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Ciornei B, David VL, Popescu D, Boia ES. Pain Management in Pediatric Burns: A Review of the Science behind It. Glob Health Epidemiol Genom 2023; 2023:9950870. [PMID: 37745034 PMCID: PMC10516692 DOI: 10.1155/2023/9950870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
Pediatric burns are a significant medical issue that can have long-term effects on various aspects of a child's health and well-being. Pain management in pediatric burns is a crucial aspect of treatment to ensure the comfort and well-being of young patients. The causes and risk factors for pediatric burns vary depending on various factors, such as geographical location, socioeconomic status, and cultural practices. Assessing pain in pediatric patients, especially during burn injury treatment, poses several challenges. These challenges stem from various factors, including the age and developmental stage of the child, the nature of burn injuries, and the limitations of pain assessment tools. In pediatric pain management, various pain assessment tools and scales are used to evaluate and measure pain in children. These tools are designed to account for the unique challenges of assessing pain in pediatric patients, including their age, developmental stage, and ability to communicate effectively. Pain can have significant physical, emotional, and psychological consequences for pediatric patients. It can interfere with their ability to engage in daily activities, disrupt sleep patterns, and negatively affect their mood and behavior. Untreated pain can also lead to increased stress, anxiety, and fear, which can further exacerbate the pain experience. Acute pain, which is short-term and typically associated with injury or illness, can disrupt a child's ability to engage in physical activities and impede their overall recovery process. On the other hand, chronic pain, which persists for an extended period, can have long-lasting effects on physical functioning and quality of life in children. The psychological consequences of burns can persist long after the physical wounds have healed, leading to ongoing emotional distress and impaired functioning. Multimodal pain management, which involves the use of multiple interventions or medications targeting different aspects of the pain pathway, has gained recognition as an effective approach for managing pain in both children and adults. However, it is important to consider the specific needs and considerations of pediatric patients when developing evidence-based guidelines for multimodal pain management in this population. Over the years, there have been significant advances in pediatric pain research and technology, leading to a better understanding of pain mechanisms and the development of innovative approaches to assess and treat pain in children. Overall, pain management in pediatric burns requires a multidisciplinary approach that combines pharmacologic and nonpharmacologic interventions.
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Affiliation(s)
- Bogdan Ciornei
- Department of Paediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Vlad Laurentiu David
- Department of Paediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Diana Popescu
- Department of Pediatric Surgery, “Louis Turcanu” Emergency Children's Hospital, Timisoara, Romania
| | - Eugen Sorin Boia
- Department of Paediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Duflos M, Hussaina H, Olsen L, Ishikawa T, Brussoni M. Is parental propensity to risk associated with their child's medically-attended injuries? A cross-sectional study. J Safety Res 2023; 85:436-441. [PMID: 37330894 DOI: 10.1016/j.jsr.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/19/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Societal expectations about safety influence parents' risk perceptions and children's risky play opportunities. This study examined parents' propensity to take risks themselves and their propensity to accept risks for their child, sex-related differences in parents' propensity to accept risks for their child, and the association between parents' propensity to accept risks for their child and that child's medically-attended injury history. METHODS A total of 467 parents attending a pediatric hospital with their 6-12-year-old child completed a questionnaire about their risk propensity for themselves and for their child and reported their child's injury history. RESULTS Parents' risk propensity for themselves was significantly higher than for their child, and fathers' risk propensity for themselves was higher than mothers'. Linear regressions showed that fathers reported significantly more propensity to accept risks for their child than mothers, but parents did not differentiate between their sons and daughters. A binary logistic regression showed that parents' propensity to accept risks for their child was a significant predictor of pediatric medically-attended injury. CONCLUSIONS Parents were more comfortable in taking risks for themselves than for their child. While fathers were more comfortable with their children engaging in risks than mothers, child's sex was not related to parents' propensity to accept risks for their child. Pediatric injury was predicted by parents' propensity to accept risks for their child. Further research investigating injury type and severity related parent risk propensity is needed to determine how parents' attitudes toward risk might relate to severe injury.
