FRACTURES IN YOUNG-CHILDREN - DISTINGUISHING CHILD-ABUSE FROM UNINTENTIONAL INJURIES
FRACTURES IN YOUNG-CHILDREN - DISTINGUISHING CHILD-ABUSE FROM UNINTENTIONAL INJURIES
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DOI：
10.1001/archpedi.1993.02160250089028
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发表时间：
1993-01-01
影响因子：
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通讯作者：
MARKOWITZ, RI
中科院分区：
文献类型：
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作者：
LEVENTHAL, JM;THOMAS, SA;MARKOWITZ, RI
目的：确定幼儿骨折的特征，有助于区分虐待儿童和无意伤害。设计。病例系列。设置。耶鲁纽黑文（康涅狄格州）医院（三级护理中心）的儿科服务。患者。从 1979 年 1 月至 1983 年 12 月期间连续接受骨折检查的 3 岁以下儿童，从急诊科或急诊室的每日日志中识别出来。结果衡量。-通过预先确定的标准以及两名临床医生和两名儿科放射科医生的共识，按照从“明确的儿童虐待”到“明确的无意伤害”的七分制对每个病例进行评级。如果没有足够的信息达成共识，则使用中间评级“未知”。结果。-在已确定的 215 名儿童的 253 例骨折中，我们24.2% 属于虐待，8.4% 属于未知，67.4% 属于无意伤害。被认为可能由虐待造成的骨折有： (1) 儿童骨折，其看护者报告儿童行为发生变化，但并非意外事件，或轻微跌倒，但伤害比预期更严重； (2) 1岁以下儿童的桡骨/尺骨、胫骨/腓骨、股骨骨折； (3) 肱骨中段或干骺端骨折。顶骨线性骨折是最常见的颅骨骨折，无论是由于虐待还是无意伤害。结论：在患有骨折的幼儿中，虐待儿童很常见。通过比较虐待造成的骨折和意外伤害造成的骨折，我们获得了经验证据来帮助临床医生和放射科医生正确检查患有此类严重伤害的儿童。
Objective.-To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries.Design.-Case series.Setting.-Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center).Patients.-Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse registry.Outcome Measure.-Each case was rated, by means of predefined criteria and a consensus of two clinicians and two pediatric radiologists, on a seven-point scale from ''definite child abuse'' to ''definite unintentional injury.'' A middle rating of ''unknown'' was used if there was not enough information to reach a consensus.Results.-Of the 253 fractures in 215 children that were identified, we categorized 24.2% as abuse, 8.4% as unknown, and 67.4% as unintentional injuries. Fractures that were considered likely due to abuse were (1) fractures in children whose caretakers reported either a change in the child's behavior, but no accidental event, or a minor fall, but the injury was more severe than expected; (2) fractures of the radius/ulna, tibia/fibula, or femur in children less than 1 year of age; or (3) midshaft or metaphyseal fractures of the humerus. Linear fractures of the parietal bone were the most common skull fractures, whether due to abuse or unintentional injuries.Conclusion.-In young children with fractures, child abuse is common. By comparing fractures due to abuse and those due to unintentional injuries, we obtained empiric evidence to help clinicians and radiologists correctly examine children with such serious injuries.