1
|
Bernardin ME, Cutler KO. Emergency Department Usage Patterns Among Pediatric Victims of Gun Violence and Physical Assault. Pediatr Emerg Care 2024; 40:415-420. [PMID: 38048545 DOI: 10.1097/pec.0000000000003089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Violent injuries are a common reason for pediatric emergency department (ED) visits, with gun violence being the leading cause of violent death among children. The objective of this study was to assess for patterns of pediatric ED usage that are associated with future ED visits for violent injuries. METHODS This case-control study included youths aged 6 to 19 years who presented to a pediatric ED over a 3-year period due to a physical assault (PA) or their first known gunshot wound (GSW). We compared them with age-, race-, and sex-matched youths presenting for nonviolent medical complaints. All previous ED visits were coded as (1) injuries due to a previous PA, (2) mental/behavioral health visits, (3) sexual/reproductive health visits, (4) sexual assault, or (5) concerns for child abuse. We used multivariate logistic regression to identify patterns of previous ED usage associated with future ED visits for injuries related to PA and/or GSW. RESULTS The PA and GSW groups used the ED for previous PAs, mental/behavioral health, sexual/reproductive health, sexual assault, and/or child abuse concerns on average 4 to 8 times as often as the control group. Previous ED visits for mental/behavioral health (odds ratio [OR] 5), sexual/reproductive health (OR 3), sexual assault (OR 9), and prior PA (OR 8) were predictive of a future ED visit for PA. Male sex (OR 6) and previous ED visits for PA (OR 5) were predictive of a future ED visit for GSW. Two percent of the PA group and 9% of the GSW group returned to the ED with a subsequent GSW in the following 16 to 40 months. CONCLUSIONS Emergency department visits due to interpersonal violence, mental/behavioral health, sexual/reproductive health, and sexual assault are associated with recurrent ED visits for violent injuries. Awareness of patterns of ED usage may aid in identifying patients at high risk for violence and increase opportunities for preventative interventions.
Collapse
Affiliation(s)
| | - Keven O Cutler
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO
| |
Collapse
|
2
|
Adjei BN, Afetor M, Ansong-Aggrey S, Okwei R, Nachibi SU, Munkaila L, Arimiyaw AW, Osei Bonsu E, Adu C, Peprah P. Substance use and adolescent injuries: a multi-country analysis of the association and mediating effect of interpersonal violence among 122,945 in-school paediatric populations in 29 countries. Front Public Health 2023; 11:1193711. [PMID: 37546313 PMCID: PMC10399213 DOI: 10.3389/fpubh.2023.1193711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Adolescent use of substances and injury experiences such as head injury have become increasingly prevalent. However, information regarding their association and the potential pathways linking them remains limited. This study examined the association between substance use and injuries, emphasizing the mediating role of interpersonal violence among adolescents. Methods We employed a multi-country analysis of Global School-based Health Surveys of 122,945 in-school adolescents aged 11-18 from 29 countries. This study was a cross-sectional school-based, nationally representative study developed by the World Health Organization and the United States Centers for Disease Control and Prevention, other United Nations allies, and country-specific institutions. Random-effects meta-analysis was performed to estimate the overall prevalence of injury and substance use and the I-square (I 2 ) statistic was used to investigate the between-country heterogeneity. Logistic regression models were fitted to examine the association between substance use and injuries. A path analysis was used to examine the potential mediation effect of interpersonal violence and employed decomposition of effects into total, direct, and indirect. Results Prevalence of substance use and injuries were 33.6% (95%CI = 28.5, 38.6%) and 41.7% (95%CI = 37.3, 46.1%), respectively. Substance use (37.8% vs. 29.4%, p = 0.001) and injuries (47.3% vs. 36.4%, p = 0.001) were significantly higher among male adolescents than females, respectively. After adjustment, substance users had 40% higher odds of injuries. The path analysis showed a mediation effect of perpetration of and victimization by interpersonal violence on the association of substance use with injuries, with total positive effects of perpetration [β = 0.18; 95%CI = 0.16, 0.19; p = 0.001] and victimization on injuries [β = 0.22; 95%CI = 0.21, 0.24; p = 0.001]. In a further subgroup analysis, tobacco users were 3.98 times more likely to sustain a gunshot wound whiles marijuana users had 2.81 times higher odds of sustaining gunshot wounds. Cigarette smokers had 45% lower odds of sustaining cut/stab wounds. Alcohol users were 53% more likely to sustain concussion/head injury and two and half times more likely to sustain gunshot wound. Conclusion A significant association exists between substance use and severe injuries among adolescents, mediated by interpersonal violence exposure. Our findings may have utility in informing substance use and interpersonal violence control policies and interventions to address adolescent injuries.
