在一家三级儿科医院的急诊室过度拥挤和儿童身体虐待评估
H Michelle Greene1, Sara Helwig2, Becca Fredin3
1Division of Emergency Medicine, Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Division of Child Abuse Pediatrics, Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Child abuse & neglect
|November 5, 2025
概括
紧急部门的过度拥挤与较少的儿童虐待案件有关. 标准化评估可能有助于在繁忙时期发现滥用.
科学领域:
- 儿科急救医学 儿科急救医学
- 儿童虐待的认可儿童虐待的认可
- 医疗保健管理的管理
背景情况:
- 紧急服务室 (ED) 过度拥挤可能会损害患者护理质量.
- 在过度拥挤的EDS中时间有限可能会阻碍儿童身体虐待的识别.
- 在繁忙的ED环境中,虐待性伤害的儿科患者可能被诊断不足.
研究的目的:
- 调查急救部门过度拥挤和儿童虐待问题的识别之间的相关性.
- 分析ED拥挤指标如何影响涉嫌虐待儿童的报告和咨询率.
主要方法:
- 从2019年1月1日到2023年6月30日的儿科ED遭遇的回顾性图表审查.
- 对ED过度拥挤指标 (mNEDOCS,停留时间,LWBS率,患者数量) 与儿童保护服务 (CPS) 报告,骨调查 (SS) 和儿童保护团队 (CPT) 咨询18岁以下儿童的比率进行比较.
- 分析包括了310,512个ED遭遇.
主要成果:
- 增加ED过度拥挤显示出与涉及CPS报告,SS和CPT咨询的ED访问比例的负相关性 (rho -0.1至 -0.21,p > 0.001).
- 在最高和最低的过度拥挤四分位数之间没有观察到患者年龄或情绪的显著差异.
- 在COVID-19期间,ED数量较低,但儿童虐待问题访问比例较高.
结论:
- 更高的ED拥挤与已确定的儿童虐待案件的比例减少有关,这表明在高峰时段潜在的诊断不足.
- 建议在ED中标准化身体虐待评估,以减轻变异性,并在过度拥挤期间改善检测.
- 这凸显了需要进行系统改进,以确保在高容量ED期间不会错过虐待儿童的情况.
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