CHILDHOOD INJURIES EVALUATED IN THE OFFICE SETTING

伤害，无论是有意的还是无意的，都是导致 儿童死亡率和发病率。虽然许多伤者都在接受治疗 初级保健医生提供的信息有限 这些医生治疗的损伤的范围和类型，以及 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。 伤害的办公室管理和医生对儿童的认可 虐待是其中一些伤害的原因，需要进一步研究。 最近医疗保健融资和提供模式的转变需要 初级保健医生为他们可能出现的问题提供治疗 已转介给急诊科或医疗专家 过去时。关于在初级保健中护理的伤害的详细信息 实践将有助于理解、规划和管理 护理，但这一信息不可用。 办公室医生很少报告虐待儿童的情况。 医生可能无法识别或报告虐待儿童的伤害，直到 发生了危及生命或致命的伤害。识别LESS 严重的儿童虐待伤害可能使医生能够在 滥用会升级并产生更严重的后果。评估 这种方法是不可能的，因为研究还没有研究如何 办公室医生经常怀疑身体虐待是导致 他们评估的伤害，或者医生事后的行为 他们确实发现了这样的问题。 这项研究有三个目标：1)提供更多关于 初级保健环境中看到的伤害范围和所提供的病例 在那里，2)用来描述医生怀疑受伤的频率 由虐待儿童造成的伤害及其处理，以及3) 测试这项研究设计的可行性，并提炼 用于全国性研究的仪器。 将招募区域执业网络中的医生来 参与进来。每位医生将填写一份调查表，提供 关于他们的办公室环境、年龄、性别、态度和 以前在识别和报告虐待儿童方面的做法。然后，对于 连续四周，50名医生每人将完成一项简短的 关于每一次办公室会面的表格。这项研究将收集人口统计数据 20,000次办公室访问信息。估计1700人中的每一个 与伤害相关的就诊，主治医生将描述他们的类型 受伤原因、受伤原因和办公室管理 受伤。他们将对受伤的严重程度和可能性进行评估 伤害是由虐待儿童造成的。 将对数据进行分析以描述以下类型的频率 伤害，其原因，管理的范围 办公室，以及办公室转介的模式。这项研究将比较 伤害总数的百分比与虐待伤害的百分比 每一位参赛医生。内科医生的办公室管理 将分析受伤与转介治疗模式的对比。这个 儿童虐待伤害、医生报告的行为和风险的范围 将描述医生归因于家庭的因素。

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.