Collapse
Affiliation(s)
- Benjamin Noble Adjei
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Maxwell Afetor
- Information, Monitoring and Evaluation Department, Ghana Health Service, Ho Polyclinic, Ho, Ghana
- Department of Mathematics and Acturial Science, KNUST, Kumasi, Ghana
| | - Samuel Ansong-Aggrey
- Department of Health Policy, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Reforce Okwei
- Department of Geography, Miami University, Oxford, OH, United States
| | | | - Lambongang Munkaila
- Department of Agribusiness and Applied Economics, North Dakota State University, Fargo, ND, United States
| | - Abdul Wahid Arimiyaw
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Osei Bonsu
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Collins Adu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Center for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Prince Peprah
- Social Policy Research Centre, UNSW, Sydney, NSW, Australia
- Centre for Primary Health Care and Equity, UNSW, Sydney, NSW, Australia
| |
Collapse
|
3
|
Marco CA, Sich M, Ganz E, Clark ANJ, Graham M. Penetrating trauma: Relationships to recreational drug and alcohol use. Am J Emerg Med 2021; 52:8-12. [PMID: 34856440 DOI: 10.1016/j.ajem.2021.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The incidence of alcohol and recreational drug use is increasing. The impact on penetrating trauma is unknown. This study was undertaken to identify the incidence of alcohol and recreational drug use prior to penetrating trauma, and to identify ISS and outcomes among patients with penetrating trauma. METHODS In this retrospective study, eligible subjects included trauma patients age 18 and older, with major trauma (admitted or evaluated by the Trauma Team) from 2017 to 2021. A chart review was conducted to identify data including mechanism of injury, ISS, alcohol level, toxicologic testing, length of stay, and final disposition. RESULTS Among 1270 adult subjects with penetrating trauma during 2017 through 2020, the majority were male (N = 1071; 84%), and African American (N = 679; 54.3%) or White (N = 537; 42.9%). Mechanisms of injury included gunshot wound (GSW) (N = 973; 76.6%) or stab wound (N = 297; 23.4%). Injury severity score (ISS) ranged from 1 to 75. Among 426 subjects (33.5%) tested for recreational drugs, 395 (93%) were positive for at least one substance. The most common recreational drugs identified included marijuana (N = 280; 65.7%), benzodiazepine ((N = 131;30.8%), alcohol ((N = 248; 25.3%), opiate ((N = 116; 27.2%), cocaine (N = 87; 20.4%), and amphetamine ((N = 84; 19.7%). Subjects with an ISS of 9 to 15 had higher odds of testing positive for opiates compared to subjects with an ISS of 1 to 3 (OR 2.3). Most patients were ultimately discharged home ((N = 912;71.8%) and a minority expired (N = 142; 11.2%). CONCLUSIONS Positive screens for alcohol and recreational drugs were common among penetrating trauma patients in this setting. The most common identified recreational drugs included marijuana, benzodiazepine, opiates, alcohol, cocaine, and amphetamine.
Collapse
Affiliation(s)
- Catherine A Marco
- Department of Emergency Medicine, Wright State University, Dayton, OH, United States of America.