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Affiliation(s)
- Mathilde Duflos
- Department of Pediatrics, University of British Columbia, Canada; British Columbia Children's Hospital Research Institute, Canada
| | - Hebah Hussaina
- Department of Pediatrics, University of British Columbia, Canada; British Columbia Children's Hospital Research Institute, Canada
| | - Lise Olsen
- School of Nursing, University of British Columbia Okanagan, Canada
| | - Takuro Ishikawa
- Department of Psychiatry, University of British Columbia, Canada
| | - Mariana Brussoni
- Department of Pediatrics, University of British Columbia, Canada; School of Population and Public Health, University of British Columbia, Canada; British Columbia Children's Hospital Research Institute, Canada; Human Early Learning Partnership, University of British Columbia, Canada; British Columbia Injury Research and Prevention Unit, Canada.
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3
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Jones M, Hill T, Coupland C, Kendrick D, Akbari A, Rodgers S, Watson MC, Tyrrell E, Merrill S, Martin A, Orton E. Cost-effectiveness of England's national 'Safe At Home' scheme for reducing hospital admissions for unintentional injury in children aged under 5. Inj Prev 2023; 29:158-165. [PMID: 36600567 DOI: 10.1136/ip-2022-044698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Injuries in children aged under 5 years most commonly occur in the home and disproportionately affect those living in the most disadvantaged communities. The 'Safe at Home' (SAH) national home safety equipment scheme, which ran in England between 2009 and 2011, has been shown to reduce injury-related hospital admissions, but there is little evidence of cost-effectiveness. MATERIALS AND METHODS Cost-effectiveness analysis from a health and local government perspective. Measures were the incremental cost-effectiveness ratio per hospital admission averted (ICER) and cost-offset ratio (COR), comparing SAH expenditure to savings in admission expenditure. The study period was split into three periods: T1 (years 0-2, implementation); T2 (years 3-4) and T3 (years 5-6). Analyses were conducted for T2 versus T1 and T3 versus T1. RESULTS Total cost of SAH was £9 518 066. 202 223 hospital admissions in the children occurred during T1-3, costing £3 320 000. Comparing T3 to T1 SAH reduced admission expenditure by £924 per month per local authority and monthly admission rates by 0.5 per local authority per month compared with control areas. ICER per admission averted was £4209 for T3 versus T1, with a COR of £0.29, suggesting that 29p was returned in savings on admission expenditure for every pound spent on SAH. CONCLUSION SAH was effective at reducing hospital admissions due to injury and did result in some cost recovery when taking into admissions only. Further analysis of its cost-effectiveness, including emergency healthcare, primary care attendances and wider societal costs, is likely to improve the return on investment further.
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Affiliation(s)
- Matthew Jones
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Trevor Hill
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Carol Coupland
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Denise Kendrick
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ashley Akbari
- Faculty of Medicine, Health, & Life Science, University of Wales Swansea, Swansea, UK
| | - Sarah Rodgers
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | | | - Edward Tyrrell
- Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Sheila Merrill
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Ashley Martin
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Elizabeth Orton
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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4
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Wang C, Toigo S, Zutrauen S, McFaull SR, Thompson W. Injuries among Canadian children and youth: an analysis using the 2019 Canadian Health Survey on Children and Youth. Health Promot Chronic Dis Prev Can 2023; 43:98-102. [PMID: 36794826 PMCID: PMC10026611 DOI: 10.24095/hpcdp.43.2.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This work provides an overview of injury patterns in Canadian children and youth aged 1 to 17 years. Self-reported data from the 2019 Canadian Health Survey on Children and Youth were used to calculate estimates for the percentage of Canadian children and youth who experienced a head injury or concussion, broken bone or fracture, or serious cut or puncture within the last 12 months, overall and by sex and age group. Head injuries and concussions (4.0%) were the most commonly reported, but the least likely to be seen by a medical professional. Injuries most frequently occurred while engaging in sports, physical activity or playing.
