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Diagnostic testing for and detection of physical abuse in infants with brief resolved unexplained events
Child Abuse & Neglect ( IF 4.863 ) Pub Date : 2022-11-21 , DOI: 10.1016/j.chiabu.2022.105952
Angela Doswell 1 , James Anderst 2 , Joel S Tieder 3 , Bruce E Herman 4 , Matt Hall 5 , Victoria Wilkins 6 , Miguel L Knochel 6 , Ron Kaplan 7 , Adam Cohen 8 , Amy M DeLaroche 9 , Beth Harper 10 , Manoj K Mittal 11 , Nirav Shastri 12 , Melanie Prusakowski 13 , Henry T Puls 14 ,
Affiliation  

Background

A Brief Resolved Unexplained Event (BRUE) can be a sign of occult physical abuse.

Objectives

To identify rates of diagnostic testing able to detect physical abuse (head imaging, skeletal survey, and liver transaminases) at BRUE presentation. The secondary objective was to estimate the rate of physical abuse diagnosed at initial BRUE presentation through 1 year of age.

Participants and setting

Infants who presented with a BRUE at one of 15 academic or community hospitals were followed from initial BRUE presentation until 1 year of age for BRUE recurrence or revisits.

Methods

This study was part of the BRUE Research and Quality Improvement Network, a multicenter retrospective cohort examining infants with BRUE. Generalized estimating equations assessed associations with performance of diagnostic testing (adjusted odds ratio (aOR)).

Results

Of the 2036 infants presenting with a BRUE, 6.2 % underwent head imaging, 7.0 % skeletal survey, and 12.1 % liver transaminases. Infants were more likely to undergo skeletal survey if there were physical examination findings concerning for trauma (aOR 8.23, 95 % CI [1.92, 35.24], p < 0.005) or concerning social history (aOR 1.89, 95 % CI [1.13, 3.16], p = 0.015). There were 7 (0.3 %) infants diagnosed with physical abuse: one at BRUE presentation, one <3 days after BRUE presentation, and five >30 days after BRUE presentation.

Conclusion

There were low rates of diagnostic testing and physical abuse identified in infants presenting with BRUE. Further study including standardized testing protocols is warranted to identify physical abuse in infants presenting with a BRUE.



中文翻译:

对具有短暂解决的不明原因事件的婴儿进行身体虐待的诊断测试和检测

背景

Brief Resolved Unexplained Event (BRUE) 可能是神秘的身体虐待的迹象。

目标

确定在 BRUE 就诊时能够检测身体虐待(头部成像、骨骼检查和肝转氨酶)的诊断测试的比率。次要目标是估计在 BRUE 初始表现到 1 岁期间诊断出的身体虐待率。

参与者和设置

在 15 家学术或社区医院之一出现 BRUE 的婴儿从最初的 BRUE 出现到 1 岁时被随访,以了解 BRUE 复发或再次访问。

方法

这项研究是 BRUE 研究和质量改进网络的一部分,该网络是一个多中心回顾性队列研究,检查患有 BRUE 的婴儿。广义估计方程评估了与诊断测试性能的关联(调整后的比值比 (aOR))。

结果

在 2036 名出现 BRUE 的婴儿中,6.2% 接受了头部成像,7.0% 接受了骨骼检查,12.1% 接受了肝转氨酶检查。如果体格检查结果与外伤有关(aOR 8.23,95% CI [1.92,35.24], p  < 0.005)或与社会史有关(aOR 1.89,95% CI [1.13,3.16]),则婴儿更有可能接受骨骼检查, p  = 0.015)。有 7 名 (0.3%) 婴儿被诊断患有身体虐待:一名在 BRUE 出现时,一名在 BRUE 出现后 <3 天,五名在 BRUE 出现后 >30 天。

结论

在患有 BRUE 的婴儿中发现的诊断测试和身体虐待的发生率很低。需要包括标准化测试方案在内的进一步研究,以确定出现 BRUE 的婴儿的身体虐待情况。

更新日期:2022-11-22
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