| | - Melanie Sich
- Wright State University, Dayton, OH, United States of America
| | - Ellie Ganz
- Wright State University, Dayton, OH, United States of America
| | | | - Mitchell Graham
- Virginia Tech, Carilion Clinic, Roanoke, VA, United States of America
| |
Collapse
|
4
|
Bernardin ME, Moen J, Schnadower D. Factors associated with pediatric firearm injury and enrollment in a violence intervention program. J Pediatr Surg 2021; 56:754-759. [PMID: 32690290 DOI: 10.1016/j.jpedsurg.2020.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/21/2020] [Accepted: 06/14/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To identify factors associated with firearm injury (FI) and willingness to enroll in a violence intervention program amongst pediatric victims of violence. METHODS Cross-sectional study of victims of violence age 6-19 years presenting to a children's hospital emergency department from 2014 to 2017. Participants were interviewed by social workers prior to being offered enrollment in a violence intervention program. We used multivariate logistic regression analyses to identify factors associated with FI and enrollment in the violence intervention program. RESULTS Four hundred seven patients were analyzed, 156 (38%) of which were victims of FI and 251 (62%) were victims of non-firearm-related physical assaults (PA). Multiple factors were associated with FI including older adolescent age, male sex, separated/divorced parents, losses in family/social network due to violence, being on probation, illicit substance use, gang affiliation, and lack of school enrollment. One hundred four patients (26%) enrolled in the violence intervention program. There was no difference in enrollment between FI and PA. However, older adolescent age, illicit substance use and probation were associated with significantly decreased odds of enrolling in the program. CONCLUSIONS Multiple identifiable and potentially actionable risk factors exist amongst pediatric victims of acute FI. More specific targeting of at-risk groups may improve enrollment in violence interventions programs. LEVEL OF EVIDENCE This is a prognostic study, investigating the natural history of pediatric firearm injuries, factors associated with firearm injuries as well as those associated with patient propensity to enroll in a violence intervention program. This study is observational in nature and utilizes patients with non-firearm-related physical assaults as a control group, making this study Level III evidence.
Collapse
Affiliation(s)
- Mary Elizabeth Bernardin
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO.
| | - Joseph Moen
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
5
|
Schmidt CJ, Rupp L, Pizarro JM, Lee DB, Branas CC, Zimmerman MA. Risk and protective factors related to youth firearm violence: a scoping review and directions for future research. J Behav Med 2019; 42:706-723. [PMID: 31367936 PMCID: PMC8682918 DOI: 10.1007/s10865-019-00076-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/26/2019] [Indexed: 12/14/2022]
Abstract
To conduct our scoping review of risk and protective factors for firearm violence among youth, we searched PubMed, Scopus, EMBASE, and Criminal Justice Abstracts for English-language research articles published between January 1985 and May 2018. We included studies of modifiable risk or protective factors associated with intentional (including suicide) or unintentional firearm victimization or perpetration with samples that included youth ≤ 17. Among the 28 included studies, 15 explored risk/protective factors for victimization, five focused on perpetration, five did not differentiate between victimization and perpetration, and five focused on suicide. Most studies examined individual-level risk factors. The few that explored factors beyond the individual were limited by methodological weaknesses and inconsistent findings. Protective factors for youth firearm outcomes were understudied. We need more research on youth firearm violence using longitudinal data and robust statistical methods. Future research is needed to understand the underlying mechanisms by which risk/protective factors influence firearm violence.
Collapse
Affiliation(s)
- Carissa J. Schmidt
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Laney Rupp
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Jesenia M. Pizarro
- Arizona State University, School of Criminology and Criminal Justice, 411 N. Central Ave. Ste. 600, Phoenix, AZ 85004
| | - Daniel B. Lee
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Charles C. Branas
- Columbia Mailman School of Public Health, Department of Epidemiology, 722 W. 168th St., New York, NY 10032
| | - Marc A. Zimmerman
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | | |
Collapse
|
6
|
