Medical diagnoses among infants at entry in out-of-home care: A Swedish population-register study.
evidence‐based practice
infant welfare
medical errors
out‐of‐home care
shaken baby syndrome
Journal
Health science reports
ISSN: 2398-8835
Titre abrégé: Health Sci Rep
Pays: United States
ID NLM: 101728855
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
04
02
2019
revised:
10
04
2019
accepted:
17
05
2019
entrez:
30
8
2019
pubmed:
30
8
2019
medline:
30
8
2019
Statut:
epublish
Résumé
Identification of child abuse involves a medical investigation and assessment of problems related to social environment and upbringing and might necessitate out-of-home care. The objective of this study was to analyse infants placed in out-of-home care in Sweden by incidence, medical diagnoses, and perinatal factors. This was a population-based register study of infants born in Sweden 1997 to 2014. Data were retrieved from registers at the Swedish National Board of Health and Welfare and Statistics Sweden. Outcome measures were out-of-home care categories: (a) "Problems Related to Social Environment/Upbringing", (b) "Abuse diagnoses without SDH (subdural haemorrhage), RH (retinal haemorrhage), rib fracture, or long bone fracture", and (c) "SDH, RH, rib fracture, or long bone fracture." As a reference population, we randomly selected infants without medical diagnoses born the same year. Overall incidence of out-of-home care was 402 per 100 000. For subcategories (a), (b), and (c), the incidences were 14.8 (n = 273), 3.77 (n = 70), and 9.83 (n = 182) per 100 000, respectively. During the study period, the first remained unchanged; the latter two have been increasing. Compared with other reasons for out-of-home care, children in category (c), "SDH, RH, rib fracture, or long bone fracture", had increased odds of being boys (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI], 1.08-2.38) and decreased odds of having a mother being single (aOR 0.49; 95% CI, 0.32-0.75) and a smoker (aOR 0.60; 95% CI, 0.37-0.96). Compared with the reference population, children in this category were more often twin born (7.7% versus 2.8%), preterm (18.5% versus 5.5%), and small-for-gestational age (5.2% versus 2.1%). SDH, RH, rib fracture, or long bone fracture constitute a minor part of medical diagnoses for infants entered in out-of-home care, but have been increasing, both in numbers and proportion. Overdiagnosis of abuse might be a possible reason but cannot be ascertained by this study design.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Identification of child abuse involves a medical investigation and assessment of problems related to social environment and upbringing and might necessitate out-of-home care. The objective of this study was to analyse infants placed in out-of-home care in Sweden by incidence, medical diagnoses, and perinatal factors.
METHODS
METHODS
This was a population-based register study of infants born in Sweden 1997 to 2014. Data were retrieved from registers at the Swedish National Board of Health and Welfare and Statistics Sweden. Outcome measures were out-of-home care categories: (a) "Problems Related to Social Environment/Upbringing", (b) "Abuse diagnoses without SDH (subdural haemorrhage), RH (retinal haemorrhage), rib fracture, or long bone fracture", and (c) "SDH, RH, rib fracture, or long bone fracture." As a reference population, we randomly selected infants without medical diagnoses born the same year.
RESULTS
RESULTS
Overall incidence of out-of-home care was 402 per 100 000. For subcategories (a), (b), and (c), the incidences were 14.8 (n = 273), 3.77 (n = 70), and 9.83 (n = 182) per 100 000, respectively. During the study period, the first remained unchanged; the latter two have been increasing. Compared with other reasons for out-of-home care, children in category (c), "SDH, RH, rib fracture, or long bone fracture", had increased odds of being boys (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI], 1.08-2.38) and decreased odds of having a mother being single (aOR 0.49; 95% CI, 0.32-0.75) and a smoker (aOR 0.60; 95% CI, 0.37-0.96). Compared with the reference population, children in this category were more often twin born (7.7% versus 2.8%), preterm (18.5% versus 5.5%), and small-for-gestational age (5.2% versus 2.1%).