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Affiliation(s)
- Chinchin Wang
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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Shi C, Lin X, Huang T, Zhang K, Liu Y, Tian T, Wang P, Chen S, Guo T, Li Z, Liang B, Qin P, Zhang W, Hao Y. The association between wind speed and the risk of injuries among preschool children: New insight from a sentinel-surveillance-based study. Sci Total Environ 2023; 856:159005. [PMID: 36162582 DOI: 10.1016/j.scitotenv.2022.159005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/09/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Injuries among preschool children are an important public health concern worldwide. Significant gaps remain in understanding the potential impact of wind speed on injuries among preschoolers. We aimed to clarify the association and its variation across subgroups to capture the vulnerability features. METHODS Using a case-crossover design and conditional logistic regression model, we compared the exposure to wind speed right before the injury events (case period) with that of control periods to determine the excess rate (ER) of injury on each of 0-3 lag days in Guangzhou, 2016-2020. Results were also stratified by sociodemographic characteristics of patients, basic characteristics of injury events, and clinical features of injuries to identify the most vulnerable subgroups of preschoolers. RESULTS Higher wind speed was significantly associated with an increased risk of injuries among preschoolers on lag 0, reaching an ER of 2.93 % (95 % confidence interval [CI] = 0.87, 5.03), but not on other lag days. The results of the stratified analyses showed that children under 3-year-old (3.41 %; 95 % CI = 0.36, 6.55), boys (3.66 %; 95 % CI = 1.04, 6.35), and non-locally registered children (3.65; 95 % CI = 0.02, 7.40) were more prone to wind-related injuries. Falls (2.67 %; 95 % CI = 0.11, 5.30) were the main cause of wind-related injuries, and taking transportation was the main activity when injuries occurred (13.16 %; 95 % CI = 4.45, 22.60). Additionally, injuries involving buildings/grounds/obstacles (4.69 %; 95 % CI = 1.66, 7.81) and the occurrence of sprain/strain (7.60 %; 95 % CI = 0.64, 15.04) showed a positive association with wind speed. CONCLUSIONS Higher wind speed was associated with a significantly elevated rate of injuries among preschoolers without delayed effects, where children under 3-year-old, boys, and non-locally registered subgroups were more susceptible to wind-related injuries. This study may provide new insights for refining the prevention measures against wind-related injuries among preschoolers.
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Affiliation(s)
- Congxing Shi
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Xiao Lin
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Tingyuan Huang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, China
| | - Kai Zhang
- Department of Environmental Health Sciences, University at Albany, the State University of New York, Rensselaer, NY, USA
| | - Yanan Liu
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Tian Tian
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Pengyu Wang
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Shimin Chen
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Tong Guo
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Zhiqiang Li
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Boheng Liang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, China
| | - Pengzhe Qin
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, China.
| | - Wangjian Zhang
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China.
| | - Yuantao Hao
- Department of Medical Statistics, Center for Health Information Research, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, 100191, Beijing, China.
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Lee K, Hwang J. The Association between Comorbidities and Comorbid Injuries on Treatment Outcome in Pediatric and Elderly Patients with Injuries in Korea: An Observational Study. Int J Environ Res Public Health 2022; 19. [PMID: 35627814 DOI: 10.3390/ijerph19106277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022]
Abstract
We aimed to compare the characteristics and types of injuries affecting pediatric and elderly patients and to identify factors associated with treatment outcomes. We used data from the 2006−2017 Korea National Hospital Discharge Survey. The patients were divided into two groups, children (0−12 years) and elderly (≥65 years), based on their age at discharge. In total, 47,528 (11,842 children and 35,686 older adults) patients with injuries were identified. The number of deaths and the LOS were 36 (0.3%) and 7.6 days (±10.1), respectively, in the children group, and 861 (2.4%) and 18.5 days (±27.3), respectively, in the elderly group (p < 0.001). In the children group, there were increased odds for surgery among boys, Medicaid and health insurance subscribers, patients with multiple injuries, patients without a subdiagnosis, and an increasing number of hospital beds. In the elderly group, there were increased odds for surgery among women, Medicaid and health insurance subscribers, patients who died, patients with a single injury, patients with a subdiagnosis, and increasing numbers of hospital beds. Treatment outcomes could be improved by providing early diagnosis and prompt treatment in pediatric patients and by taking multilateral approaches for multiple injuries and comorbidities in elderly patients.
