Reports of Maltreatment in a Children's Hospital: Evaluation of the Epidemiological Profile and Its Relationship with the Outcome in Fractures
Notificações de maus-tratos em um hospital infantil: Avaliação do perfil epidemiológico e sua relação com o desfecho em fraturas
Rev. Bras. Ortop. (Online); 59 (2), 2024
Publication year: 2024
Abstract Objective To describe suspected/confirmed cases of child maltreatment related to fractures in a pediatric hospital in southern Brazil. Method Study of the Information System of Notifiable Diseases notifications and the victims' medical records between January/2016 and December/2020. Variables related to the victim, the perpetrator, the type of abuse, the presence of fractures, and their anatomical location and death were evaluated. Logistic regression was performed to identify fracture-related variables, adjusted for sex and age. The results were expressed in odds ratios and their respective 95% confidence intervals. It was considered significant p < 0.05. Results There were 276 cases, 73 infants (26.4%), male predominance (151, 54.7%), with authorship of the mistreatment by relatives (245, 96,0%), 85 (31,5%), they presented fractures, with five deaths (1.9%).
Factors related to the presence of fracture:
age of the victim (less than two years old; n = 82; or 2.48; 95% CI: 1.45 - 4.25), having more than two aggressors involved (n = 144; or 2.09; 95% CI: 1.16-3.75), the medium being traffic/automobile accident, (n = 52; or 2.65; 95% CI: 1.04-6.75), consult an orthopedist (n = 91; or 6.77 / 95% CI: 3.66-12.51), and the need for surgical intervention (n = 15; OR 36.72; 95% CI: 8.22-164.03). Conclusions The importance of suspicion, early identification of aggression, and the correct completion of notifications for activating the system of guaranteeing rights and removal of the aggressor was emphasized.
Resumo Objetivo Descrever os casos suspeitos/confirmados de maus-tratos infantis relacionados a fraturas, atendidos em um hospital pediátrico no Sul do Brasil. Método Estudo das notificações do Sistema de Informação de Agravos de Notificação e dos prontuários das vítimas, entre janeiro/2016 e dezembro/2020. Avaliadas variáveis relacionadas à vítima, ao autor, à tipologia de maus-tratos, à presença de fraturas e sua localização anatômica e óbito. Regressão logística foi realizada para identificar as variáveis relacionadas à fratura, ajustada para sexo e idade, expressa em razão de chance e seus respectivos intervalos de confiança de 95%. Foi considerado significativo p < 0.05. Resultados Houve 276 casos, 73 lactentes (26,4%), predomínio do sexo masculino (151, 54,7%), com autoria dos maus-tratos por parentes (245, 96,0%), 85 (31,5%), apresentaram fraturas, sendo cinco óbitos (1,9%).