Falvo F, Schmid A. Bridging the Gap: Drug and Alcohol Screening in Adolescent Trauma Patients. J Emerg Nurs 2018; 44:325-330. [DOI: 10.1016/j.jen.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/23/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
|
7
|
Pulver A, Davison C, Parpia A, Purkey E, Pickett W. Nonmedical Use of Prescription Opioids and Injury Risk Among Youth. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016. [DOI: 10.1080/1067828x.2015.1115795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ariel Pulver
- University of Toronto, Toronto, Ontario, Canada
- Queen's University, Kingston, Ontario, Canada
| | - Colleen Davison
- Queen's University, Kingston, Ontario, Canada
- Kingston General Hospital Research Centre, Kingston, Ontario, Canada
| | | | - Eva Purkey
- Queen's University, Kingston, Ontario, Canada
| | - William Pickett
- Queen's University, Kingston, Ontario, Canada
- Kingston General Hospital Research Centre, Kingston, Ontario, Canada
| |
Collapse
|
8
|
Roberts SP, Siegel MB, DeJong W, Naimi TS, Jernigan DH. Brand preferences of underage drinkers who report alcohol-related fights and injuries. Subst Use Misuse 2015; 50:619-929. [PMID: 25612075 PMCID: PMC4441549 DOI: 10.3109/10826084.2014.997392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A significant body of research has demonstrated an association between adolescent alcohol consumption and subsequent fights and injuries. To date, however, no research has identified which brands are associated with alcohol-related fights and injuries among underage drinkers. OBJECTIVES We aimed to: (1) report the prevalence of alcohol-related fights and injuries among a national sample of underage drinkers in the U.S. and (2) describe the relationship between specific alcohol brand consumption and these alcohol-related negative consequences. METHODS We recruited 1,031 self-reported drinkers (ages 13-20 years) via an internet panel maintained by Knowledge Networks to complete an online survey. Respondents reported their past-month overall and brand-specific alcohol consumption, risky drinking behavior, and past-year alcohol-related fights and injuries. RESULTS Over one-quarter of the respondents (26.7%, N = 232) reported at least one alcohol-related fight or injury in the past year. Heavy episodic drinkers were over six times more likely to report one of these negative alcohol-related consequences (AOR: 6.4, 95% CI: 4.1-9.9). Respondents of black race and those from higher-income households were also significantly more likely to report that experience (AOR: 2.2, 95% CI: 1.3-3.7; AOR: 1.8, 95% CI: 1.1-3.0 and 1.1-3.2, respectively). We identified eight alcohol brands that were significantly associated with alcohol-related fights and injuries. CONCLUSIONS/IMPORTANCE: Alcohol-related fights and injuries were frequently reported by adolescent respondents. Eight alcohol brands were significantly more popular among drinkers who experienced these adverse consequences. These results point to the need for further research on brand-specific correlates of underage drinking and negative health outcomes.
Collapse
Affiliation(s)
- Sarah P Roberts
- 1Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts , USA
| | | | | | | | | |
Collapse
|
9
|
Roberts SP, Siegel MB, DeJong W, Naimi TS, Jernigan DH. The relationships between alcohol source, autonomy in brand selection, and brand preference among youth in the USA. Alcohol Alcohol 2014; 49:563-71. [PMID: 25113176 PMCID: PMC4128668 DOI: 10.1093/alcalc/agu034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 11/12/2022] Open
Abstract
AIMS We aimed to describe the sources from which youth in the USA commonly obtain alcohol, their role in selecting the brands they drink and the relationship of these variables to their indicated alcohol brand preferences. METHODS We recruited 1031 underage drinkers in the age range of 13-20 through an internet panel managed by Knowledge Networks. Respondents completed an online survey assessing their recent brand-specific alcohol use, the source of their most recently consumed alcohol and whether the respondent or another person selected the brand they drank. RESULTS Alcohol sources were more often passive than transactional. Nearly equal proportions of youth reported that they did versus did not choose the brand of their most recent drink. Analysis revealed that the brand preferences of passive versus active source drinkers were highly similar, as were the brand preferences of respondent versus non-respondent choice drinkers. Stratification of respondents by age did not significantly change these results. CONCLUSION Our findings suggest that youth are consuming a homogenous list of preferred brands regardless of the source of their most recently obtained alcohol or who selected the brand they drank.
