PERFIL EPIDEMIOLÓGICO DAS LESÕES EM PACIENTES COM ALTA SUSPEIÇÃO DIAGNÓSTICA DE MAUS TRATOS

Souza, Isaias Silva Ribeiro de; Poncio, Victor Peyneau; Molina, Matheus Giovanni Medina; Perera, Georges Akira Shigekiyo; Cocco, Luiz Fernando; Dobashi, Eiffel Tsuyoshi

doi:10.1590/1413-785220253304e290194

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Original Article/Trauma • Acta Ortop Bras 33 (4) • 2025 • https://doi.org/10.1590/1413-785220253304e290194 linkcopiar

PERFIL EPIDEMIOLÓGICO DAS LESÕES EM PACIENTES COM ALTA SUSPEIÇÃO DIAGNÓSTICA DE MAUS TRATOS

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo: Analisar o perfil epidemiológico de crianças vítimas de maus-tratos atendidas no Hospital Geral de Pirajussara, São Paulo, e investigar as características das lesões associadas.

Métodos: Conduzido um estudo transversal retrospectivo com revisão de prontuários dos pacientes com suspeita de maus-tratos, idade igual ou inferior a 18 anos, entre janeiro de 2012 e dezembro de 2022. Analisaram-se dados sobre sexo, idade, mecanismo de trauma, presença de fraturas e desfecho.

Resultados: Dos 58 prontuários analisados, 50% (n=29) referiam-se a adolescentes. O abuso mais comum foi por força corporal (36,21%, n=21), seguido por trauma direto por objeto (13,79%, n=8). Fraturas foram encontradas em 41,38% dos casos (n=24), com maior frequência em crânio e face (33,33%, n=7). Lesões cerebrais foram mais prevalentes entre as lesões associadas (42,42%, n=14). A maioria dos pacientes (77,59%, n=45) recebeu alta apresentando internação média de 9 dias.

Conclusões: Maus-tratos são prevalentes em crianças menores de 1 ano e adolescentes (13-18 anos). Os padrões de lesões e mecanismos de abuso evidenciam a necessidade de protocolos rigorosos para triagem e manejo. A capacitação contínua e a vigilância são essenciais para a prevenção e intervenção eficaz. Nível de Evidência: III; Estudo Transversal Retrospectivo.

Descritores:
Abuso de Crianças; Maus-Tratos de Menores; Epidemiologia; Agressão; Fraturas Ósseas; Criança

	N (%)
Barueri	1 (1.72)
Carapicuiba	1 (1.72)
Cotia	1 (1.72)
Embu of the Arts	21 (36.21)
Ibiuna	1 (1.72)
Itaberada	1 (1.72)
Itapecerica da Serra	1 (1.72)
Itapevi	1 (1.72)
São Paulo	6 (10.34)
Taboão da Serra	24 (41.38)

		Total	Male	Female
N (%)		58	31 (53.45)	27 (46.55)
Average age (years) (SD)		10.20 (6.55)	9.72 (6.8)	10.75 (6.33)
Min-Max		1 day - 18 years	1 day - 18 years	1 month - 18 years
Division by age group N(%)	< 1 year	12 (20.69)	7 (12.07)	5 (8.62)
	1-6 years	6 (10.34)	4 (6.9)	2 (3.44)
	7-12 years	11 (18.96)	7 (12.07)	4 (6.89)
	13-18 years	29 (50)	13 (22.41)	16 (27.59)
Cases per year N(%)	2015	18 (31.03)	14 (24.14)	4 (6.9)
	2016	12 (20.69)	4 (6.9)	8 (13.79)
	2017	7 (12.07)	4 (6.9)	3 (5.17)
	2018	7 (12.07)	4 (6.9)	3 (5.17)
	2019	4 (6.9)	1 (1.72)	3 (5.17)
	2020	4 (6.9)	1 (1.72)	3 (5.17)
	2021	4 (6.9)	2 (3.45)	2 (3.44)
	2022	2 (3.45)	1 (1.72)	1 (1.72)

