Department of Pediatric General, Thoracic and Minimally Invasive Surgery, St. Christopher's Hospital for Children, 160 E. Erie Avenue, Philadelphia, PA, 19134, USA.
Department of Pediatric General, Thoracic and Minimally Invasive Surgery, St. Christopher's Hospital for Children, 160 E. Erie Avenue, Philadelphia, PA, 19134, USA.
J Pediatr Surg. 2024 Jun;59(6):1142-1147. doi: 10.1016/j.jpedsurg.2024.02.004. Epub 2024 Feb 8.
Physical abuse is a major public health concern and a leading cause of morbidity and mortality in infants. Clinical decision tools derived from trauma registries can facilitate timely risk-stratification. The Trauma Quality Improvement Program (TQIP) database does not report age for children <1 year who are at highest risk for abuse. We report a method to capture these infants despite the missing age.
Patients ≤17 years were identified from TQIP (2017-2019). The primary outcomes included injuries resulting from confirmed or suspected child abuse captured by diagnosis codes or report/investigation of physical abuse, or different caregiver at discharge available in TQIP. We used two methods to select infants within TQIP. In the first, World Health Organization (WHO) growth standards for stature or length-for-age and weight-for-age were selected to capture children younger than 1 year. In the second, a K-means machine learning algorithm was used to cluster patients by weight and height. We compared outcome and injury data with and without patients <1 year.
Using the WHO growth standard 19,916 children <1 year were identified. A total of 20,513 patients had a report of physical abuse filed, and 9393 were infants <1 year. Increased age-adjusted odds ratios [95% CI] were seen for fractures of the upper limb (1.28 [1.22-1.34]), vertebrae (1.89 [1.68-2.13]), ribs (5.2 [4.8-5.63]), and spinal cord (3.39 [2.85-4.02]) and head injuries (1.55 [1.5-1.6]) with infants included.
In a nationwide trauma registry, WHO growth standards can be used to capture patients under one year who are more adversely impacted by maltreatment.
Retrospective, Cross-sectional.
Level III, Diagnostic.
身体虐待是一个主要的公共卫生问题，也是婴儿发病率和死亡率的主要原因。从创伤登记处得出的临床决策工具可以帮助进行及时的风险分层。创伤质量改进计划（TQIP）数据库不报告年龄在 1 岁以下的儿童，这些儿童面临虐待的风险最高。尽管存在年龄缺失，但我们报告了一种方法来捕捉这些婴儿。
从 TQIP（2017-2019 年）中确定了≤17 岁的患者。主要结局包括通过诊断代码或报告/调查身体虐待确认或疑似儿童虐待导致的损伤，或 TQIP 中提供的不同护理人员出院。我们使用两种方法在 TQIP 中选择婴儿。在第一种方法中，选择了世界卫生组织（WHO）的身高或年龄别身长和年龄别体重生长标准来捕捉年龄小于 1 岁的儿童。在第二种方法中，使用 K-均值机器学习算法根据体重和身高对患者进行聚类。我们比较了有和没有年龄小于 1 岁的患者的结局和损伤数据。
使用 WHO 生长标准 19，确定了 19916 名年龄小于 1 岁的儿童。共有 20513 名患者有身体虐待报告，9393 名是年龄小于 1 岁的婴儿。包括婴儿在内，上肢骨折（1.28 [1.22-1.34]）、椎骨（1.89 [1.68-2.13]）、肋骨（5.2 [4.8-5.63]）和脊髓（3.39 [2.85-4.02]）和头部损伤（1.55 [1.5-1.6]）的年龄调整比值比[95%CI]增加。
在全国性创伤登记处中，世卫组织生长标准可用于捕捉受虐待影响更大的 1 岁以下患者。
回顾性，横断面。
三级，诊断。