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Curtis K, Kennedy B, Lam MK, Mitchell RJ, Black D, Jan S, Burns B, Dinh M, Holland AJ. Predictors of 12 month functional outcomes and length of stay of severely injured children in NSW, Australia. A longitudinal multi-centre study. Injury 2022; 53:1684-9. [PMID: 35031107 DOI: 10.1016/j.injury.2021.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/16/2021] [Accepted: 12/31/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The majority of paediatric injury outcomes studies focus on mortality rather than the impact on long-term quality of life, health care use and other health-related outcomes. This study sought to determine predictors of 12-month functional and psychosocial outcomes for children sustaining major injury in NSW. METHODS The study included all children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW at a paediatric trauma centre (PTC). Children were identified through the three PTCs and NSW Trauma Registry. The paediatric Quality of Life Inventory (PedsQL) and EuroQol five-dimensional EQ-5D-Y were used to measure HRQoL post-injury, completed via parent/carer proxy recruited through NSW PTCs. RESULTS There were 510 children treated at the three NSW PTCs during the 15-month study period. The mean (SD) age was 6.7 (6.0) years, with a median NISS (New Injury Severity Score) of 11 (IQR: 9-18). Regression analysis showed worse psychosocial health at twelve months was associated with hospital length of stay (LoS) and number of body regions injured (F2,65 = 5.85, p = 0.005). Physical outcome was associated with LoS and intensive care unit (ICU) admission (F2,66 = 13.48, p < 0.001). Hospital LoS was significantly associated with NISS and head injury (F2,398 = 51.5, p < 0.001). CONCLUSION Hospital length of stay and polytrauma are independent factors that negatively influence psychological and physical outcomes of children with major injuries. Early intervention to enable emotional well-being, discharge home and long-term follow up such as dedicated family support and rehabilitation at home could reduce preventable poor outcomes.
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Martin-Herz SP, McMahon RJ, Malzyner S, Chiang N, Zatzick DF. Impact of posttraumatic stress disorder and depressive symptoms on quality of life in adolescents after general traumatic injury. J Trauma Stress 2022; 35:386-397. [PMID: 34861072 DOI: 10.1002/jts.22750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Abstract
Posttraumatic stress disorder (PTSD) and depressive symptoms have been associated with poorer health-related quality of life in adolescents after general traumatic injuries; few studies have examined the broader construct of postinjury quality of life (QOL). We evaluated the impact of traumatic injury on adolescent QOL and examined factors that potentially contribute to poorer outcomes, using the Youth Quality of Life Instrument-Research Version as the outcome measure. Data were collected within 30 days postinjury and 2, 5, and 12 months postinjury. Mixed-model regression (MMR) was used for the main analyses. Participants (N = 204) were drawn from a prospective cohort study of 12-18-year-olds admitted to a Level 1 trauma center (n = 108) and healthy participants from a local cross-sectional study (n = 116); study group participants were significantly older. The initial MMR indicated that female adolescents had significantly lower QOL, B = -2.69, 95% CI [-4.68, -0.70], and were more likely to score above the cutoffs for PTSD (19.1% vs. 2.0%), χ2 (1, N = 381) = 34.6, p < .001, or depression (32.8% vs. 14.0%), χ2 (1, N = 381) = 18.7, p < .001, on post hoc analyses. Adolescents with mental health conditions in the year postinjury had significant QOL deficits without predicted improvements toward baseline, PTSD: B = -10.05, 95% CI [-15.29, -4.81]; depression: B = -18.00, 95% CI [-21.69, -14.31]. These findings highlight the importance of ongoing mental health monitoring and care for adolescents, particularly female adolescents, following traumatic injury even when physical recovery appears complete.
