Background

Children with abusive injuries have worse mortality, length-of-stay, complications, and healthcare costs compared to those sustaining an accidental injury. Long-term functional impairment is common in children with abusive head trauma but has not been examined in a cohort with heterogeneous body region injuries.

Objective

To assess for an independent association between child physical abuse and functional impairment at discharge and six-month follow-up.

Participants and setting

Seriously injured children (<15 years) treated at seven pediatric trauma centers.

Methods

Functional status was compared between child physical abuse and accidental injury groups at discharge and six-month follow-up. Functional impairment was defined at discharge (“new domain morbidity”) as a change from pre-injury ≥2 points in any of the six domains of the Functional Status Scale (FSS), and impairment at six-month follow-up as an abnormal total FSS score.

Results

Children with abusive injuries accounted for 10.5% (n = 45) of the cohort. New domain morbidity was present in 17.8% (n = 8) of child physical abuse patients at discharge, with 10% (n = 3) of children having an abnormal FSS at six-months. There were no differences in new domain morbidity at hospital discharge between children injured by abuse and or accidental injury. However, children injured by physical abuse were 4.09 (2.15, 7.78) times more likely to have functional impairment at six months.

Conclusions

Child physical abuse is an independent risk factor for functional impairment at six-month follow-up. Functional status measurement for this high-risk group of children should be routinely measured and incorporated into trauma center quality assessments.

中文翻译：

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六个月随访时的功能状态损伤与儿童身体虐待机制独立相关

 背景

与遭受意外伤害的儿童相比，遭受虐待的儿童的死亡率、住院时间、并发症和医疗费用更高。长期功能障碍在头部受虐待的儿童中很常见，但尚未在异质身体区域损伤的队列中进行检查。

 客观的

评估出院时和六个月随访期间儿童身体虐待与功能障碍之间的独立关联。

 参加者及设置

严重受伤的儿童（<15 岁）在七个儿科创伤中心接受治疗。

 方法

在出院时和六个月的随访中比较儿童身体虐待组和意外伤害组的功能状态。出院时的功能障碍（“新领域发病率”）被定义为功能状态量表（FSS）六个领域中任何一个领域与受伤前相比发生≥2分的变化，六个月随访时的功能障碍被定义为异常FSS 总分。

 结果

遭受虐待的儿童占该群体的 10.5% (n = 45)。出院时 17.8% (n = 8) 的儿童身体虐待患者存在新领域发病率，其中 10% (n = 3) 的儿童在六个月时出现异常 FSS。因虐待和/或意外伤害而受伤的儿童出院时的新领域发病率没有差异。然而，遭受身体虐待的儿童在六个月时出现功能障碍的可能性是其 4.09（2.15，7.78）倍。

 结论

六个月随访时，儿童身体虐待是功能障碍的独立危险因素。应定期测量这一高危儿童群体的功能状态测量并将其纳入创伤中心质量评估中。