背景:儿童虐待非常普遍,但仍未得到医疗保健提供者的认可。2015年,俄亥俄州儿童医院协会制定了及时识别虐待性陪审团(TRAIN)合作,以促进儿童身体虐待(CPA)筛查。我们的机构在2019年实施了TRAIN倡议。这项研究的目的是检查TRAIN倡议在该机构的影响。
方法:在本回顾性图表回顾中,我们记录了一个独立的二级儿科创伤中心急诊科(ED)就诊的儿童前哨损伤(SIS)的发生率。通过瘀斑的诊断来定义和识别SIS,挫伤,骨折,头部受伤,颅内出血,腹部创伤,开放性伤口,裂伤,磨损,口咽损伤,生殖器损伤,中毒,或烧伤儿童<6.01个月。患者被分层为培训前(PRE),1/2017-9/2018,或列车后(POST),10/2019-7/2020,期间。重复损伤定义为在初次就诊后12个月内对任何先前提到的诊断进行后续就诊。人口统计学/就诊特征采用卡方分析,费舍尔的精确测试,和学生的配对t检验。
结果:在前时期,<6.01个月大的儿童进行了12,812次ED访问;这些访问中有2.8%是由SIS患者进行的。在POST期间,有5,372次ED访问,2.6%涉及SIS(p=4)。对SIS患者进行骨骼调查的比率从PRE期间的17.1%增加到POST期间的27.2%(p=0.01)。在PRE和POST期间,骨骼调查的阳性率分别为18.9%和26.3%(p=.45)。SIS患者在TRAIN前后的重复损伤率没有显着差异(p=0.44)。
结论:在该机构实施TRAIN似乎与骨骼调查率的提高有关。
Child maltreatment is distressingly prevalent yet remains under-recognized by healthcare providers. In 2015 the Ohio Children\'s Hospital Association developed the Timely Recognition of Abusive INjuries (TRAIN) collaborative in an effort to promote child physical abuse (CPA) screening. Our institution implemented the TRAIN initiative in 2019. The objective of this study was to examine the effects of the TRAIN initiative at this institution.
In this retrospective chart review we recorded the incidence of sentinel injuries (SIS) in children presenting to the Emergency Department (ED) of an independent level 2 pediatric trauma center. SIS were defined and identified by a diagnosis of ecchymosis, contusion, fracture, head injury, intracranial hemorrhage, abdominal trauma, open wound, laceration, abrasion, oropharyngeal injury, genital injury, intoxication, or burn in a child < 6.01 months of age. Patients were stratified into pre-TRAIN (PRE), 1/2017-9/2018, or post-TRAIN (POST), 10/2019-7/2020, periods. Repeat injury was defined as a subsequent visit for any of the previously mentioned diagnoses within 12 months of the initial visit. Demographics/visit characteristics were analyzed using Chi square analysis, Fischer\'s exact test, and student\'s paired t-test.
In the PRE period, 12,812 ED visits were made by children < 6.01 months old; 2.8% of these visits were made by patients with SIS. In the POST period there were 5,372 ED visits, 2.6% involved SIS (p = .4). The rate of skeletal surveys performed on patients with SIS increased from 17.1% in the PRE period to 27.2% in the POST period (p = .01). The positivity rate of skeletal surveys in the PRE versus POST period was 18.9% and 26.3% respectively (p = .45). Repeat injury rates did not differ significantly in patients with SIS pre- versus post-TRAIN (p = .44).
Implementation of TRAIN at this institution appears to be associated with increased skeletal survey rates.