Salimi-Jazi Fereshteh, Liang Norah E, Huang Zhuoyi, Tennakoon Lakshika, Rafeeqi Talha, Trickey Amber, Chao Stephanie D
Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
JAMA Netw Open. 2024 Dec 2;7(12):e2451588. doi: 10.1001/jamanetworkopen.2024.51588.
Child abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging.
To describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter cross-sectional study performed between 2022 and 2024 examined a representative national sample of children and adolescents (aged <18 years) admitted for pediatric trauma indications from 2006 to 2019. Data were from the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database. Patient demographics, injury severity, and hospitalization characteristics were classified by race and ethnicity and compared using univariate and multivariate regression. Statistical analysis was performed between March 2022 and October 2024.
The SCA subgroup was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes corresponding to child and adolescent maltreatment.
The primary outcome was the racial and ethnic composition of pediatric patients admitted after traumatic injury with SCA vs those without SCA.
Among the weighted total of 634 309 pediatric patients with complete data included in the study, 13 579 patients had injuries attributable to SCA (SCA subgroup; mean [SD] age, 1.70 [0.04] years; 7650 male [56.3%]; 2868 Black [21.1%], 2293, Hispanic [16.9%], and 5675 White [41.8%]) and 620 730 patients did not (non-SCA subgroup; mean [SD] age, 9.70 [0.01] years; 395 158 male [63.7%]; 86 376 Black [13.9%], 108 406 Hispanic [17.5%], and 298 748 White [48.1%]). The racial and ethnic distribution of the non-SCA subgroup was similar to that of the 2010 US Census. In the SCA subgroup, Black patients (odds ratio [OR], 1.75; 95% CI, 1.65-1.85; P < .001) and Hispanic patients were overrepresented (OR, 1.11; 95% CI, 1.05-1.18; P < .001) and White patients were underrepresented compared with the Census. After controlling for socioeconomic factors and hospital characteristics among 504 365 (weighted) observations in White, Black, and Hispanic patients (493 530 patients without and 10 835 patients with SCA), Black race remained an independent risk factor associated with SCA (OR, 1.10; 95% CI, 1.03-1.17; P = .004), whereas Hispanic race was found to be a protective factor associated with decreased odds of SCA (OR, 0.71; 95% CI, 0.67-0.76; P < .001). Compared with White patients in the SCA subgroup, Black patients had a 26.5% (95% CI, 11.0%-44.3%) longer length of stay (P < .001) for mild to moderate injuries and a 40.1% (95% CI, 16.4%-68.5%) longer length of stay (P < .001) for serious injury.
In this study, Black children and adolescents were suspected to have experienced child abuse at higher rates than children and adolescents of other racial and ethnic backgrounds. More research is necessary to understand the origins of these disparities to reduce them in child abuse identification.
虐待儿童是幼儿发病的主要原因。准确检测仍然具有挑战性。
描述因创伤性损伤入院的儿科患者中，儿童虐待嫌疑（SCA）方面的种族和民族差异。
设计、背景和参与者：这项回顾性、多中心横断面研究于2022年至2024年进行，研究对象为2006年至2019年因儿科创伤指征入院的具有全国代表性的儿童和青少年样本（年龄<18岁）。数据来自儿童住院数据库（KID），这是最大的公开可用的全付费儿科住院护理数据库。按种族和民族对患者人口统计学、损伤严重程度和住院特征进行分类，并使用单变量和多变量回归进行比较。统计分析于2022年3月至2024年10月进行。
使用与儿童和青少年虐待相对应的《国际疾病分类》第九版临床修订本（ICD-9-CM）和《国际疾病分类》第十版临床修订本（ICD-10-CM）编码确定SCA亚组。
主要结局是因创伤性损伤入院且有SCA的儿科患者与无SCA的儿科患者的种族和民族构成。
在纳入研究的634309名有完整数据的加权儿科患者中，13579名患者的损伤归因于SCA（SCA亚组；平均[标准差]年龄，1.70[0.04]岁；7650名男性[56.3%]；2868名黑人[21.1%]，2293名西班牙裔[16.9%]，5675名白人[41.8%]），620730名患者没有（非SCA亚组；平均[标准差]年龄，9.70[0.01]岁；395158名男性[63.7%]；86376名黑人[13.9]%，108406名西班牙裔[17.5%]，298748名白人[48.1%]）。非SCA亚组的种族和民族分布与2010年美国人口普查相似。在SCA亚组中，与人口普查相比，黑人患者（优势比[OR]，1.75；95%置信区间，1.65-1.85；P<.001）和西班牙裔患者占比过高（OR，1.11；95%置信区间，1.05-1.18；P<.001），白人患者占比过低。在对白种人、黑人和西班牙裔患者的504365例（加权）观察中（493530例无SCA患者和10835例有SCA患者），在控制了社会经济因素和医院特征后，黑人种族仍然是与SCA相关的独立危险因素（OR，1.10；95%置信区间，1.03-1.17；P=.004），而西班牙裔种族被发现是与SCA几率降低相关的保护因素（OR，0.71；95%置信区间，0.67-0.76；P<.001）。与SCA亚组中的白人患者相比，黑人患者轻度至中度损伤的住院时间长26.5%（95%置信区间，11.0%-44.3%）（P<.001），严重损伤的住院时间长40.1%（95%置信区间，16.4%-68.5%）（P<.001）。
在本研究中，黑人儿童和青少年被怀疑遭受虐待的比例高于其他种族和民族背景的儿童和青少年。需要更多研究来了解这些差异的根源，以减少虐待儿童识别中的差异。