CONCLUSION
CONCLUSIONS
SDH, RH, rib fracture, or long bone fracture constitute a minor part of medical diagnoses for infants entered in out-of-home care, but have been increasing, both in numbers and proportion. Overdiagnosis of abuse might be a possible reason but cannot be ascertained by this study design.
Identifiants
pubmed: 31463369
doi: 10.1002/hsr2.133
pii: HSR2133
pmc: PMC6707026
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e133Déclaration de conflit d'intérêts
None declared.
Références
Int J Equity Health. 2017 Jul 27;16(1):135
pubmed: 28747194
Pediatrics. 2015 May;135(5):e1337-54
pubmed: 25917988
Pediatrics. 2014 Feb;133(2):e477-89
pubmed: 24470642
Lancet. 2012 Feb 25;379(9817):758-72
pubmed: 22169108
Arch Dis Child. 2018 Jul;103(7):714
pubmed: 29728419
Pediatr Radiol. 2017 Oct;47(11):1386-1389
pubmed: 28785782
Pediatrics. 2017 Nov;140(5):
pubmed: 29074609
Acta Obstet Gynecol Scand. 2009;88(5):575-83
pubmed: 19330564
Arch Dis Child. 2019 Nov;104(11):1122
pubmed: 31164377
Pediatr Radiol. 2018 Feb;48(2):284-286
pubmed: 29058040
J Trauma. 2003 Jun;54(6):1107-10
pubmed: 12813330
Lancet. 2018 May 19;391(10134):2008-2018
pubmed: 29731173
Arch Dis Child. 2018 Jun;103(6):606-610
pubmed: 29510999
Child Abuse Negl. 2018 Feb;76:237-249
pubmed: 29154020
Child Abuse Negl. 2006 May;30(5):497-522
pubmed: 16701895
Pediatr Emerg Care. 2019 Feb;35(2):96-103
pubmed: 27749806
Pediatr Radiol. 2019 Mar;49(3):422-423
pubmed: 30783699
Arch Dis Child. 2009 Nov;94(11):860-7
pubmed: 19531526
Pediatr Radiol. 2018 Aug;48(8):1048-1065
pubmed: 29796797
Eur J Public Health. 2018 Aug 1;28(4):641-646
pubmed: 29672696
Childs Nerv Syst. 2010 May;26(5):637-45
pubmed: 19946688
Radiol Clin North Am. 2011 Jan;49(1):205-29
pubmed: 21111136
Health Sci Rep. 2019 Jul 18;2(8):e133
pubmed: 31463369
Pediatrics. 2011 Sep;128(3):e550-64
pubmed: 21844052
PLoS One. 2018 Oct 31;13(10):e0206340
pubmed: 30379890
Pediatr Radiol. 2019 Mar;49(3):424-428
pubmed: 30783700
Child Abuse Negl. 1998 Sep;22(9):931-7
pubmed: 9777262
PLoS One. 2018 Dec 19;13(12):e0208033
pubmed: 30566429
Forensic Sci Int. 2009 May 30;187(1-3):6-13
pubmed: 19303229
Pediatr Emerg Care. 2020 Jul;36(7):e426
pubmed: 30964848
J Epidemiol. 2020 Jun 5;30(6):276-277
pubmed: 31178472
Acta Paediatr. 2018 Sep;107 Suppl 472:3-23
pubmed: 30146789
Paediatr Perinat Epidemiol. 2006 May;20(3):182-7
pubmed: 16629692
Child Abuse Negl. 2016 Sep;59:78-87
pubmed: 27521764
Acta Paediatr. 1995 Apr;84(4):447-52
pubmed: 7795358
West J Emerg Med. 2011 May;12(2):144-58
pubmed: 21691518
Pediatrics. 1992 Aug;90(2 Pt 1):179-85
pubmed: 1641278
BMC Public Health. 2011 Jun 09;11:450
pubmed: 21658213
Child Abuse Negl. 2015 Apr;42:63-71
pubmed: 25455962
Pediatr Radiol. 2014 Dec;44 Suppl 4:S647-53
pubmed: 25501737
Arch Dis Child. 1997 May;76(5):393-6; discussion 396-7
pubmed: 9196352