Thyen U, Leventhal J M, Yazdgerdi S R, Perrin J M
Department of Pediatrics, Harvard Medical School Boston, MA, USA.
Child Abuse Negl. 1997 Feb;21(2):187-98. doi: 10.1016/s0145-2134(96)00144-5.
This study examined factors associated with clinicians' concerns about abuse and neglect and reporting hospitalized children to Child Protective Services (CPS). Data came from a cross-sectional chart review from a random sample of pediatric hospitalizations 1988-1990 in three cities for five condition groups (n = 5,446), and included evidence of clinicians' concerns about physical abuse or neglect and reports to CPS, family income, ethnicity, family structure, child's age, and illness severity at admission. Concerns about abuse were noted in 2.5% of the total sample, concerns about neglect in 3.1%, and 2.9% of children were reported to CPS. Concerns about abuse were most frequent in children with head trauma (8.2%), and concerns about neglect in children with toxic ingestion (12.3%). Young age of child, low income, and single parent family were independently associated with increased frequencies of concerns and reports. Low income was significantly associated with clinicians' concerns about neglect, but not abuse or reports to CPS. Ethnicity was not significant after controlling for income and family structure. Severity of illness was associated with concerns about physical abuse (p = .02) among children with head trauma, and with concerns about neglect and frequency of reporting among children with meningitis (p < .01). Our results confirm the associations among neglect, poverty, and single-parent families among hospitalized children. Increasing severity of illness may make clinicians consciously or unconsciously consider that care has been delayed and the child neglected.
本研究调查了与临床医生对虐待和忽视问题的担忧以及向儿童保护服务机构（CPS）报告住院儿童情况相关的因素。数据来自对1988 - 1990年三个城市五个疾病组（n = 5446）儿科住院病例的随机抽样横断面图表回顾，包括临床医生对身体虐待或忽视的担忧证据、向CPS的报告、家庭收入、种族、家庭结构、儿童年龄以及入院时的疾病严重程度。在总样本中，2.5%的儿童被发现存在虐待担忧，3.1%存在忽视担忧，2.9%的儿童被报告给CPS。头部创伤儿童中虐待担忧最为常见（8.2%），中毒儿童中忽视担忧最为常见（12.3%）。儿童年龄小、低收入和单亲家庭与担忧和报告频率增加独立相关。低收入与临床医生对忽视的担忧显著相关，但与虐待担忧或向CPS的报告无关。在控制收入和家庭结构后，种族因素不显著。疾病严重程度与头部创伤儿童的身体虐待担忧相关（p = 0.02），与脑膜炎儿童的忽视担忧和报告频率相关（p < 0.01）。我们的结果证实了住院儿童中忽视、贫困和单亲家庭之间的关联。疾病严重程度增加可能使临床医生有意识或无意识地认为护理被延迟且儿童被忽视。
