Child Maltreatment Evaluations Following Out-of-Hospital Cardiac Arrests

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics Pub Date : 2025-01-09 DOI:10.1016/j.acap.2025.102777

Sabrina M. Darwiche MD, MPH , Cindy W. Christian MD , Cody-Aaron L. Gathers MD, MSHP , Ryan W. Morgan MD, MTR , Maryam Y. Naim MD, MSCE , Joanne N. Wood MD, MSHP

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引用次数: 0

Abstract

Objective

In children admitted after an out-of-hospital cardiac arrest (OHCA), this study 1) determines the proportion that undergo physical abuse and toxin exposure evaluation, child protection team (CPT) consultation, and child protective services (CPS) referral, and 2) evaluates the association between demographic, social, clinical characteristics with CPT consultation and CPS referral.

Methods

A retrospective chart review was conducted of children <4 years old admitted following an OHCA between November 2012 and February 2023. Associations between demographics, caregiver social risk factors, and clinical characteristics with CPT consultation and CPS referral were examined using logistic regression.

Results

Among 157 cases, 70 (45%) had skeletal surveys; 8 (11%) identified an occult fracture. Seventy-five (48%) children had toxicology testing; 16 of the 75 (21%) revealed a toxic ingestion. Sixteen of the 49 (33%) patients receiving ophthalmologic evaluations had significant retinal hemorrhages. Seventy-seven (49%) patients had a CPT consultation, while 74 (47%) were referred to CPS. A history concerning for ingestion perfectly predicted CPT consultation. History of ingestion, injury on exam, positive skeletal survey, and positive toxicology testing perfectly predicted CPS referral. In multivariate analyses, unsafe sleep history (84% versus 41%, P < 0.001) and caregiver social risk factors (82% versus 31%, P < 0.001) were associated with CPT consultation, while caregiver social risk factors (70% versus 34%, P < 0.001) and normal medical work-up (53% versus 38%, P = 0.050) were associated with CPS referral.

Conclusions

Following OHCA, a child maltreatment evaluation may be underutilized with medical decision-making around CPT consultation and CPS referral driven by knowledge of caregiver social risk factors.

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院外心脏骤停后的儿童虐待评估

目的：在院外心脏骤停（OHCA）后入院的儿童中，本研究1)确定接受身体虐待和毒素暴露评估、儿童保护小组（CPT）咨询和儿童保护服务（CPS）转诊的比例，2)评估人口统计学、社会、临床特征与CPT咨询和CPS转诊之间的关系。方法：回顾性分析2012年11月至2023年2月间接受OHCA治疗的< 4岁儿童。人口统计学、护理者社会危险因素和临床特征与CPT咨询和CPS转诊之间的关系采用logistic回归进行检验。结果：157例患者中有70例（45%）进行了骨骼调查；8例（11%）发现隐匿性骨折。75名（48%）儿童进行了毒理学检测；75例患者中有16例（21%）出现中毒。49例接受眼科检查的患者中有16例（33%）有明显的视网膜出血。77例（49%）患者进行了CPT咨询，而74例（47%）患者转介到CPS。关于摄入的病史完全可以预测CPT咨询。进食史，检查损伤，骨骼调查阳性，毒理学检测阳性，完美预测CPS转诊。在多变量分析中，不安全睡眠史（84%对41%）结论：在OHCA之后，在看护人社会风险因素的驱动下，围绕CPT咨询和CPS转诊的医疗决策中，儿童虐待评估可能未得到充分利用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Pediatrics PEDIATRICS-

CiteScore

4.60

自引率

12.90%

发文量

300

审稿时长

60 days

期刊介绍： Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.