研究背景：區辨兒童傷害意圖為有效防止進一步的傷害的首要條件，尤其幼兒因年齡及發展的限制無法清楚表達傷害的過程，臨床醫護人員區辨傷害意圖的能力更顯重要。台灣目前未有一標準化工具協助醫護人員區辨兒童虐待，增加執行上的困難。
研究目的：建構中文版幼兒傷害意圖區辨判準，評價中文版判準的信效度及可行性。
研究方法：描述性回溯性研究，方便取樣選取台灣南部某醫學中心2007年1月～2009年12月因外傷入院的共157本病歷。收案標準：1.國際疾病分類碼(ICD-9-CM)N-code 800-999或E-code E800-E999為出院主診斷2.三歲以下之幼兒。研究工具以Thomas et al. (1991)之「Criteria Used by the Clinicians to
Distinguish Abuse from Accidents；CDAA」工具，建構成中文版幼兒傷害意圖區辨判斷標準(Criteria for Distinguishing Abuse From Accidents- Mandarin version; CDAA-M)。
研究結果：中文版幼兒傷害意圖區辨判斷標準(CDAA-M)顯示良好的專家效度(CVI= 0.8~1)、同時效度(Kappa係數 = .611）及信度(Kappa係數 = .77)。以CDAA-M評估157本病歷，發現8人(5.1%)被歸為兒童虐待，5人為極高度為虐待(3.2%)，0人(0%)為可疑的虐待，其餘分佈於確定意外至可疑的意外(81%)，而有17人(10.9%)病歷紀錄不清楚故歸類在原因不明。確定為兒虐中有一人重複入院多次，以CDAA-M評估則比病歷上診斷通報時間提早870天辨識出兒童虐待。此外，男性發生兒虐為女性的2.103倍，而早產兒與兒虐的發生有顯著的關連。
結論：中文版幼兒傷害意圖區辨判準具有良好的信效度及區辨性，提供臨床照護一實用性高的參考工具。

Background: Distiguishing the intent of injury is a top priority for injury intervention and prevention, especially for young children due to their age and developmental limitation to articulate the injury. No standardized instrument is available to help health professionals distinguish the intent of children’s injuries.Purpose: The purpose of this study was to develop and test the psychometrics of “Criteria for Distinguishing Abuse From Accidents- Mandarin version; CDAA-M” and its feasibility.
Method: A descriptive and retrospective study design is used. A total of 157 charts from a medical center in southern Taiwan were reviewed to examine the comprehensiveness of medical and nursing records in the past three years (2007.1-2009.12). The criteria for sapling were: 1. the discharge diagnosis code of ICD-9-CM N-code 800-999 and E-code E800-E999 and 2. Children aged 0 to 3 who were hospitalized. . “Criteria for Distinguishing Abuse From Accidents- Mandarin version; CDAA-M”; modified and developed from Thomas et al. (1991) “Criteria Used by the Clinicians to Distinguish Abuse from Accidents; CDAA” were used to collect data. .
Results: The CDAA-M demonstrated a good expert validity (CVI = 0.8~1), concurrent validity (Kappa = .611) and inter-rater reliability (Kappa = .77). Of 157 charts, 8 cases are recognized as “definite child abuse”, 5 “likely abuse” and 0 “questionable abuse”. Eighty-one percent ranged from “definite accident” to “questionable accident” , and 17 (10.9%) cases are classified as unknown. In one particular case of the definite abuse, the child was repeatedly hospitalized, and was finally diagnosed “child abuse” at age 4. The CDAA-M distinguished it as a “likely abuse” 870 days earlier before the final report by the hospital. Furthermore, the incident of being a case of child abuse for boys was 2.103 times than that of girls. Being a premature was also associated with child abuse.
Conclusion: The CDAA-M is a valid and reliable instrument with good discrimination to distinguish abuse from accidents. The CDAA-M provides a practicaland useful tool for clinical use.

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