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Affiliation(s)
- Susanne P Martin-Herz
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Robert J McMahon
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.,B.C. Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | | | - Nikki Chiang
- University of California, Berkeley, Berkeley, California, USA
| | - Douglas F Zatzick
- Department of Psychiatry, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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Perea LL, Echeverria Rosario K, Staman S, Fox N. Pediatric Trauma: What Hurts? Pediatr Emerg Care 2022; 38:e943-e946. [PMID: 34267158 DOI: 10.1097/pec.0000000000002499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pediatric trauma patients are injured during crucial developmental years and require subsequent absence from school and activities. The impact of these changes on pediatric trauma patients is not well studied. We sought to assess the functional and emotional impact of pediatric trauma. In addition, the inpatient experience was evaluated for performance improvement purposes. METHODS A prospective survey was conducted at our trauma center (February 2019 to May 2019) of admitted trauma patients (<18 years). Patients who died before admission and nonaccidental trauma patients were excluded. Patients completed an inpatient survey and another at 3 months postdischarge. RESULTS Sixty patients were enrolled; 31 completed follow-up. Patients were 10 ± 5 years, 75% being male (n = 45), with an Injury Severity Score of 7 ± 6. A total of 13% were seen by behavioral medicine while inpatient; 18% of patients had preexisting anxiety. Preexisting functional limitations existed in 7% of the patients. At 3 months, 71% were back to preinjury academics, and 58% had returned to extracurriculars. At follow-up, 10% of patients felt withdrawn, and 32% felt emotional/distracted. Only 13% of patients were undergoing therapy compared with 7% preinjury. Patients communicated their best/worst experiences. CONCLUSION Pediatric trauma patients experience significant functional and emotional limitations after trauma. This suggests that all pediatric trauma patients should be evaluated by behavioral medicine during their admission with postdischarge support services offered. Performance improvement opportunities were identified in areas of pain control and communication.
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Affiliation(s)
- Lindsey L Perea
- From the Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Hospital, Lancaster, PA
| | | | - Stacey Staman
- Department of Surgery, Division of Trauma, Cooper University Hospital, Camden, NJ
| | - Nicole Fox
- Department of Surgery, Division of Trauma, Cooper University Hospital, Camden, NJ
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10
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Dipnall JF, Rivara FP, Lyons RA, Ameratunga S, Brussoni M, Lecky FE, Bradley C, Beck B, Lyons J, Schneeberg A, Harrison JE, Gabbe BJ. Predictors of health-related quality of life following injury in childhood and adolescence: a pooled analysis. Inj Prev 2021; 28:301-310. [PMID: 34937765 DOI: 10.1136/injuryprev-2021-044309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Injury is a leading contributor to the global disease burden in children and places children at risk for adverse and lasting impacts on their health-related quality of life (HRQoL) and development. This study aimed to identify key predictors of HRQoL following injury in childhood and adolescence. METHODS Data from 2259 injury survivors (<18 years when injured) were pooled from four longitudinal cohort studies (Australia, Canada, UK, USA) from the paediatric Validating Injury Burden Estimates Study (VIBES-Junior). Outcomes were the Paediatric Quality of Life Inventory (PedsQL) total, physical, psychosocial functioning scores at 1, 3-4, 6, 12, 24 months postinjury. RESULTS Mean PedsQL total score increased with higher socioeconomic status and decreased with increasing age. It was lower for transport-related incidents, ≥1 comorbidities, intentional injuries, spinal cord injury, vertebral column fracture, moderate/severe traumatic brain injury and fracture of patella/tibia/fibula/ankle. Mean PedsQL physical score was lower for females, fracture of femur, fracture of pelvis and burns. Mean PedsQL psychosocial score was lower for asphyxiation/non-fatal submersion and muscle/tendon/dislocation injuries. CONCLUSIONS Postinjury HRQoL was associated with survivors' socioeconomic status, intent, mechanism of injury and comorbidity status. Patterns of physical and psychosocial functioning postinjury differed according to sex and nature of injury sustained. The findings improve understanding of the long-term individual and societal impacts of injury in the early part of life and guide the prioritisation of prevention efforts, inform health and social service planning to help reduce injury burden, and help guide future Global Burden of Disease estimates.
