Kazemi Foad, Jiang Kelly, Robinson Shenandoah, Cohen Alan R
J Neurosurg Pediatr. 2025 Apr 25:1-10. doi: 10.3171/2025.1.PEDS24499.
Child abuse is a critical public health issue that profoundly affects pediatric health and well-being. Child abuse patients who have sustained traumatic brain injuries (TBIs) present with a unique subset of injuries with complex medical and social implications. This study aims to explore the socioeconomic disparities, injury characteristics, and outcomes in child abuse patients who have sustained TBIs.
The authors conducted a retrospective review of their institutional emergency department (ED) database (June 2016-June 2023) to identify pediatric TBI cases (patient age ≤ 18 years) using ICD-10 codes based on a modified Centers for Disease Control and Prevention framework. Documented cases of child abuse, neglect, or inadequate supervision with investigations by a multidisciplinary child protection team were identified by reviewing the records of ED admissions. Patient demographics, zip codes, injury characteristics, and clinical outcomes were collected. The Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS), with higher ISSs and lower TRISSs indicating more severe injuries, respectively, were obtained. The Social Deprivation Index was used to assess neighborhood disadvantage, with higher scores indicating adverse health outcomes. Standard bivariate and multivariate regression analyses were performed.
This study included 2954 patients with TBI, whose mean age was 7.05 ± 5.50 years; 36.6% of the patients were female and 40.4% were White. Among the overall cohort of TBI cases, 86.6% were non-child abuse cases, while 13.4% were child abuse cases. The child abuse cohort had a significantly lower average age (2.02 vs 7.83 years, p < 0.001) than the non-child abuse group. In multivariate regression models, child abuse patients had higher odds of being conveyed to the hospital via private transport (adjusted odds ratio [aOR] 2.201, p < 0.001); had higher odds of residing in a deprived neighborhood, as indicated by the SDI (aOR 1.009, p < 0.001); and had sustained more severe injuries on admission, as indicated by the ISS and TRISS (aOR 1.064, p < 0.001; aOR 0.970, p < 0.001, respectively). Child abuse patients had higher odds of a prolonged hospital stay (aOR 4.061, p < 0.001), a nonroutine discharge (aOR 6.186, p < 0.001), ED transfer to the intensive care unit (aOR 2.696, p < 0.001), and death on admission (aOR 3.131, p < 0.001).
This study highlights neighborhood disadvantage, more severe injuries, and adverse outcomes in child abuse-related TBI, emphasizing the need for targeted interventions to address socioeconomic disparities and improve healthcare for this vulnerable population.
虐待儿童是一个严重的公共卫生问题，对儿童健康和福祉有深远影响。遭受创伤性脑损伤（TBI）的虐待儿童患者呈现出一组独特的损伤，具有复杂的医学和社会影响。本研究旨在探讨遭受TBI的虐待儿童患者的社会经济差异、损伤特征和预后。
作者对其机构急诊科（ED）数据库（2016年6月至2023年6月）进行回顾性研究，根据修改后的疾病控制与预防中心框架，使用ICD-10编码识别儿科TBI病例（患者年龄≤18岁）。通过审查ED入院记录，确定有记录的虐待儿童、忽视或监督不足且经多学科儿童保护团队调查的病例。收集患者人口统计学信息、邮政编码、损伤特征和临床结局。获得损伤严重程度评分（ISS）和创伤及损伤严重程度评分（TRISS），较高的ISS和较低的TRISS分别表明损伤更严重。社会剥夺指数用于评估社区劣势，分数越高表明健康结局越差。进行标准的双变量和多变量回归分析。
本研究纳入2954例TBI患者，平均年龄为7.05±5.50岁；36.6%的患者为女性，40.4%为白人。在整个TBI病例队列中，86.6%为非虐待儿童病例，而13.4%为虐待儿童病例。虐待儿童队列的平均年龄（2.02岁对7.83岁，p<0.001）显著低于非虐待儿童组。在多变量回归模型中，虐待儿童患者通过私人交通工具送往医院的几率更高（调整优势比[aOR]2.201，p<0.001）；如社会剥夺指数所示，居住在贫困社区的几率更高（aOR 1.009，p<0.001）；入院时损伤更严重，如ISS和TRISS所示（分别为aOR 1.064，p<0.001；aOR 0.970，p<0.001）。虐待儿童患者住院时间延长（aOR 4.061，p<0.001）、非常规出院（aOR 6.186，p<0.001）、从ED转至重症监护病房（aOR 2.696，p<0.001）和入院死亡（aOR 3.131，p<0.001）的几率更高。
本研究强调了与虐待儿童相关的TBI中的社区劣势、更严重的损伤和不良结局，强调需要有针对性的干预措施来解决社会经济差异并改善这一弱势群体的医疗保健。
