Johnson Katie L, Tham See Wan, Brown Emily C B, Walco Gary A, Feldman Kenneth W, Wiester Rebecca T, Wilkins Stephanie N, Campbell Kristine A
Mayo Clinic Department of Pediatrics, Division of Child Abuse Pediatrics, Rochester, Minnesota, USA.
Pediatric Pain Medicine Clinic, University of Washington, Seattle, Washington, USA.
Child Abuse Rev. 2024 Jan-Feb;33(1). doi: 10.1002/car.2861. Epub 2024 Feb 19.
Adolescents with chronic pain can at times present with disability out of proportion to diagnostic workup. This is also a defining feature of medical child abuse (MCA). The aim of this study was to identify themes from the clinical narratives of adolescents with chronic pain that may indicate concern for MCA. This qualitative, retrospective study at an academic children's hospital between 2011 and 2019 identified 37 adolescents aged 13-18 years old with chronic pain and varying levels of concern for MCA. Conventional, inductive content analysis was used to identify themes from the medical records of all patients, which were reviewed by an interdisciplinary panel of experts. Themes were organised into three tiers related to the level of concern for MCA: 'Green zone' themes including fatigue or sleep problems, psychosocial distress, and social withdrawal were common among all patients. 'Yellow zone' themes including fragmented care, caregiver catastrophising, caregiver misrepresentation, medical provider exasperation, and sick identity were more common among patients in whom medical providers raised concern for MCA. A single 'red zone' theme, reportable harm to the child, was only present in patients diagnosed by a child abuse paediatrician as having MCA. A visual display of the results is provided for further research and clinical application.
患有慢性疼痛的青少年有时会出现与其诊断检查结果不相称的残疾情况。这也是医疗虐待儿童（MCA）的一个典型特征。本研究的目的是从患有慢性疼痛的青少年的临床叙述中识别出可能表明存在MCA问题的主题。这项于2011年至2019年在一家学术儿童医院开展的定性回顾性研究，确定了37名年龄在13至18岁之间、患有慢性疼痛且对MCA存在不同程度担忧的青少年。采用传统的归纳性内容分析法，从所有患者的病历中识别主题，这些病历由一个跨学科专家小组进行审查。主题根据对MCA的担忧程度分为三个层次：“绿色区域”主题包括疲劳或睡眠问题、心理社会困扰和社交退缩，在所有患者中都很常见。“黄色区域”主题包括护理碎片化、照顾者灾难化、照顾者虚假陈述、医疗服务提供者恼怒和患病身份认同，在医疗服务提供者对MCA表示担忧的患者中更为常见。唯一一个“红色区域”主题，即对儿童的可报告伤害，仅出现在被儿童虐待儿科医生诊断为患有MCA的患者中。研究结果以可视化形式呈现，以供进一步研究和临床应用。
