 1/pediatric trauma center; 95% confidence interval, 1.83-8.86). Initial presentation to a level 2 adult or combined adult/pediatric trauma center was also associated with higher risk for subsequent injury-related admission (odds ratio, 3.19; 95% confidence interval, 1.40-7.27).
Most children at high risk for physical abuse initially present to community hospitals, not dedicated trauma centers. Children initially evaluated in high-level pediatric trauma centers had lower risk of subsequent injury-related admission. This unexplained variability suggests stronger collaboration is needed between community hospitals and regional pediatric trauma centers at the time of initial presentation to recognize and protect vulnerable children.
遭受身体虐待的儿童最初可能因被低估的轻微损伤而到医院就诊，但随后可能会遭受更严重的损伤。本研究的目的是：1）描述最初因身体虐待高风险诊断而就诊的幼儿；2）描述他们最初就诊的医院特征；3）评估初始就诊医院类型与随后因损伤而入院之间的关联。
纳入了佛罗里达州医疗管理局数据库中 2009-2014 年年龄小于 6 岁且有高风险诊断（先前与>70%的儿童身体虐待风险相关的代码）的患者。根据患者最初就诊的医院类型进行分类：社区医院、成人/综合创伤中心或儿科创伤中心。主要结局是在 1 年内因损伤相关而再次入院。使用多变量逻辑回归评估初始就诊医院类型与结局之间的关联，调整了人口统计学、社会经济状况、预先存在的合并症和损伤严重程度等因素。
共有 8626 名高风险儿童符合纳入标准。68%的高风险儿童最初就诊于社区医院。在 1 年内，有 3%的高风险儿童经历了随后因损伤相关而入院。多变量分析显示，最初就诊于社区医院与随后因损伤相关而入院的风险增加相关（比值比，4.03 比 1 级/儿科创伤中心；95%置信区间，1.83-8.86）。最初就诊于 2 级成人或成人/儿科综合创伤中心也与随后因损伤相关而入院的风险增加相关（比值比，3.19；95%置信区间，1.40-7.27）。
大多数身体虐待高风险儿童最初就诊于社区医院，而不是专门的创伤中心。最初在高水平儿科创伤中心接受评估的儿童随后因损伤相关入院的风险较低。这种无法解释的差异表明，在最初就诊时，社区医院和区域性儿科创伤中心之间需要加强合作，以识别和保护弱势儿童。