Collapse
Affiliation(s)
- Sarah P Roberts
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Michael B Siegel
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - William DeJong
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Timothy S Naimi
- Department of Community Health Sciences and Section of General Internal Medicine, Boston University Schools of Medicine and Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - David H Jernigan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 West Broadway, Room 292, Baltimore, MD 21205, USA
| |
Collapse
|
10
|
Johnson KN, Raetz A, Harte M, McMahon LE, Grandsoult V, Garcia-Filion P, Notrica DM. Pediatric trauma patient alcohol screening: a 3 year review of screening at a Level I pediatric trauma center using the CRAFFT tool. J Pediatr Surg 2014; 49:330-2. [PMID: 24528979 DOI: 10.1016/j.jpedsurg.2013.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Alcohol use is a risk factor for adult trauma. Alcohol may significantly influence pediatric trauma risk, but literature is sparse. The aim of this study was to examine the impact of alcohol use screening in pediatric trauma patients. METHODS A retrospective review was performed of all trauma patients to identify those undergoing CRAFFT alcohol screening assessment between July 1, 2009, and January 31, 2011. Inclusion criteria involved screening of level 1 or 2 trauma activations for patients greater than 12 years. RESULTS During the study period, 232 patients were eligible for screening, of which 51% (n=118) were screened. Among the patients screened, 21 (18%) had a positive screen (mean age 14.6 years, range 13-16). Twenty patients were referred for further counseling. Sixteen males and 5 females screened positive during the study. The most common mechanism of injury in the positive screen patients was motor vehicle or ATV accident (n=9), followed by assault (n=6), and motor versus pedestrian collision (n=2). Of the 21 patients who screened positive, 10 had positive blood alcohol content (BAC) or urine drug screen (UDS) at the time of injury. No patients with a positive screen returned during the study as a trauma patient. CONCLUSION Alcohol and drug screening for injured pediatric trauma patients is frequently omitted despite policy-required screening. Of those patients screened, 18% admitted to risky alcohol or drug-related behaviors or had positive BAL or UDS at presentation. Pediatric trauma screening for risky alcohol use identifies a significant number of children. Alcohol and drug screening in pediatric trauma appears over age 13 years to have a yield which justifies continued screening. Alcohol related trauma recidivism, however, does not seem common.
Collapse
Affiliation(s)
- Kevin N Johnson
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona
| | - Alaina Raetz
- Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Melissa Harte
- Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Lisa E McMahon
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona; Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | | | - Pamela Garcia-Filion
- Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - David M Notrica
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona; Trauma Center, Phoenix Children's Hospital, Phoenix, Arizona; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona.
| |
Collapse
|
11
|
Trahan J, Serban D, Tender GC. Gunshot wounds to the spine in post-Katrina New Orleans. Injury 2013; 44:1601-6. [PMID: 23850336 DOI: 10.1016/j.injury.2013.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 05/30/2013] [Accepted: 06/20/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gunshot wounds (GSW) to the spine represent a major health concern within today's society. Our study assessed the epidemiologic characteristics of patients with GSW to the spine treated in New Orleans. PATIENTS AND METHODS A retrospective chart review was performed from January 2007 through November 2011 on all the patients who were seen in the emergency room and diagnosed with a gunshot wound to the spine. Epidemiologic factors, as well as the results of admission toxicology screening, were noted. Outcome analysis was performed on patients undergoing conservative versus operative management for their injuries. Clinical outcomes were assessed using the ASIA classification system. Complications related to initial injury, neurosurgical procedures, and hospital stay were noted. RESULTS A total of 147 patients were enrolled. Of those diagnosed with a GSW to the spine, 88 (59.8%) received an admission toxicology screen. Seventy-three (83%) patients out of those tested had a positive screen, with the most common substances detected being cannabis, cocaine, and alcohol. In regards to management, 127 (87%) patients were treated conservatively and only one (0.7%) patient improved clinically from ASIA D to E. Of the 20 patients who underwent surgery, one (5%) patient had clinical improvement post-operatively from ASIA C to D. CONCLUSIONS This study evaluates the largest number of patients with GSW to the spine per year treated in a single centre, illustrating the violent nature of New Orleans. In this urban population, there was a clear correlation between drug use and suffering a GSW to the spine. Surgical intervention was seldom indicated in these patients and was predominately used for fixation of unstable fractures and decompression of compressive injuries, particularly below T11. Minimally invasive techniques were used successfully at our institution to minimize the risk of post-operative CSF leak.