					Male		Female		Internation
		N (%)	Min-max	Middle Age (SD)	N (%)	Age Mean (SD)	N (%)	Middle Age (SD)	Yes N(%)	No N(%)	Duration (days) Mean (SD)
		N (%)	Min-max	Middle Age (SD)	N (%)	Age Mean (SD)	N (%)	Middle Age (SD)	Yes N(%)	No N(%)	Duration (days) Mean (SD)
Mechanism of abuse	Abandonment of incapable	2 (3.45)	1 day - 2 months	0.09 (0.12)	2 (3.45)	0.09 (0.12)	0		2 (3.45)	0	3.5 (3.54)
	Sexual abuse	2 (3.45)	14 - 16 years	15 (1.41)	0		2 (3.45)	15 (1.41)	2 (3.45)	0	2.5 (2.12)
	Affecting	1 (1.72)	9 years	9	1 (1.72)	9	0		1 (1.72)	0	7
	Spaning	6 (10.34)	12 - 18 years	15.17 (2.32)	4 (6.9)	14.5 (2.65)	2 (3.45)	16.5 (0.71)	5 (8.62)	1 (1.72)	33.8 (39.19)
	White gun injury	4 (6.9)	13 - 18 years	15.5 (3.54)	1 (1.72)	18	3 (5.17)	16.33 (2.89)	4 (6.9)	0	5 (2.94)
	Fire gun injury	4 (6.9)	5 - 18 years	11.5 (6.95)	3 (5.17)	13.33 (7.23)	1 (1.72)	6	2 (3.45)	2 (3.45)	4 (4.24)
	Body strength	21 (36.21)	1 month - 18 years	10.51 (6.55)	10 (17.24)	9.85 (7.32)	11 (18.97)	11.10 (6.07)	15 (25.86)	6 (10.34)	4.13 (3.44)
	Human bite	1 (1.72)	15 years	15	0		1 (1.72)	15	0	1 (1.72)
	Negligence	2 (3.45)	5 months - 11 years	5.71 (7.48)	1 (1.72)	11	1 (1.72)	0.42	2 (3.45)	0	6 (0)
	Direct Trauma by Object	8 (13.79)	3 - 18 years	10.88 (5.54)	5 (8.62)	9.8 (6.83)	3 (5.17)	12.67 (2.52)	5 (8.62)	3 (5.17)	4 (3.67)
	Fall	5 (8.62)	1 month - 12 years	3.6 (5.12)	3 (5.17)	5.78 (5.87)	2 (3.45)	0.33 (0.35)	5 (8.62)	0	17.8 (19.77)
	No data	3 (5.17)	2 months - 14 years	4.78 (7.98)	1 (1.72)	0.17	2 (3.45)	7.09 (9.78)	1 (1.72)	2 (3.45)	3
Fraud	Yes*	21 (36.21)	1 month - 18 years	9.66 (7.13)	14 (24.14)	9.49 (7.48)	7 (12.07)	10.01 (6.91)	20 (34.48)	1 (1.72)	9.45 (19.54)
	No	34 (58.62)	1 day - 18 years	10.66 (6.28)	15 (25.86)	10.34 (6.28)	19 (32.76)	10.91 (6.44)	21 (36.21)	13 (22.41)	7.14 (10.50)
	No data	3 (5.17)	2 months - 13 years	8.72 (7.41)	2 (3.45)	6.59 (9.07)	1 (1.72)	13	2 (3.45)	1 (1.72)	30.5 (41.72)
*Yes	Hand	4 (19.05)	15 - 17 years	15.5 (1)	3 (14.29)	15.67 (1.15)	1 (4.76)	15	3 (5.17)	1 (1.72)	3 (1)
	Lower members	5 (23.81)	1 month - 17 years	4.85 (7.08)	4 (19.05)	5.56 (7.96)	1 (4.76)	2	5 (8.62)	0	6 (5.15)
	Superior members	5 (23.81)	1 month - 15 years	7.82 (6.59)	1 (4.76)	3	4 (19.05)	9.02 (6.94)	5 (8.62)	0	3.6 (1.67)
	Crane and face	7 (33.33)	4 months - 18 years	9.8 (8.25)	6 (28.57)	8.6 (8.34)	1 (4.76)	17	7 (12.07)	0	16.57 (32.42)
Associated injuries	Yes**	33 (56.9)	1 day - 18 years	9.49 (7.15)	16 (27.59)	8.86 (7.03)	17 (29.31)	10.08 (7.42)	27 (46.55)	6 (10.34)	7.07 (9.72)
	No	23 (39.66)	1 month - 18 years	11.53 (5.42)	13 (22.41)	11.25 (6.47)	10 (17.24)	11.9 (3.96)	15 (25.86)	8 (13.79)	9.93 (22.4)
	No data	2 (3.45)	2 months - 13 years	6.59 (9.07)	2 (3.45)	6.59 (9.07)	0		1 (1.72)	1 (1.72)	60
**Yes	Brain	14 (42.42)	1 day - 18 years	6.28 (7.33)	8 (24.24)	6.57 (7.1)	6 (18.18)	5.89 (8.3)	8 (13.79)	6 (10.34)	6 (6.26)
	Torax	5 (15.15)	2 months - 18 years	10.83 (7.99)	4 (12.12)	10.29 (9.12)	1 (3.03)	13	5 (8.62)	0	7.2 (0.84)
	Abdomen	3 (9.09)	10 - 18 years	14.33 (4.04)	2 (6.06)	14 (5.66)	1 (3.03)	15	3 (5.17)	0	6 (4.58)
	Nerves and tendons	2 (6.06)	14 - 18 years	16 (2.83)	0		2 (6.06)	16 (2.83)	2 (3.45)	0	3 (0)
Outcome	Altab	45 (77.59)	1 month - 18 years	10.64 (6.19)	22 (37.93)	9.94 (6.5)	23 (39.66)	11.31 (5.93)	36 (62.07)	9 (15.52)	9 (16.31)
	Death	6 (10.34)	1 day - 18 years	3.91 (7.17)	4 (6.9)	5.79 (8.46)	2 (3.45)	0.14 (0.04)	1 (1.72)	5 (8.62)	1
	Judicial transfer	1 (1.72)	11 years	11	1 (1.72)	11	0		1 (1.72)	0	8
	Escape	1 (1.72)	4 months	0.33	1 (1.72)	0.33	0		1 (1.72)	0	4
	Ambulatory route	1 (1.72)	18 years	18	1 (1.72)	18	0		1 (1.72)	0	1
	No data	4 (6.9)	13 - 17 years	15 (1.63)	2 (3.45)	15 (2.83)	2 (3.45)	15 (0)	3 (5.17)	1 (1.72)	20.67 (34.06)

