Hultman Lyndsey, Doswell Angela, Puls Henry T, Carpenter Shannon L, Bachim Angela, McNamara Caitlin R, Brink Farah W, Frasier Lori D, Harper Nancy S, Laub Natalie, Campbell Kristine A, Lindberg Daniel M, Wood Joanne N, Anderst James
Division of Child Adversity and Resilience, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, Kansas City, MO, United States of America.
Division of Child Abuse and Neglect, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT, United States of America.
Child Abuse Negl. 2025 May;163:107431. doi: 10.1016/j.chiabu.2025.107431. Epub 2025 Mar 29.
Using a multicenter child abuse pediatrics research network (CAPNET), the study objectives were to characterize the adherence to American Academy of Pediatrics (AAP) recommendations for bleeding disorder testing and the frequency of bleeding disorder identification.
We performed a descriptive study of bleeding disorder evaluations among children younger than 10 years of age who presented with bruising and/or intracranial hemorrhage (ICH) concerning for abuse from February 2021-May 2022 utilizing CAPNET. Cases were classified as bruising without ICH or ICH with or without bruising. Based on AAP guidance, testing was not recommended in cases with concomitant suspicious injuries, inflicted injury history, patterned injury, and low clinical concern for abuse. The primary outcome was adherence to AAP recommendations for testing by study group. We also calculated the frequency of bleeding disorder identification.
A total of 2491 children presented with bruising and/or ICH concerning for abuse during the study period. 25.1 % of subjects (468 with bruising and 157 with ICH) were recommended to have testing by AAP criteria. Of these, 10.5 % cases of bruising and 33.1 % cases of ICH completed all AAP recommended testing. Among CAPNET centers, AAP recommended testing completion ranged from 0 to 34.1 % of bruising cases and 4.8-100 % of ICH cases. In total, 0.7 % (18/2491) cases had a newly identified bleeding disorder, with more identified at one center with higher testing rates.
Testing for bleeding disorders based on AAP recommendations frequently did not occur and varied by CAPNET center. Although rare, bleeding disorders were present among cases with testing.
利用多中心儿童虐待儿科研究网络（CAPNET），本研究的目的是描述对美国儿科学会（AAP）关于出血性疾病检测建议的遵循情况以及出血性疾病的识别频率。
我们对2021年2月至2022年5月期间因疑似虐待而出现瘀伤和/或颅内出血（ICH）的10岁以下儿童进行了出血性疾病评估的描述性研究，采用CAPNET。病例分为无ICH的瘀伤或伴有或不伴有瘀伤的ICH。根据AAP指南，对于伴有可疑损伤、有受伤史、有形态损伤且对虐待临床关注度低的病例，不建议进行检测。主要结局是各研究组对AAP检测建议的遵循情况。我们还计算了出血性疾病的识别频率。
在研究期间，共有2491名儿童因疑似虐待而出现瘀伤和/或ICH。根据AAP标准，25.1%的受试者（468例瘀伤和157例ICH）被建议进行检测。其中，10.5%的瘀伤病例和33.1%的ICH病例完成了所有AAP建议的检测。在CAPNET各中心中，AAP建议检测的完成率在瘀伤病例中为0至34.1%，在ICH病例中为4.8%至100%。总体而言，0.7%（18/2491）的病例有新确诊的出血性疾病，在一个检测率较高的中心发现的更多。
基于AAP建议的出血性疾病检测经常未进行，且因CAPNET中心而异。虽然罕见，但在接受检测的病例中存在出血性疾病。