Collapse
Affiliation(s)
- Jayme Trahan
- Neurosurgery Program, Louisiana State University, New Orleans, LA, USA
| | | | | |
Collapse
|
12
|
Guidelines for alcohol screening in adolescent trauma patients: a report from the Pediatric Trauma Society Guidelines Committee. J Trauma Acute Care Surg 2013; 74:671-82. [PMID: 23354268 DOI: 10.1097/ta.0b013e31827d5f80] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol misuse is an important source of preventable injuries in the adolescent population. While alcohol screening and brief interventions are required at American College of Surgeons-accredited trauma centers, there is no standard screening method. To develop guidelines for testing, we reviewed available evidence regarding adolescent alcohol screening after injury, focusing on the questions of which populations require screening, which screening tools are most effective, and at which time point screening should be performed. METHODS A comprehensive PubMed search for articles related to alcoholism, trauma, and screening resulted in 1,013 article abstracts for review. Eighty-five full-length articles were considered for inclusion. Articles were excluded based on study type, location (non-US), year of publication, and nonapplicability to the study questions. RESULTS Twenty-six articles met full inclusion criteria. Results support universal screening for alcohol misuse in the adolescent trauma population. Although adolescents 14 years and older are more likely to test positive for alcohol misuse, studies suggest screening may need to start at 12 years or younger. Both survey and biochemical screens can identify at-risk adolescents, with the Alcohol Use Disorders Identification Test and the two-question survey based on the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria for alcohol-use disorders being the most sensitive surveys available. CONCLUSION Injured adolescent trauma patients should be universally screened for alcohol misuse during their hospital visit. To maximize the number of at-risk adolescents targeted for interventions, screening should begin at minimum at 12 years. As no screen identifies all at-risk adolescents, a serial screening method using both biochemical tests and standardized questionnaires may increase screening efficacy.
Collapse
|
13
|
Caputo ND, Shields CP, Ochoa C, Matarlo J, Leber M, Madlinger R, Waseem M. Violent and fatal youth trauma: is there a missed opportunity? West J Emerg Med 2012; 13:146-50. [PMID: 22900103 PMCID: PMC3415801 DOI: 10.5811/westjem.2011.6.6765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 04/29/2011] [Accepted: 06/13/2011] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Accidents and assaults (homicides) are the leading causes of death among the youth of the United States, accounting for 53.3% of deaths among children aged 1 to19 years. Victim recidivism, defined as repeated visits to the emergency department (ED) as a victim of violent trauma, is a significantly growing public health problem. As 5-year mortality rates for recidivism are as high as 20%, it is important to determine whether victims with a history of violent trauma are at increased risk for fatal outcome with their next trauma. We hypothesized that victims of violent trauma who have had 1 prior ED visit for violent trauma will have increased odds of fatal outcome. METHODS A retrospective chart review was conducted for patients presenting with penetrating trauma to the ED from January 1, 1999 to December 31, 2009. All patients between the ages of 15 to 25 years who presented to the ED for any penetrating trauma were included. Patients with prior presentations for penetrating trauma were compared to those patients who were first-time presenters to determine the odds ratio of fatal outcome. RESULTS Overall, 15,395 patients were treated for traumatic presentations. Of these, 1,044 met inclusion criteria. Demographically, 79.4% were Hispanic, 19.4% were African American, and 0.96% were Caucasian. The average age was 21 years, and 98% of the population was male. One hundred and forty-seven (14%) had prior presentations, and 897 (86%) did not. Forty of the 147 patients (27%) with prior presentations had a fatal outcome as compared to 29 patients of the 868 (3%) without prior presentations, with odds ratio of 10.8 (95% confidence interval, 6.4-18.1; Pearson χ(2), P < 0.001). The 5-year mortality rate for those patients with fatal outcomes was calculated at 16.5%. CONCLUSION Patients who had prior ED visits for penetrating trauma were at greater risk for fatal outcomes compared to those with no prior visits. Therefore, trauma-related ED visits might offer an opportunity for education and intervention. This may help to prevent future fatalities.
