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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Variation in occult injury screening for children with suspected abuse in selected US children's hospitals
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Variation in occult injury screening for children with suspected abuse in selected US children's hospitals

机译：美国部分儿童医院对疑似虐待儿童进行隐匿性损伤筛查的差异

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OBJECTIVE: To describe variation across selected US children's hospitals in screening for occult fractures in children <2 years old diagnosed with physical abuse and in infants <1 year old who have injuries associated with a high likelihood of physical abuse. METHODS: We performed a retrospective study of children <2 years old with a diagnosis of physical abuse and infants <1 year old with non-motor vehicle crash-associated traumatic brain injuries or femur fractures admitted to 40 hospitals within the Pediatric Hospital Information System database from January 1, 1999, to December 31, 2009. We examined variation among the hospitals in the performance of screening for occult fractures as defined by receipt of skeletal survey or radionuclide bone scan. Marginal standardization implemented with logistic regression analysis was used to examine hospital variation after adjusting for patient demographic characteristics, injury severity, and year of admission. RESULTS: Screening for occult fractures was performed in 83% of the 10 170 children <2 years old with a diagnosis of physical abuse, 68% of the 9942 infants who had a traumatic brain injury, and 77% of the 2975 infants who had femur fractures. After adjustment for patient characteristics, injury severity, and year of admission, hospitals varied significantly in use of screening for occult fractures in all 3 groups of children. CONCLUSIONS: The observed variation in screening for occult fractures in young victims of physical abuse and infants who have injuries associated with a high likelihood of abuse underscores opportunities to improve the quality of care provided to this vulnerable population.
机译：目的：描述各美国儿童医院在筛查诊断为遭受身体虐待的＜2岁的儿童和＜1岁的婴儿中遭受与肢体虐待相关的伤害的隐匿性骨折的变化。方法：我们对儿科医院信息系统数据库中的40所医院接受诊断为受身体虐待的2岁以下儿童和非机动车碰撞相关的颅脑外伤或股骨骨折的1岁以下婴儿进行了回顾性研究。从1999年1月1日至2009年12月31日。我们检查了各医院之间的隐匿性骨折筛查性能的差异，这些特征是通过接受骨骼检查或放射性核素骨扫描确定的。在调整患者的人口统计学特征，损伤严重程度和入院时间后，采用逻辑回归分析进行的边际标准化用于检查医院的差异。结果：筛查隐匿性骨折的发生率是在10170名2岁以下被诊断为身体虐待的儿童中，有83％，68％的9942名患有颅脑外伤的婴儿和77％的2975例患有股骨的婴儿骨折。在根据患者特征，损伤严重程度和入院年份进行调整后，医院对所有3组儿童的隐匿性骨折进行筛查的方法差异很大。结论：在年轻的身体虐待受害者和因虐待可能性高而受伤的婴儿中，隐匿性骨折的筛查结果存在差异，这突显了改善为这一弱势群体提供医疗服务质量的机会。

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