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Affiliation(s)
- Joanna F Dipnall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Frederick P Rivara
- Departments of Pediatrics and Epidemiology, and the Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Ronan A Lyons
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University, Swansea, UK.,National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK
| | - Shanthi Ameratunga
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Population Health, University of Auckland, Auckland, New Zealand.,Kidz First Hospital and Population Health Directorate, Counties Manukau District Health Board, Auckland, New Zealand
| | - Mariana Brussoni
- Department of Pediatrics, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Fiona E Lecky
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK.,Emergency Department, Salford Royal Hospital, Salford, UK
| | - Clare Bradley
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | - Amy Schneeberg
- British Columbia Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - James E Harrison
- Flinders Institute for Health and Medical Research, Flinders University, Adelaide, South Australia, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University, Swansea, UK
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11
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Burd RS, Jensen AR, VanBuren JM, Alvey JS, Richards R, Holubkov R, Pollack MM. Long-Term Outcomes after Pediatric Injury: Results of the Assessment of Functional Outcomes and Health-Related Quality of Life after Pediatric Trauma Study. J Am Coll Surg 2021; 233:666-675.e2. [PMID: 34592405 DOI: 10.1016/j.jamcollsurg.2021.08.693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Disability and impaired health-related quality of life can persist for months among injured children. Previous studies of long-term outcomes have focused mainly on children with specific injury types rather than those with multiple injured body regions. This study's objective was to determine the long-term functional status and health-related quality of life after serious pediatric injury, and to evaluate the associations of these outcomes with features available at hospital discharge. STUDY DESIGN We conducted a prospective observational study at 7 Level I pediatric trauma centers of children treated for at least 1 serious (Abbreviated Injury Scale severity 3 or higher) injury. Patients were sampled to increase the representation of less frequently injured body regions and multiple injured body regions. Six-month functional status was measured using the Functional Status Scale (FSS) and health-related quality of life using the Pediatric Quality of Life Inventory. RESULTS Among 323 injured children with complete discharge and follow-up assessments, 6-month FSS score was abnormal in 33 patients (10.2%)-16 with persistent impairments and 17 previously normal at discharge. Increasing levels of impaired discharge FSS score were associated with impaired FSS and lower Pediatric Quality of Life Inventory scores at 6-month follow-up. Additional factors on multivariable analysis associated with 6-month FSS impairment included older age, penetrating injury type, severe head injuries, and spine injuries, and included older age for lower 6-month Pediatric Quality of Life Inventory scores. CONCLUSIONS Older age and discharge functional status are associated with long-term impairment of functional status and health-related quality of life. Although most seriously injured children return to normal, ongoing disability and reduced health-related quality of life remained 6 months after injury. Our findings support long-term assessments as standard practice for evaluating the health impacts of serious pediatric injury.
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Affiliation(s)
- Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Medical Center.
| | | | - John M VanBuren
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Jessica S Alvey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Rachel Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Murray M Pollack
- Department of Pediatrics, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington DC
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Ramirez MR, Flores JE, Woods-Jaeger B, Cavanaugh JE, Peek-Asa C, Branch C, Bolenbaugh M, Chande V, Pitcher G, Ortega HW, Randell KA, Wetjen K, Roth L, Kenardy J. Comparative Effectiveness of Parent-Based Interventions to Support Injured Children. Pediatrics 2021; 148:peds.2020-046920. [PMID: 34556547 DOI: 10.1542/peds.2020-046920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES A comparative effectiveness trial tested 2 parent-based interventions in improving the psychosocial recovery of hospitalized injured children: (1) Link for Injured Kids (Link), a program of psychological first aid in which parents are taught motivational interviewing and stress-screening skills, and (2) Trauma Education, based on an informational booklet about trauma and its impacts and resources. METHODS A randomized controlled trial was conducted in 4 children's hospitals in the Midwestern United States. Children aged 10 to 17 years admitted for an unintentional injury and a parent were recruited and randomly assigned to Link or Trauma Education. Parents and children completed questionnaires at baseline, 6 weeks, 3 months, and 6 months posthospitalization. Using an intent-to-treat analysis, changes in child-reported posttraumatic stress symptoms, depression, quality of life, and child behaviors were compared between intervention groups. RESULTS Of 795 injured children, 314 children and their parents were enrolled into the study (40%). Link and Trauma Education was associated with improved symptoms of posttraumatic stress, depression, and pediatric quality of life at similar rates over time. However, unlike those in Trauma Education, children in the Link group had notable improvement of child emotional behaviors and mild improvement of conduct and peer behaviors. Compared with Trauma Education, Link was also associated with improved peer behaviors in rural children. CONCLUSION Although children in both programs had reduced posttrauma symptoms over time, Link children, whose parents were trained in communication and referral skills, exhibited a greater reduction in problem behaviors.