Collapse
Affiliation(s)
- Nicholas D. Caputo
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| | - Christopher P. Shields
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| | - Cesar Ochoa
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| | - Jennifer Matarlo
- Lincoln Medical and Mental Health Center, Department of Surgery, Division of Trauma Surgery, Bronx, New York
| | - Mark Leber
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| | - Robert Madlinger
- Lincoln Medical and Mental Health Center, Department of Surgery, Division of Trauma Surgery, Bronx, New York
| | - Muhammed Waseem
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| |
Collapse
|
14
|
Vital E, Oliveira R, do Céu Machado M, de Matos MG. Injuries and risk-taking behaviours in Portuguese adolescents: Highlights from the health behaviour in school-aged children survey. JOURNAL OF SAFETY RESEARCH 2011; 42:327-331. [PMID: 22093566 DOI: 10.1016/j.jsr.2011.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 05/02/2011] [Accepted: 06/27/2011] [Indexed: 05/31/2023]
Abstract
AIM Injuries in adolescence are an important public health problem and a major cause of morbidity and mortality in this age group. This study aimed to determine the behaviour profile associated to risk of injury and the differences between genders, region and ethnic origin. METHODS A cross-sectional study design of a nationally representative sample of 1581 adolescents of the Portuguese Health Behaviour in School-Aged Children study. RESULTS An occurrence of one injury-related event in the previous year was reported by 21.4% of the respondents and 5.9% referred having more than one injury-related event. Boys reported higher frequency of those events when compared to girls, and non-Portuguese subjects referred higher frequency of events. Scoring higher in violence-related behaviour and psychosomatic complaints was associated to higher chances of referring more than one injury-related event. CONCLUSION Gender, social background and behaviour profile are factors that seem to influence the risk of injuries. This information should guide those involved in the planning of injuries prevention programs in youth.
Collapse
|
15
|
Martin KL, Vogt KN, Girotti MJ, Stewart TC, Parry NG. Drug Use and Screening in Pediatric Trauma. Ther Drug Monit 2011; 33:439-42. [DOI: 10.1097/ftd.0b013e318222d951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Abstract
Prairie voles (Microtus ochrogaster) are socially monogamous rodents that form pair bonds-a behavior composed of several social interactions including attachment with a familiar mate and aggression toward conspecific strangers. Therefore, this species has provided an excellent opportunity for the study of pair bonding behavior and its underlying neural mechanisms. In this chapter, we discuss the utility of this unique animal model in the study of aggression and review recent findings illustrating the neurochemical mechanisms underlying pair bonding-induced aggression. Implications of this research for our understanding of the neurobiology of human violence are also discussed.
Collapse
Affiliation(s)
- Kyle L Gobrogge
- Department of Psychology and Program in Neuroscience, Florida StateUniversity, Tallahassee, Florida, USA
| | | |
Collapse
|
17
|
The role of mesocorticolimbic dopamine in regulating interactions between drugs of abuse and social behavior. Neurosci Biobehav Rev 2010; 35:498-515. [PMID: 20600286 DOI: 10.1016/j.neubiorev.2010.06.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 06/08/2010] [Accepted: 06/11/2010] [Indexed: 01/07/2023]
Abstract
The use of addictive drugs can have profound short- and long-term consequences on social behaviors. Similarly, social experiences and the presence or absence of social attachments during early development and throughout life can greatly influence drug intake and the susceptibility to drug abuse. The following review details this reciprocal interaction, focusing on common drugs of abuse (e.g., psychostimulants, opiates, alcohol and nicotine) and social behaviors (e.g., maternal, sexual, play, aggressive and bonding behaviors). The neural mechanisms underlying this interaction are discussed, with a particular emphasis on the involvement of the mesocorticolimbic dopamine system.
Collapse
|
18
|
Abstract
In terms of cost and years of potential lives lost, injury arguably remains the most important public health problem facing the United States. Care of traumatically injured patients depends on early surgical intervention and avoiding delays in the diagnosis of injuries that threaten life and limb. In the critical care phase, successful outcomes after injury depend almost solely on diligence, attention to detail, and surveillance for iatrogenic infections and complications.
Collapse
Affiliation(s)
- Hugo Bonatti
- University of Virginia School of Medicine, 1215 Lee Street, Charlottesville, VA 22908, USA
| | | |
Collapse
|
19
|
Lee CS, Abrantes AM, Colby SM, López SR, Jordan TJ. Medical student judgments of adolescents with alcohol use disorders (AUD). Subst Use Misuse 2008; 43:709-21. [PMID: 18393085 PMCID: PMC3107532 DOI: 10.1080/10826080701202791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED The clinical encounter presents opportunities for detection and intervention of adolescent alcohol use disorders (AUDs). AIMS Investigate (a) identification rate of AUDs, (b) whether AUD identification predicts clinical judgment, and (c) patient characteristics influences on clinical judgment. Medical students (n=123) read a case study and completed questions on diagnosis and clinical judgment. Twenty-five percent of participants identified AUD adolescents, who were more negatively rated than non-AUD adolescents. Prior clinical experience and addiction training predicted AUD identification. Patient race and gender influenced clinical judgment ratings. Addictions training is needed to improve identification rates. Study limitations are noted.
