Epidemiology and clinical analysis of critical patients with child maltreatment admitted to the intensive care units

Abstract

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.

Clinical diagnosis and treatment of pediatric anti‑N‑methyl‑D‑aspartate receptor encephalitis: A single center retrospective study

“…In addition, the second-line treatment was also combined with plasma replacement or cyclophosphamide treatment (17). Follow-up was performed every 4 months (with the longest follow-up period lasting for 2 years), in which the patients were evaluated via the PCPC system and a score ≥3 indicated poor prognosis (16,18).…”

Clinical role of low hemoglobin ratio in poor neurologic outcomes in infants with traumatic intracranial hemorrhage

“…Infants with TBI are often complicated with intracranial hemorrhage (ICH) due to high vascularization and physiologically more immature brains, which can cause anemia resulting in cerebral ischemic damage. In addition, the survivors of infant TBI frequently suffer from long-term poor neurologic outcomes 3,4 .…”

Traumatization and Trauma Cases: Childhood Adversity and Deafness

“…Child abuse or non-accidental trauma amongst children persists as a US-national disgrace and disease-epidemic endowing permanent health hazards effects when left untreated an undiscovered in the clinical setting; to this purpose the higher levels of prevalence of non-accidental child trauma at American College of Surgeons' verified Pediatric Trauma Centers offer evidence of increasingly greater measures of trauma among pediatric trauma patients as the result of more comprehensive experience and training of clinicians [12]. It must be considered that children with abuse who are admitted to the intensive care units may present high mortality and morbidity with commonly required immediate critical care; among neglected and abused children mortality rates reached 9.86%, a frightening statistic [13]. Childhood trauma has been found to provide the origin for multiple expressions of psychopathology [14][15][16].…”