Objective: 

Child abuse is a major cause of childhood injury, morbidity, and death. There is a paucity of data on the practice of abuse interventions among this vulnerable population. The aim of our study was to identify the factors associated with interventions for child abuse on a national scale.

Methods: 

Retrospective analysis of 2017 to 2018 American College of Surgeons (ACS) Pediatric Trauma Quality Improvement Program (TQIP). All children presenting with suspected/confirmed child abuse and an abuse report filed were included. Patients with missing information regarding abuse interventions were excluded. Outcomes were abuse investigations initiated among those with abuse reports, and change of caregiver at discharge among survivors with an investigation initiated. Multivariable regression analyses were performed.

Results: 

A total of 7774 child abuse victims with an abuse report were identified. The mean age was 5±5 years, 4221 (54%) patients were White, 2297 (30%) Black, 1543 (20%) Hispanic, and 5298 (68%) had government insurance. The most common mechanism was blunt (63%), followed by burns (10%) and penetrating (10%). The median Injury Severity Score was 5 (1–12). The most common form of abuse was physical (92%), followed by neglect (6%), sexual (3%), and psychological (0.1%). The most common perpetrator of abuse was a care provider/teacher (49.5%), followed by a member of the immediate family (30.5%), or a member of the extended/step/foster family (20.0%). Overall, 6377 (82%) abuse investigations were initiated for those with abuse reports. Of these, 1967 (33%) resulted in a change of caregiver. Black children were more likely to have abuse investigated, and Black and Hispanic children were more likely to experience change of caregiver after investigations, while privately insured children were less likely to experience both.

Conclusions: 

Significant racial, ethnic, and socioeconomic disparities exist in the nationwide management of child abuse. Further studies are strongly warranted to understand contributing factors and possible strategies to address them.

Level of Evidence: 

Level III—therapeutic/care management.

中文翻译：

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虐待儿童创伤的全国性管理：探索种族、民族和社会经济差异

客观的： 

虐待儿童是儿童受伤、发病和死亡的主要原因。关于在这一弱势群体中实施虐待干预的数据很少。我们研究的目的是在全国范围内确定与虐待儿童干预措施相关的因素。

方法： 

2017 年至 2018 年美国外科学院 (ACS) 儿科创伤质量改进计划 (TQIP) 的回顾性分析。包括所有出现疑似/确认虐待儿童和提交虐待报告的儿童。缺失有关虐待干预信息的患者被排除在外。结果是在有虐待报告的人中发起虐待调查，以及在发起调查的幸存者中更换护理人员。进行了多变量回归分析。

结果： 

总共确定了 7774 名有虐待报告的虐待儿童受害者。平均年龄为 5±5 岁，4221 名（54%）患者为白人，2297 名（30%）黑人，1543 名（20%）西班牙裔，5298 名（68%）有政府保险。最常见的机制是钝性（63%），其次是烧伤（10%）和穿透性（10%）。受伤严重程度评分中位数为 5 (1-12)。最常见的虐待形式是身体虐待（92%），其次是忽视（6%）、性虐待（3%）和心理虐待（0.1%）。最常见的施虐者是护理人员/教师（49.5%），其次是直系亲属（30.5%）或大家庭/继/寄养家庭成员（20.0%）。总体而言，针对有滥用报告的人发起了 6377 项 (82%) 滥用调查。其中，1967 年 (33%) 导致护理人员更换。黑人儿童更有可能接受虐待调查，

结论： 

在全国范围内对虐待儿童的管理中存在显着的种族、民族和社会经济差异。进一步的研究非常有必要了解促成因素和解决这些问题的可能策略。

证据等级： 

III 级——治疗/护理管理。