Fortin Kristine, Wood Joanne N, Udell Sean M, Christian Cindy W
Intermountain Healthcare, Park City, Utah.
Pediatr Emerg Care. 2024 Jul 1;40(7):527-531. doi: 10.1097/PEC.0000000000003191. Epub 2024 May 2.
The aims of this study were to describe chief complaints provided at emergency department triage for young children ultimately given a diagnosed with injuries concerning for physical abuse and compare chief complaints by hospital child protection team assessment (abuse most likely, accident most likely, undetermined) among children younger than 2 years who were the subject of a report to child protective services.
This is a retrospective review of children evaluated by the child protection team at an urban children's hospital over a 5-year period. Children younger than 2 years who were the subject of a report to child protective services for suspected physical abuse were included. Chief complaints noted in emergency department triage notes were categorized as follows: 1, medical sign or symptom; 2, accidental trauma incident; 3, identified injury; 4, concern for abuse; or 5, multiple unrelated complaints. Child protection team assessments were categorized as follows: 1, abuse most likely; 2, accident most likely; or 3, undetermined. We used descriptive statistics and tests of association (χ 2 , Fisher exact, Kruskal-Wallis).
Median age of the 422 children included was 4.9 months. Child protection team assessment was abuse most likely in 44%, accident most likely in 23%, and undetermined in 34%. Chief complaints in the overall sample were 39% medical, 29% trauma incident, 16% injury, 10% abuse concern, and 6% multiple unrelated. When the abuse most likely and accident most likely groups were compared, medical chief complaints were more common in the former (47% vs 19%, P < 0.001), whereas trauma incident chief complaints were more common in the latter (19% vs 64%, P < 0.001). Most common medical complaints in the abuse most likely group were altered mental status, abnormal limb use, swelling, pain, apnea, and vomiting.
Many children found to have injuries concerning for abuse (47%) present without mention of trauma, injury, or abuse concern as part of the chief complaint. Our findings suggest important topics to include in training physicians about recognition of abuse.
本研究旨在描述最终被诊断为疑似身体虐待所致损伤的幼儿在急诊科分诊时提供的主要诉求，并比较儿童保护服务机构接到报告的2岁以下儿童中，根据医院儿童保护团队评估结果（极有可能是虐待、极有可能是意外、无法确定）分类的主要诉求。
这是一项对一家城市儿童医院的儿童保护团队在5年期间评估的儿童进行的回顾性研究。纳入了因疑似身体虐待而被儿童保护服务机构接到报告的2岁以下儿童。急诊科分诊记录中 noted 的主要诉求分类如下：1. 医学体征或症状；2. 意外创伤事件；3. 已确认的损伤；4. 对虐待的担忧；或5. 多个不相关的诉求。儿童保护团队的评估分类如下：1. 极有可能是虐待；2. 极有可能是意外；或3. 无法确定。我们使用了描述性统计和关联性检验（χ²检验、Fisher精确检验、Kruskal-Wallis检验）。
纳入的422名儿童的中位年龄为4.9个月。儿童保护团队评估结果为极有可能是虐待的占44%，极有可能是意外的占23%，无法确定的占34%。总体样本中的主要诉求为39%是医学方面的，29%是创伤事件，16%是损伤，10%是对虐待的担忧，6%是多个不相关的。比较极有可能是虐待和极有可能是意外的两组时，医学方面的主要诉求在前者中更常见（47%对19%，P<0.001），而创伤事件方面的主要诉求在后者中更常见（19%对64%，P<0.001）。极有可能是虐待组中最常见的医学诉求是精神状态改变、肢体使用异常、肿胀、疼痛、呼吸暂停和呕吐。
许多被发现有疑似虐待所致损伤的儿童（47%）在主要诉求中未提及创伤、损伤或对虐待的担忧。我们的研究结果提示了在培训医生识别虐待方面应纳入的重要主题。
