Hospitalized Cases of Child Abuse in America Who, What, When, and Where
Hospitalized Cases of Child Abuse in America Who, What, When, and Where
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DOI：
10.1097/bpo.0b013e31819aad44
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发表时间：
2009-04-01
影响因子：
1.7
通讯作者：
Spratt, Kevin F.
中科院分区：
文献类型：
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作者：
Bullock, Daniel P.;Koval, Kenneth J.;Spratt, Kevin F.
背景：骨科医生需要认识到儿童虐待的特点。本研究的目的是确定虐待儿童的共同特点，并划定功能的身体伤害的情况下，将提高关注儿童abuse.Methods：一个具有全国代表性的样本，所有儿科住院出院日历年1997年，2000年和2003年查询身体伤害的诊断。病例被确定为诊断为虐待儿童的病例，对照组被确定为没有诊断为虐待儿童的病例。编码的儿童虐待的发生率和跨时间，人口统计学和伤害模式的比较进行了确定。病例与对照组进行了比较，编码的虐待儿童的相对风险计算使用广义线性模型指定的泊松分布和日志link.Results：有665,195例身体伤害的情况下确定。其中，11，554人（1.74%）被诊断为虐待儿童。28%的虐待儿童病例中存在需要矫形治疗的骨折。编码儿童虐待的3个最强的人口统计学预测因素是年龄小于1岁，年龄1至2岁，医疗补助作为主要支付者，调整后的相对风险分别为11.46，3.07和1.99。冬季和平日的介绍显着较高的编码虐待儿童。编码儿童虐待的最大调整相对风险的骨折是肋骨或胸骨（5.34）和肩胛骨（3.22）。骨盆骨折是唯一的骨折显着降低调整后的相对风险编码childabuse.Conclusions：这项研究表明，年轻的年龄仍然是一个强有力的预测儿童虐待的设置身体伤害。支持功能包括医疗补助作为主要付款人和冬季或工作日介绍。骨科医生应该特别注意虐待儿童的情况，因为28%的病例有骨折需要骨科治疗。证据等级：预后研究，III级（病例对照研究）。
Background: Orthopaedic surgeons need to recognize features of child abuse. The purpose of this study was to identify common characteristics of child abuse and to delineate features of physical injury cases that would raise concern for child abuse.Methods: A nationally representative sample of all pediatric inpatient discharges for calendar years 1997, 2000, and 2003 was queried for physical injury diagnoses. Cases were identified as those with a diagnosis of child abuse and controls were those without the diagnosis of child abuse. Incidence of coded child abuse and a comparison of rates across time, demographics, and injury pattern were determined. Cases were compared with controls, and relative risks for coded child abuse were computed using the generalized linear model specifying the Poisson distribution and a log link.Results: There were 665,195 physical injury cases identified. Of these, 11,554 (1.74%) had a diagnosis of child abuse. Fracture requiring orthopaedic management was present in 28% of the child abuse cases. The 3 strongest demographic predictors of coded child abuse were age Younger than 1 year, age 1 to younger than 2 years, and Medicaid as primary payer with adjusted relative risks of 11.46, 3.07, and 1.99, respectively. Winter and weekday presentation were significantly higher for coded child abuse. Fractures with the greatest adjusted relative risks for coded child abuse were rib or sternum (5.34) and scapula (3.22). Pelvic fracture was the only fracture significant for lowered adjusted relative risk of coded child abuse.Conclusions: This study shows that young age continues to be a strong predictor of child abuse in the setting of physical injury. Supporting features include Medicaid as primary payer and winter or weekday presentation. Orthopaedists should be particularly aware of child abuse as 28% of cases had a fracture requiring orthopaedic management.Level of Evidence: Prognostic Study, Level III (case-control study).