The Prevalence of Bruising Among Infants in Pediatric Emergency Departments.
The Prevalence of Bruising Among Infants in Pediatric Emergency Departments.
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DOI：
10.1016/j.annemergmed.2015.06.021
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发表时间：
2016-01
影响因子：
6.2
通讯作者：
Kanegaye JT
中科院分区：
文献类型：
--
作者：
Pierce MC;Magana JN;Kaczor K;Lorenz DJ;Meyers G;Bennett BL;Kanegaye JT
瘀伤可能表明虐待婴儿。在儿科急诊室（PED）环境中，婴儿的瘀伤患病率尚不清楚。我们的目的是确定瘀伤的患病率，相关的主诉（CC），以及在以前健康的婴儿到PED的滥用评价的频率。我们对接受PED治疗的≤12个月婴儿进行了一项前瞻性、观察性、多中心研究。使用了结构化抽样。儿科急诊医学（PEM）临床医生进行了全面的皮肤检查，以筛选瘀伤。研究者记录皮肤发现、访视日期、患者年龄、CC和滥用评估。主要结果是瘀伤的发生率。次要结果是基于CC和滥用频率评估的瘀伤患病率。用95%置信区间（CI）计算瘀伤患病率的点估计值和患者亚组之间瘀伤患病率的差异。在2488名婴儿中，有88名发现了瘀伤（3.5%，95% CI：[2.9%，4.4%]）。≤5个月和>5个月婴儿的瘀伤发生率分别为1.3%和6.4%（差异5.1%，95% CI：[3.6%，6.8%]）。对于≤5个月大的婴儿，83%的瘀伤与创伤性CC相关，只有0.2%的医疗CC婴儿有瘀伤。PEM临床医生对23%的有瘀伤的婴儿进行了滥用评估，对于≤ 5个月的婴儿，这一比例增加到50%。在PED中评价的≤ 12个月儿童的瘀伤患病率较低，在年龄层内增加，并且最常与创伤CC相关。大多数瘀伤的婴儿没有接受虐待评估。
Bruising can indicate abuse for infants. Bruise prevalence among infants in the Pediatric Emergency Department (PED) setting is unknown. Our objective was to determine prevalence of bruising, associated chief complaints (CC), and frequency of abuse evaluations in previously healthy infants presenting to PEDs. We conducted a prospective, observational, multi-center study of infants ≤12 months old presenting to PEDs. Structured sampling was utilized. Pediatric Emergency Medicine (PEM) clinicians performed complete skin examinations to screen for bruising. Study investigators documented skin findings, date of visit, patient's age, CC, and abuse evaluation. The primary outcome was prevalence of bruising. Secondary outcomes were prevalence of bruising based on CC and frequency of abuse evaluation. Point estimates of bruise prevalence and differences in bruise prevalence between patient subgroups were calculated with 95% confidence intervals (CI). Bruising was identified in 88 of 2488 infants (3.5%, 95% CI: [2.9%, 4.4%]). Rates of bruising for infants ≤5 and >5 months old were 1.3% and 6.4%, respectively (difference 5.1%, 95% CI: [3.6%, 6.8%]). For infants ≤5 months old, 83% of bruising was associated with a trauma CC and only 0.2% of infants presenting with a medical CC had bruising. PEM clinicians obtained abuse evaluations on 23% of infants with bruising and that rate increased to 50% for infants ≤ 5 months of age. Bruising prevalence in children ≤ 12 months of age evaluated in PEDs was low, increased within age strata, and was most often associated with a trauma CC. Most bruised infants did not undergo an abuse evaluation.