The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming.
Retrospective chart review conducted on all children 0-17 years admitted to the Children's Hospital of Eastern Ontario (CHEO) between April 1, 1996, and March 31, 2000, following acute trauma. Each record was reviewed and assigned an ISS using the AIS 1990 revision. All cases with an ISS > 11 were included in the study.
There were 2610 trauma cases admitted to CHEO over the study period. Of these, 237 (9.1%) had severe trauma (ISS > 11). Sixty-two percent were male. Twenty-nine percent were between the ages of 10 and 14 years, 27% between 5 and 9 years, 16% between 15 and 17 years, 15% between 1 and 4 years, and 13% less than 1 year old. The most common mechanisms of injury were due to motor vehicle traffic (39%), falls (24%), child abuse (8%), and sports (5%). Of those resulting from motor vehicle traffic, 53 (57%) were occupants, 22 (24%) were pedestrians, and 18 (19%) were cyclists. When combining traffic and nontraffic mechanisms, 26 (11% of all severe trauma cases) occurred as a result of cycling incidents. The most severe injury in 65% of patients was to the head and neck body region.
Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse.
The rate at which children are maltreated is one of the most sensitive measures of demographic, social, and economic conditions. Although the consequences of maltreatment and the effectiveness of treatment programs in reducing the incidence have been extensively studied, little attention has been given to identifying spatial variations in maltreatment in terms of characteristics of areas, especially demographic, social or economical. Maltreatment may differ markedly in terms of an area's socio-demographic and economic makeup and this phenomenon needs to be studied in a structural context. This study employs an ecological perspective to predict variations in the rate of maltreatment (including neglect and abuse) among children aged 0 to 19 years in Alberta, Canada in 1986. Several hypotheses are tested in a multivariate framework and the implications of the findings in assessing the effectiveness of intervention strategies are briefly discussed.
While child welfare policy and legislation reflects that children who are exposed to domestic violence are in need of protection because they are at risk of emotional and physical harm, little is known about the profile of families and children identified to the child welfare system and the system's response. The objective of this study was to examine the child welfare system's response to child maltreatment investigations substantiated for exposure to domestic violence (EDV).
This study is based on a secondary analysis of data collected in the 2003 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003). Bivariate analyses were conducted on substantiated investigations. A binary logistic regression was also conducted to attempt to predict child welfare placements for investigations involving EDV.
What emerges from this study is that the child welfare system's response to EDV largely depends on whether it occurs in isolation or with another substantiated form of child maltreatment. For example, children involved in substantiated investigations that involve EDV with another form of substantiated maltreatment are almost four times more likely than investigations involving only EDV to be placed in a child welfare setting (Adjusted Odds Ratio=3.87, p
Self-reported data from 375 early and mid-adolescent school children in a Siberian city estimated a prevalence of child abuse at 28.9%. Of these children, 3.8% suffered injuries that required medical attention. This prevalence of child abuse indicates the need for additional research and development of a system to identify and manage child abuse in Russia.
We explored trends in six developed countries in three types of indicators of child maltreatment for children younger than 11 years, since the inception of modern child protection systems in the 1970s. Despite several policy initiatives for child protection, we recorded no consistent evidence for a decrease in all types of indicators of child maltreatment. We noted falling rates of violent death in a few age and country groups, but these decreases coincided with reductions in admissions to hospital for maltreatment-related injury only in Sweden and Manitoba (Canada). One or more child protection agency indicators increased in five of six countries, particularly in infants, possibly as a result of early intervention policies. Comparisons of mean rates between countries showed five-fold to ten-fold differences in rates of agency indicators, but less than two-fold variation in violent deaths or maltreatment-related injury, apart from high rates of violent child death in the USA. These analyses draw attention to the need for robust research to establish whether the high and rising rates of agency contacts and out-of-home care in some settings are effectively reducing child maltreatment.
Comment In: Lancet. 2012 Jun 2;379(9831):2048; author reply 204922656878
Comment In: Lancet. 2012 Jun 2;379(9831):2048-9; author reply 204922656877
The fact that most etiological studies of physical abuse have not taken into account co-occurrence of different forms of maltreatment calls into question the validity of our knowledge on the subject. The aim of this study, therefore, is to compare the etiological patterns of cases of physical abuse reported to Quebec child protective services (CPS) according to whether the abuse occurs alone or co-occurs with other forms of maltreatment. The data are taken from the Quebec Incidence Study (QIS), which examined 4,929 reports investigated by Quebec CPS in the fall of 1998. The cases included 514 children who were physically abused: 269 of them were not subjected to any other type of maltreatment and 245 were also victims of one or two other forms of maltreatment. The survey form provided information on more than 30 characteristics of the children reported, their families, and their parental figures. Bivariate and direct logistic regression analyses revealed that the profile of physical abuse cases varies depending on whether the physical abuse occurs alone (what we are calling dysnormality) or in combination with one or two other forms of maltreatment (dysfunctionality). Those results will help deepen our etiological knowledge of physical abuse and may serve to inspire different types of intervention for the two groups of children.
OBJECTIVES: At 6 sites serving 21 communities, Alaska implemented Healthy Families Alaska, a home visitation program using paraprofessionals designed to decrease child abuse and neglect. The primary study objective was to compare changes over time in Child Protective Services outcomes by Healthy Families Alaska enrollment status. METHODS: Enrollment status was linked to birth certificates for birth years 1996-2002 which in turn was linked to the Alaska Child Protective Services database for outcome years 1996-2004. All children were followed through the study databases until age 2 years. RESULTS: There were 40,099 children born during 1996-2002 to residents of Healthy Families Alaska communities and 985 were enrolled in the program. Physical abuse referrals among enrolled children decreased from 73 to 42 per 1000 child-years of follow-up from 1996-1998 to 2000-2002 (p=.005); all of this decrease occurred among children who received 20 or more home visitations. This decrease may have been unrelated to program impact as a similar decrease in referral was seen among unenrolled high-risk children. Compared to unenrolled high-risk children, enrolled children had a modest decrease in the proportion with substantiated neglect but no difference in the proportion with neglect referral or physical abuse referral or substantiation. CONCLUSIONS: Little evidence exists that Alaska's home visitation program had a measurable impact on child maltreatment outcomes. PRACTICE IMPLICATIONS: Within Alaskan communities that had a home visitation program targeting families at high risk for child abuse, changes in Child Protective Services outcomes among children less than 2 years of age were followed over time by program enrollment status. Enrollment was associated with a substantial decrease in physical abuse referrals, but a similar decrease was seen among unenrolled high-risk children. No improvement was seen in physical abuse substantiation. A greater number of home visitations was not associated with fewer abuse outcomes. This work supports most of the recent literature, which questions the field effectiveness of home visitation programs. In combination with other studies, the current work may lead decision-makers and funding agencies to re-examine the usefulness of home visitation programs, particularly those using a methodology similar to that implemented in Alaska.