Darwiche Sabrina M, Christian Cindy W, Gathers Cody-Aaron L, Morgan Ryan W, Naim Maryam Y, Wood Joanne N
Department of Pediatrics (SM Darwiche, CW Christian, and JN Wood), Children's Hospital of Philadelphia, Philadelphia, Pa; Safe Place and PolicyLab (SM Darwiche, C-AL Gathers, and JN Wood), Children's Hospital of Philadelphia, Philadelphia, Pa.
Department of Pediatrics (SM Darwiche, CW Christian, and JN Wood), Children's Hospital of Philadelphia, Philadelphia, Pa; Perelman School of Medicine at the University of Pennsylvania (CW Christian, RW Morgan, MY Naim, and JN Wood), Philadelphia, Pa.
Acad Pediatr. 2025 Apr;25(3):102777. doi: 10.1016/j.acap.2025.102777. Epub 2025 Jan 9.
In children admitted after an out-of-hospital cardiac arrest (OHCA), this study 1) determines the proportion that undergo physical abuse and toxin exposure evaluation, child protection team (CPT) consultation, and child protective services (CPS) referral, and 2) evaluates the association between demographic, social, clinical characteristics with CPT consultation and CPS referral.
A retrospective chart review was conducted of children <4 years old admitted following an OHCA between November 2012 and February 2023. Associations between demographics, caregiver social risk factors, and clinical characteristics with CPT consultation and CPS referral were examined using logistic regression.
Among 157 cases, 70 (45%) had skeletal surveys; 8 (11%) identified an occult fracture. Seventy-five (48%) children had toxicology testing; 16 of the 75 (21%) revealed a toxic ingestion. Sixteen of the 49 (33%) patients receiving ophthalmologic evaluations had significant retinal hemorrhages. Seventy-seven (49%) patients had a CPT consultation, while 74 (47%) were referred to CPS. A history concerning for ingestion perfectly predicted CPT consultation. History of ingestion, injury on exam, positive skeletal survey, and positive toxicology testing perfectly predicted CPS referral. In multivariate analyses, unsafe sleep history (84% versus 41%, P < 0.001) and caregiver social risk factors (82% versus 31%, P < 0.001) were associated with CPT consultation, while caregiver social risk factors (70% versus 34%, P < 0.001) and normal medical work-up (53% versus 38%, P = 0.050) were associated with CPS referral.
Following OHCA, a child maltreatment evaluation may be underutilized with medical decision-making around CPT consultation and CPS referral driven by knowledge of caregiver social risk factors.
在院外心脏骤停（OHCA）后入院的儿童中，本研究1）确定接受身体虐待和毒素暴露评估、儿童保护团队（CPT）咨询以及儿童保护服务（CPS）转诊的比例，2）评估人口统计学、社会和临床特征与CPT咨询和CPS转诊之间的关联。
对2012年11月至2023年2月期间因OHCA入院的4岁以下儿童进行回顾性病历审查。使用逻辑回归分析人口统计学、照顾者社会风险因素和临床特征与CPT咨询和CPS转诊之间的关联。
在157例病例中，70例（45%）进行了骨骼检查；8例（11%）发现隐匿性骨折。75例（48%）儿童进行了毒理学检测；75例中的16例（21%）显示有毒物摄入。49例接受眼科评估的患者中有16例（33%）有明显的视网膜出血。77例（49%）患者接受了CPT咨询，而74例（47%）被转诊至CPS。关于摄入的病史能完美预测CPT咨询。摄入病史、检查时的损伤、骨骼检查阳性和毒理学检测阳性能完美预测CPS转诊。在多变量分析中，不安全睡眠史（84%对41%，P<0.001）和照顾者社会风险因素（82%对31%，P<0.001）与CPT咨询相关，而照顾者社会风险因素（70%对34%，P<0.001）和正常的医学检查（53%对38%，P=0.050）与CPS转诊相关。
OHCA后，儿童虐待评估在围绕CPT咨询和CPS转诊的医疗决策中可能未得到充分利用，而这些决策是由照顾者社会风险因素的知识驱动的。
