CHILDHOOD INJURIES EVALUATED IN THE OFFICE SETTING

在办公室环境中评估儿童伤害

• 批准号: 2707273
• 负责人: EMALEE G. FLAHERTY
• 金额: $ 7.15万
• 依托单位: LURIE CHILDREN'S HOSPITAL OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-03-01 至 1999-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2707273
• 关键词: adolescence (12-20); behavioral /social science research tag; child (0-11); child abuse; clinical research; disease /disorder etiology; disease /disorder proneness /risk; health related legal; health services research tag; human subject; injury; outpatient care; patient care management; pediatrics; primary care physician

Injuries, both intentional and unintentional, are a leading cause of mortality and morbidity in childhood. While many injuries are treated by primary care physicians, only limited information is available about the scope and type of injuries treated by these physicians and no information has been collected about how frequently child abuse is responsible for injury related office visits. Both the office management of injuries and physician recognition of chid abuse as a cause of some of these injuries require further research. Recent shifts in health care financing and delivery patterns require that primary care physicians provide treatment for problems they may have referred to emergency departments or medical specialists in the past. Detailed information on injuries cared for in primary care practices would be helpful for understanding, planning and managing care, yet this information is not available. Child abuse is infrequently reported by office-based physicians. Physicians may fail to identify or report child abuse injuries until a life-threatening or fatal injury has occurred. Identification of less serious chid abuse injuries might enable physicians to intervene before abuse escalates and produces more serious consequences. Evaluation of this approach has not been possible, as research has not examined how frequently office-based physicians suspect physical abuse as a cause of the injuries that they evaluate, nor the behavior of physicians after they do identify such problems. This study has three goals: 1) to provide more information about the scope of injuries seen in the primary care setting and the case provided there, 2) to describe how frequently physicians suspect an injury is caused by child abuse and their management of those injuries, and 3) to test the feasibility of this research design and to refine the instruments for a nationwide study. Physicians in a regional practice network will be recruited to participate. Each physician will complete a survey form supplying information about their office setting, age, gender, attitudes and previous practice in identifying and reporting child abuse. Then for four successive weeks, each of fifty physicians will complete a short form about each office encounter. This study will collect demographic information of 20,000 office visits. For each of the estimated 1700 injury related visits, the treating physician will describe they type of injury, the cause of the injury and the office management of the injury. They will rate the severity of the injury and the likelihood that the injury was caused by child abuse. The data will be analyzed to describe the frequency of types of injuries, their causes, the spectrum of management provided in the office, and the patterns of office referral. The study will compare the percent of total injury with the percent of abuse injuries evaluated by each participating physician. The physician's in-office management of injuries versus referral for treatment patterns will be analyzed. The spectrum of child abuse injuries, physician reporting behavior, and risk factors attributing to families by physicians will be described.

伤害，无论是故意的还是无意的，都是导致 儿童死亡率和发病率。 虽然许多受伤的人得到了治疗， 对于初级保健医生来说，关于以下内容的信息有限 这些医生治疗的伤害的范围和类型， 已经收集了关于虐待儿童的频率的信息， 负责与伤害相关的办公室访问。 无论是对伤害的办公室管理还是对儿童的医生识别 虐待是造成其中一些伤害的原因，需要进一步研究。 最近卫生保健筹资和提供模式的转变要求 初级保健医生提供治疗的问题，他们可能 已转介急诊科或医疗专家， 过去 关于初级保健中受伤护理的详细信息 实践将有助于理解，规划和管理 护理，但这一信息不可用。 诊所医生很少报告虐待儿童的情况。 医生可能无法识别或报告儿童虐待伤害，直到 发生危及生命或致命的伤害。识别较少 严重的儿童虐待伤害可能使医生能够在 虐待行为升级并产生更严重的后果。 评价 这种方法是不可能的，因为研究还没有研究如何 经常办公室的医生怀疑身体虐待是导致 他们评估的伤害，也不是医生的行为， 他们确实发现了这些问题。 本研究有三个目的：1）提供更多关于 在初级保健环境中看到的伤害范围和提供的病例 2）描述医生怀疑受伤的频率 由虐待儿童及其对这些伤害的管理造成的，以及3） 测试本研究设计的可行性，并完善 用于全国范围的研究。 将招募区域实践网络中的医生， 参加 每位医生将填写一份调查表， 关于他们的办公室环境、年龄、性别、态度和 在识别和报告虐待儿童方面的以往做法。 那么对于 连续四周，每五十名医生将完成一个简短的 关于每一次办公室聚会 这项研究将收集人口统计学 20，000次办公室访问的信息。 估计1700人中， 受伤相关的访问，治疗医生将描述他们的类型 伤害的原因和办公室管理的伤害， 损伤 他们将评估受伤的严重程度和 是虐待儿童造成的 将对数据进行分析，以描述 伤害，其原因，提供的管理范围， 办公室，以及办公室转介模式。 该研究将比较 总伤害的百分比与虐待伤害的百分比， 每一位参与的医生。 医生的办公室管理 将分析受伤与转诊治疗模式的关系。 的 儿童虐待伤害、医生报告行为和风险的范围 将描述医生归因于家庭的因素。