Collapse
Affiliation(s)
- Christina S Lee
- Department of Community Health, Center for Alcohol and Addiction Studies, Butler Hospital and Brown Medical School, Brown University, Providence, Rhode Island 02912, USA.
| | | | | | | | | |
Collapse
|
20
|
Abstract
In this article, we tested the hypothesis that the number and demographic characteristics of admissions to our trauma center were related to unemployment rates. The correlation study was conducted at The American College of Surgeons-verified level I trauma center in our area (New Orleans, Louisiana). It included all trauma admissions. Monthly unemployment rate data from our area were obtained from the Bureau of Labor Statistics. The hospital trauma registry supplied trauma emergency room admissions and demographic data. Mean daily trauma admissions were calculated for each month. Pearson correlations were used for statistical analysis. Over 24,000 trauma admissions occurred over a six-year period. Unemployment rates correlated with penetrating trauma admissions (r = 0.50; p < 0.001). Interestingly, unemployment rates inversely correlated with total trauma admissions (r = -0.73; p < 0.001), blunt trauma admissions (r = -0.81; p < 0.001), and ratio of blunt-to-penetrating trauma admissions (r = -0.82; p < 0.001). Higher percentage of male patients (r = 0.66; p < 0.001), percentage of African-American patients (r = 0.53; p < 0.001), and mortality (r = 0.56; p < 0.001) correlated positively with higher unemployment rates. We concluded that as unemployment rates decrease, emergency room penetrating trauma admissions decrease, while total and blunt trauma admissions increase. As the socioeconomic status (measured by unemployment rates) of the community changes, so do the demographic make-up and mortality of the trauma population. Our findings suggest that during times of economic hardships, certain population groups are at higher risk for trauma. Prevention should be aimed accordingly.
Collapse
Affiliation(s)
- Atul K Madan
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | | | | | | | | |
Collapse
|
21
|
van den Bree MBM, Whitmer MD, Pickworth WB. Predictors of smoking development in a population-based sample of adolescents: a prospective study. J Adolesc Health 2004; 35:172-81. [PMID: 15313498 DOI: 10.1016/j.jadohealth.2003.09.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2003] [Indexed: 11/18/2022]
Abstract
PURPOSE To study the development of smoking behavior in adolescents using a longitudinal, multivariate design. METHODS Adolescents (n = 14,133, age range 12 to 18 years) took part in the longitudinal Add Health study (two waves, separated by 1 year, 56% smokers and 44% nonsmokers at Wave 1). Eight risk factor domains were established at Wave 1 (daily activities, psychological health, personality, school situation, family functioning, rough living, religion, and neighborhood status), which were further separated into subdomains by factor analysis. Subdomains were used to predict risk at Wave 2 of smoking initiation, progression, or failure to discontinue, using logistic regression analysis. Analyses were performed for boys and girls separately and results corrected for age, race, urbanicity, and socioeconomic status. RESULTS Use/abuse of other substances by self and peers influenced most stages of smoking, whereas trouble in school was associated with initiation and progression of smoking. Poor family relations predicted initiation of experimental smoking for girls, whereas low involvement in active pastimes predicted failure to discontinue experimental smoking. For boys, low religiosity predicted progression to regular smoking and failure to quit regular smoking, whereas delinquency also reduced success of regular smoking discontinuation. CONCLUSIONS These findings may direct efforts for prevention and intervention of adolescent smoking behavior and may also provide guidance for future studies.
Collapse
Affiliation(s)
- Marianne B M van den Bree
- University of Wales, College of Medicine, Division of Psychological Medicine, Heath Park, Cardiff CF14 4XN, Wales, United Kingdom
| | | | | |
Collapse
|
22
|
Abstract
Although nations continue to remain involved in ongoing armed conflicts, the threat of direct exposure to violence for American children and youth is more likely to be from the interpersonal violence that occurs in homes, neighborhoods, and schools. Exposure to interpersonal violence has a very serious impact on most youth. Focusing on violence prevention remains a vital component of providing comprehensive health care for all youth.
Collapse
Affiliation(s)
- Helen D Pratt
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | | |
Collapse
|