Adachi Kaho, Srivatsa Adith, Raymundo Allison, Bhargava Daksh, Mehta Ankit I
1University of Illinois College of Medicine at Chicago; and.
2Department of Neurosurgery, University of Illinois at Chicago, Illinois.
J Neurosurg Pediatr. 2024 Nov 1;35(2):111-117. doi: 10.3171/2024.8.PEDS24205. Print 2025 Feb 1.
Abusive head trauma (AHT) is the leading cause of death from physical child abuse in children younger than 5 years of age in the United States. The mortality rate among patients with AHT is 25%, and the recurrence rate of child abuse rises to 35% when there is a lack of intervention. Thus, identifying child abuse is crucial yet especially challenging for infants and toddlers as they are preverbal. Current guidelines for child abuse do not sufficiently address the specific needs of a younger population. This study aimed to evaluate clinical factors associated with abuse among such populations.
The National Trauma Data Bank was queried from 2017 to 2019 for patients younger than 3 years with acute head trauma. Patients who were suspected of having experienced child abuse (suspected child abuse [SCA] group) were propensity score matched with patients who were not suspected of having experienced child abuse (non-SCA group) based on demographics, comorbidities, and Glasgow Coma Scale (GCS) scores. Paired Student t-test and chi-square tests were used to compare differences in hospital outcomes between the two groups. Multivariable regression analysis was used to determine factors associated with SCA (p < 0.05).
The authors identified 10,844 patients in the SCA group and 27,912 in the non-SCA group. Regression analysis results showed that patients in the SCA group had higher rates of prematurity (OR 2.30, p < 0.001), GCS scores < 13 (OR 1.79, p < 0.001), congenital disorders (OR 1.56, p < 0.001), and public insurance use (68.38% vs 52.88% p < 0.001). Black and Hispanic patients were more likely to be in the SCA group (OR 1.56, p < 0.001 and OR 1.35, p < 0.001, respectively). Following propensity score matching, SCA patients had a longer length of hospital stay (3.17 vs 1.34 days, p < 0.001) and higher mortality rate (4.89% vs 3.58%, p < 0.001).
Acute head injuries in the SCA group were associated with prematurity, congenital disorder, low GCS score, and public insurance use. As such, the current guidelines should implement clinical history and insurance type to better reflect the at-risk patient population when evaluating infants and toddlers for potential abuse. There could be overidentification of child abuse among Black and Hispanic patients, and further research is warranted.
在美国，虐待性头部创伤（AHT）是5岁以下儿童身体虐待致死的主要原因。AHT患者的死亡率为25%，在缺乏干预的情况下，虐待儿童的复发率升至35%。因此，识别虐待儿童至关重要，但对于尚不能言语的婴幼儿来说尤其具有挑战性。目前的虐待儿童指南并未充分满足较年轻人群的特殊需求。本研究旨在评估此类人群中与虐待相关的临床因素。
查询2017年至2019年国家创伤数据库中3岁以下急性头部创伤患者的信息。将疑似遭受过虐待儿童的患者（疑似虐待儿童[SCA]组）与未被怀疑遭受过虐待儿童的患者（非SCA组），根据人口统计学、合并症和格拉斯哥昏迷量表（GCS）评分进行倾向得分匹配。采用配对学生t检验和卡方检验比较两组患者的住院结局差异。使用多变量回归分析确定与SCA相关的因素（p<0.05）。
作者在SCA组中识别出10844例患者，在非SCA组中识别出27912例患者。回归分析结果显示，SCA组患者的早产率更高（比值比[OR]2.30，p<0.001）、GCS评分<13（OR 1.79，p<0.001）、先天性疾病（OR 1.56，p<0.001）以及使用公共保险的比例更高（68.38%对52.88%，p<0.001）。黑人和西班牙裔患者更有可能属于SCA组（分别为OR 1.56，p<0.001和OR 1.35，p<0.001）。倾向得分匹配后，SCA组患者的住院时间更长（3.17天对1.34天，p<0.001），死亡率更高（4.89%对3.58%，p<0.001）。
SCA组的急性头部损伤与早产、先天性疾病、低GCS评分和使用公共保险有关。因此，当前指南应纳入临床病史和保险类型，以便在评估婴幼儿是否可能遭受虐待时，能更好地反映高危患者群体。在黑人和西班牙裔患者中可能存在对虐待儿童的过度识别，有必要进行进一步研究。
