Alpert Emily, Wood Joanne N, Shults Justine, Lindberg Daniel M, Campbell Kristine A, Bhatia Aashim, Anderst James D, Bachim Angela, Berger Rachel P, Brink Farah W, Frasier Lori D, Harper Nancy S, Laub Natalie, Melville John, Leonard Jan, Henry M Katherine
Perelman School of Medicine at the University of Pennsylvania (E Alpert), Philadelphia, Pa.
Division of General Pediatrics and PolicyLab (JN Wood), Children's Hospital of Philadelphia, Department of Pediatrics and Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
Acad Pediatr. 2025 Mar;25(2):102597. doi: 10.1016/j.acap.2024.10.009. Epub 2024 Oct 28.
This was a cross-sectional study of infants age <12 months receiving subspecialty child abuse evaluations from February 2021 to December 2022 at 10 sites in CAPNET, a multicenter child abuse research network. Infants were included if they underwent a skeletal survey and lacked overt signs of possible ICI or blunt head injury. Outcome was completion of neuroimaging (computed tomography [CT] or magnetic resonance imaging [MRI]). Multivariable logistic regression was used to assess associations between demographic, clinical, and hospital factors with neuroimaging use.
Of 1114 infants, 746 (67%) underwent neuroimaging ranging from 51% to 80% across CAPNET hospitals. In multivariable analysis, young age, presence of rib fracture(s), and site had significant associations with neuroimaging. Insurance type and race and ethnicity did not contribute significantly to the model. After adjustment for case-mix, there was significant variation across hospitals, with neuroimaging use ranging from 51% (95% CI: 43%, 59%) to 79% (95% CI 71%, 88%).
We identified significant variation in neuroimaging use across CAPNET hospitals, highlighting the need for guideline development and care standardization during the care of infants undergoing abuse evaluations.
1）量化在对无明显头部外伤体征或症状的婴儿进行身体虐待专科评估时，各医院在使用神经影像学检查筛查颅内损伤（ICI）方面的差异；2）评估基于种族、民族和保险类型的神经影像学检查使用是否存在不均衡情况。
这是一项横断面研究，研究对象为2021年2月至2022年12月期间在多中心儿童虐待研究网络CAPNET的10个地点接受儿童虐待专科评估的12个月以下婴儿。如果婴儿接受了骨骼检查且没有可能的ICI或钝性头部损伤的明显体征，则纳入研究。观察指标是神经影像学检查（计算机断层扫描[CT]或磁共振成像[MRI]）的完成情况。采用多变量逻辑回归分析来评估人口统计学、临床和医院因素与神经影像学检查使用之间的关联。
在1114名婴儿中，746名（67%）接受了神经影像学检查，CAPNET各医院的这一比例在51%至80%之间。在多变量分析中，年龄小、存在肋骨骨折以及研究地点与神经影像学检查有显著关联。保险类型以及种族和民族对模型没有显著贡献。在对病例组合进行调整后，各医院之间存在显著差异，神经影像学检查的使用率在51%（95%CI：43%，59%）至79%（95%CI 71%，88%）之间。
我们发现CAPNET各医院在神经影像学检查的使用上存在显著差异，这突出了在对接受虐待评估的婴儿进行护理期间制定指南和规范护理标准的必要性。
