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2017 ; 96
(23
): e7107
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Epidemiology and clinical analysis of critical patients with child maltreatment
admitted to the intensive care units
#MMPMID28591056
Lee EP
; Hsia SH
; Huang JL
; Lin JJ
; Chan OW
; Lin CY
; Lin KL
; Chang YC
; Chou IJ
; Lo FS
; Lee J
; Hsin YC
; Chan PC
; Hu MH
; Chiu CH
; Wu HP
Medicine (Baltimore)
2017[Jun]; 96
(23
): e7107
PMID28591056
show ga
Children with abuse who are admitted to the intensive care unit (ICU) may have
high mortality and morbidity and commonly require critical care immediately. It
is important to understand the epidemiology and clinical characteristics of these
critical cases of child maltreatment.We retrospectively evaluated the data for
355 children with maltreatments admitted to the ICU between 2001 and 2015.
Clinical factors were analyzed and compared between the abuse and the neglect
groups, including age, gender, season of admission, identifying settings, injury
severity score (ISS), etiologies, length of stay (LOS) in the ICU, clinical
outcomes, and mortality. In addition, neurologic assessments were conducted with
the Pediatric Cerebral Performance Category (PCPC) scale.The most common type of
child maltreatments was neglect (n?=?259), followed by physical abuse (n?=?96).
The mean age of the abuse group was less than that of the neglect group
(P?.05). Infants accounted for the majority of the abuse group, and the most
common etiology of abuse was injury of the central nervous system (CNS). In the
neglect group, most were of the preschool age and the most common etiologies of
abuse were injury of the CNS and musculoskeletal system (P?.001). The mortality
rate in the ICU was 9.86%. The ISS was significantly associated with mortality in
both the 2 groups (both P?.05), whereas the LOS in the ICU and injuries of the
CNS, musculoskeletal system, and respiratory system were all associated with
mortality in the neglect group (all P?.05). The PCPC scale showed poor
prognosis in the abuse group as compared to the neglect group (P?.01).In the
ICU, children in the abuse group had younger age, higher ISS, and worse
neurologic outcome than those in the neglect group. The ISS was a predictor for
mortality in the abuse and neglect groups but the LOS in the ICUs, injuries of
the CNS, musculoskeletal system, and respiratory system were indicators for
mortality in the neglect group. Most importantly, identifying the epidemiological
information may provide further strategies to reduce the harm, lower the medical
costs, and improve clinical care quality and outcomes in children with abuse.