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[TFN1] The prevalence of hospitalization and non-hospitalization was calculated compared to the general sample (N=58). The prevalence of fractures and associated lesions was calculated compared to the general sample (N=58) and the prevalence of specific fractures and associated lesions was calculated compared to the positive fractural cases sample (N=21) and associated lesions (N=33). ^aDirect trauma per object includes contundent object (aspirator); perforating-cutting object; direct trauma by skate and direct trauma by unspecified objects. ^a‘Fall’ includes falls from objects such as a plate, bed, or crib, as well as falls from different floor levels. ^bIncludes post-surgical discharge; post-procedures; post-evaluation of social service; post-evaluation of custodial council and judicial discharge after loss of custody.

[TFN2] ^*
38.1% (N=8) presented laterality to the right, 33.33% (N=7) to the left and 14.29% (N=3) did not contain data. *Hand fractures include phalanges and metacarpal. *Lower limb fractures include femur and tibia. *Upper limb fractures include humerus and forearm. *Face and skull fractures include skull, occipit, orbit, jaw, and nasal fracture.

[TFN3] ^**
Brain injuries include TCE, extradural hematoma, intracranial hypertension and cerebral death.** Thoracic lesions include pneumothorax and increased mediastinum. ** Abdominal lesions include liver, kidney, splenic and unspecified lesions.