Versorgungsbedarf von Kindern und Jugendlichen mit einem Schädel-Hirn-Trauma

The Youth Health Care measure-satisfaction, utilization, and needs (YHC-SUN)-development of a self-report version of the Child Health Care (CHC-SUN) proxy-measure

BACKGROUND

The transition of health care of youth (age 15-25) with chronic conditions requires the assessment of adolescents' access, use and needs as well as satisfaction with the health services they use. The aim of this study was to test the adolescent adaptation of the parent version "Child Health Care Questionnaire - Satisfaction, Utilization and Needs" (CHC-SUN) concerning its psychometric performance and appropriateness for adolescents and young adults.

METHODS

The Youth Health Care Measure (YHC-SUN) was designed to allow self-report of youth and it was pilot-tested in a small sample using cognitive debriefing. A cross-sectional survey in a sample of youth with chronic conditions in the transition period was carried out.

RESULTS

One hundred eighty-two ambulatory care patients with three conditions participated in the survey. The subscales of the section on satisfaction with care showed excellent internal consistencies, uni-dimensionality and fit to the model of the parent version. There was no impact of gender and education on satisfaction with care. Associations with age, diagnosis, experiences with care and health literacy affecting the satisfaction with care indicate discriminatory and content validity.

CONCLUSIONS

Potential applications of the new instrument are evaluations of health care services for adolescents and young adults using self-reports and evaluations of transition programs and interventions such as patient education.

Pediatric traumatic brain injury and radiation risks: a clinical decision analysis

OBJECTIVE

To determine the optimal imaging strategy for young children with minor head injury considering health-related quality of life and radiation risk. In children with minor head trauma, the risk of missing a clinically important traumatic brain injury (ciTBI) must be weighed against the risk of radiation-induced malignancy from computed tomography (CT) to assess impact on public health.

STUDY DESIGN

We included children <2 years old with minor blunt head trauma defined by a Glasgow Coma Scale score of 14-15. We used decision analysis to model a CT-all versus no-CT strategy and assigned values to clinical outcomes based on a validated health-related quality of life scale: (1) baseline health; (2) non-ciTBI; (3) ciTBI without neurosurgery, death, or intubation; and (4) ciTBI with neurosurgery, death, or intubation >24 hours with probabilities from a prospective study of 10000 children. Sensitivity analysis determined the optimal management strategy over a range of ciTBI risk.

RESULTS

The no-CT strategy resulted in less risk with the expected probability of a ciTBI of 0.9%. Sensitivity analysis for the probability of ciTBI identified 4.8% as the threshold above which CT all becomes the preferred strategy and shows that the threshold decreases with less radiation. The CT all strategy represents the preferred approach for children identified as high-risk.

CONCLUSION

Among children <2 years old with minor head trauma, the no-CT strategy is preferable for those at low risk, reserving CT for children at higher risk.

[Mental retardation and ADHD]

Hyperactivity syndromes and disorders (ADHD and HKD) include the symptoms of overactivity, inattention, and impulsivity, which occur in many other mental disorders as well, including mental retardation (MR). It is not surprising that symptoms of ADHD occur significantly higher in children with learning disabilities. Dekker and Koot (2003) found a prevalence of 14.8 % for ADHD in Dutch children attending special schools, and Emerson (2003) reported rates of 8.7 % for HKD in children with global learning disability, representing a 10-fold increased risk compared to the prevalence of hyperactivity (0.9 %) in the general population sample. Yet only very few studies have been published concerning ADHD in children with mental retardation. Several features distinguish the diagnoses of ADHD and MR. In contrast to the limited knowledge about the differences and similarities of ADHD and MR, many studies considered stimulant medication as a pharmacological management strategy for children suffering from ADHD, MR, or both. According to these studies, psychostimulants may improve the target symptoms of hyperactivity, impulsivity, disinhibition, and inattention, albeit with caveats: ADHD symptoms in patients with MR may be less responsive to medical treatment than in patients without MR. Moreover, people with MR may be more susceptible to side effects.