儿童头部外伤的风险因素。

IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Journal of neurosurgery. Pediatrics Pub Date : 2024-11-01 DOI:10.3171/2024.8.PEDS24205
Kaho Adachi, Adith Srivatsa, Allison Raymundo, Daksh Bhargava, Ankit I Mehta
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引用次数: 0

摘要

目的:在美国,虐待性头部创伤(AHT)是导致 5 岁以下儿童因身体虐待而死亡的主要原因。虐待性头部外伤患者的死亡率为 25%,如果缺乏干预,儿童虐待的复发率将上升至 35%。因此,识别虐待儿童行为至关重要,但对于语言发育尚未成熟的婴幼儿来说尤其具有挑战性。目前的虐童指南并没有充分考虑到低龄儿童的特殊需求。本研究旨在评估此类人群中与虐待相关的临床因素:从 2017 年到 2019 年,对国家创伤数据库中 3 岁以下的急性头部创伤患者进行了查询。根据人口统计学、合并症和格拉斯哥昏迷量表(GCS)评分,将疑似经历过虐待儿童的患者(疑似虐待儿童[SCA]组)与未疑似经历过虐待儿童的患者(非SCA组)进行倾向评分匹配。采用配对学生 t 检验和卡方检验来比较两组住院结果的差异。多变量回归分析用于确定与 SCA 相关的因素(P < 0.05):作者在 SCA 组和非 SCA 组分别发现了 10,844 名和 27,912 名患者。回归分析结果显示,SCA 组患者的早产率较高(OR 2.30,p < 0.001),GCS 评分 < 13(OR 1.79,p < 0.001),先天性疾病(OR 1.56,p < 0.001),使用公共保险的比例较高(68.38% vs 52.88% p < 0.001)。黑人和西班牙裔患者更有可能属于 SCA 组(OR 分别为 1.56,p < 0.001 和 OR 1.35,p < 0.001)。倾向得分匹配后,SCA 患者的住院时间更长(3.17 天 vs 1.34 天,p < 0.001),死亡率更高(4.89% vs 3.58%,p < 0.001):SCA组的急性颅脑损伤与早产、先天性疾病、低GCS评分和使用公共保险有关。因此,在对婴幼儿进行潜在虐待评估时,现行指南应考虑临床病史和保险类型,以更好地反映高危患者群体。黑人和西班牙裔患者中可能存在过度识别虐待儿童的情况,因此有必要开展进一步研究。
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Risk factors for abusive head trauma in the pediatric population.

Objective: Abusive head trauma (AHT) is the leading cause of death from physical child abuse in children younger than 5 years of age in the United States. The mortality rate among patients with AHT is 25%, and the recurrence rate of child abuse rises to 35% when there is a lack of intervention. Thus, identifying child abuse is crucial yet especially challenging for infants and toddlers as they are preverbal. Current guidelines for child abuse do not sufficiently address the specific needs of a younger population. This study aimed to evaluate clinical factors associated with abuse among such populations.

Methods: The National Trauma Data Bank was queried from 2017 to 2019 for patients younger than 3 years with acute head trauma. Patients who were suspected of having experienced child abuse (suspected child abuse [SCA] group) were propensity score matched with patients who were not suspected of having experienced child abuse (non-SCA group) based on demographics, comorbidities, and Glasgow Coma Scale (GCS) scores. Paired Student t-test and chi-square tests were used to compare differences in hospital outcomes between the two groups. Multivariable regression analysis was used to determine factors associated with SCA (p < 0.05).

Results: The authors identified 10,844 patients in the SCA group and 27,912 in the non-SCA group. Regression analysis results showed that patients in the SCA group had higher rates of prematurity (OR 2.30, p < 0.001), GCS scores < 13 (OR 1.79, p < 0.001), congenital disorders (OR 1.56, p < 0.001), and public insurance use (68.38% vs 52.88% p < 0.001). Black and Hispanic patients were more likely to be in the SCA group (OR 1.56, p < 0.001 and OR 1.35, p < 0.001, respectively). Following propensity score matching, SCA patients had a longer length of hospital stay (3.17 vs 1.34 days, p < 0.001) and higher mortality rate (4.89% vs 3.58%, p < 0.001).

Conclusions: Acute head injuries in the SCA group were associated with prematurity, congenital disorder, low GCS score, and public insurance use. As such, the current guidelines should implement clinical history and insurance type to better reflect the at-risk patient population when evaluating infants and toddlers for potential abuse. There could be overidentification of child abuse among Black and Hispanic patients, and further research is warranted.

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来源期刊
Journal of neurosurgery. Pediatrics
Journal of neurosurgery. Pediatrics 医学-临床神经学
CiteScore
3.40
自引率
10.50%
发文量
307
审稿时长
2 months
期刊介绍: Information not localiced
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