Christoffel K K, Zieserl E J, Chiaramonte J
Am J Dis Child. 1985 Sep;139(9):876-80. doi: 10.1001/archpedi.1985.02140110030023.
Deaths during two years at a pediatric teaching hospital were studied to develop guidelines for clinicians who must decide when to explore the possibility of child abuse or neglect when a child dies unexpectedly. Unexpected deaths were defined as deaths occurring before arrival at the hospital or within ten days of hospitalization in children past the first month of life and unrelated to any previously known congenital anomaly or medical condition. There were 43 such deaths during two years. The majority (27) were due to natural causes. However, nine deaths were related to suspected child abuse or neglect (SCAN) and in three of those cases evidence of injury was found only at autopsy. The SCAN cases were more often mistaken for medical illness than for uninflicted injury, indicating that autopsy and postmortem skeletal survey are warranted whenever a child dies unexpectedly. The two factors "dead on arrival" and "1 year of age or less" had a positive predictive value for SCAN of 89% and a negative predictive value of 94%. The two factors identify a high-risk group requiring at least hospital-based investigation into the possibility of abuse or neglect. Reporting for SCAN is warranted when unsuspected trauma is found post mortem, there is direct physical or social evidence of child abuse or neglect, or the child is in the high-risk group and hospital-based investigation falls to eliminate the possibility that maltreatment contributed to the child's death.
为制定相关指南，供临床医生在儿童意外死亡时决定是否探讨虐待或忽视儿童的可能性时参考，对一家儿科教学医院两年内的死亡病例进行了研究。意外死亡定义为：出生后第一个月后的儿童在到达医院之前或住院十天内死亡，且与任何先前已知的先天性异常或疾病无关。两年内共有43例此类死亡病例。其中大多数（27例）是自然原因导致的。然而，9例死亡与疑似虐待或忽视儿童（SCAN）有关，其中3例仅在尸检时发现有受伤证据。SCAN病例被误诊为疾病的情况比被误诊为非故意伤害的情况更常见，这表明只要儿童意外死亡，就有必要进行尸检和死后骨骼检查。“入院时已死亡”和“一岁及以下”这两个因素对SCAN的阳性预测值为89%，阴性预测值为94%。这两个因素确定了一个高危群体，至少需要在医院进行调查，以确定是否存在虐待或忽视的可能性。当尸检时发现意外创伤、有虐待或忽视儿童的直接身体或社会证据，或者儿童属于高危群体且医院调查未能排除虐待导致儿童死亡的可能性时，就有必要报告SCAN。