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Affiliation(s)
- Marizen R Ramirez
- University of Minnesota, Minneapolis, Minnesota .,University of Iowa, Iowa City, Iowa
| | | | - Briana Woods-Jaeger
- Mercy Children's Hospital, Kansas City, Missouri.,Emory University, Atlanta, Georgia
| | | | | | | | | | | | | | - Henry W Ortega
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
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13
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Dipnall JF, Rivara FP, Lyons RA, Ameratunga S, Brussoni M, Lecky FE, Bradley C, Beck B, Lyons J, Schneeberg A, Harrison JE, Gabbe BJ. Health-Related Quality of Life (HRQoL) Outcomes Following Injury in Childhood and Adolescence Using EuroQol (EQ-5D) Responses with Pooled Longitudinal Data. Int J Environ Res Public Health 2021; 18:10156. [PMID: 34639458 DOI: 10.3390/ijerph181910156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Injury is a leading contributor to the global disease burden in children, affecting their health-related quality of life (HRQoL)-yet valid estimates of burden are absent. METHODS This study pooled longitudinal data from five cohort studies of pediatric injury survivors (5-17 years) at baseline, 1-, 4-, 6-, 12-, and 24- months (n = 2334). HRQoL post-injury was measured using the 3-level EQ-5D utility score (EQ-5D) and five health states (mobility, self-care, activity, pain, anxiety and depression (anxiety)). RESULTS Mean EQ-5D post-injury did not return to baseline level (0.95) by 24 months (0.88) and was lower for females over time (-0.04, 95%CI -0.05, -0.02). A decreased adjusted risk ratio over time (ARR) was observed for intentional injuries (pain: 0.85, 95%CI 0.73,0.98; anxiety: 0.62, 95%CI 0.49,0.78); spinal cord injuries (mobility: 0.61, 95%CI 0.45,0.83), self-care: 0.76, 95%CI 0.63,0.91, activity: 0.64, 95%CI 0.47,0.88); moderate/severe traumatic brain injury (activity: 0.83, 95%CI 0.71,0.96). ARRs were also low for certain fractures, with various health states affected. CONCLUSIONS HRQoL outcomes over time for children and adolescents post-injury differed across key demographic and injury related attributes. HRQoL did not reach levels consistent with full health by 24 months with recovery plateauing from 6 to 24 months. Tailored interventions are required to respond to the varying post-injury recovery trajectories in this population.
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14
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Smith J, Chhina H, Sidhu P, Brussoni M, Pike I, Cooper A. Paediatric elbow fractures and public play spaces: adherence to standards for children's playground equipment and surfacing. BMJ Paediatr Open 2021; 5:e001125. [PMID: 34786490 PMCID: PMC8587356 DOI: 10.1136/bmjpo-2021-001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/05/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Supracondylar humerus fractures (SCHF) are the most common fractures sustained following a fall onto an outstretched hand among healthy children, and one of the leading causes of hospital admission and surgical intervention. The aim of this study was to examine SCHF occurring at public play spaces-particularly to determine whether or not the playground equipment implicated in injurious falls aligned with Canadian playground safety standards. METHODS Cases of children who attended the provincial paediatric orthopaedic clinic following SCHF at a public playground between April 2017 and October 2019 were included in the study. A research assistant visited each playground to measure the play structure type and dimensions, height of the equipment at the point from which the child fell and the type and depth of the surface material, and compare measurements to the 2016 safety standards. Child demographics and injury classification were also noted. Descriptive statistics were calculated and a scatterplot of fall height and surface depth was generated. RESULTS Forty-three sites, representing 47 SCHF cases (18 female, 29 male), were included in the final analysis. Fourteen children sustained type 1 fracture, 23 had type 2 fracture and the remaining 10 had type 3 fracture. Five children with type 2 fracture and all 10 children with type 3 fracture required surgery. The majority of sites had engineered wood fibre surfacing, with surfacing at 35 sites being less than 300 mm deep. Twenty-six play structures were upper body equipment (ie, monkey bars or similar), seven were track rides, five were rotating structures and the rest comprised a variety of classified and unclassified structures. Twenty-seven children fell from a height exceeding 2 m. CONCLUSIONS The majority of SCHF cases occurred at playgrounds with insufficient surface depth and/or non-compliant equipment. Upper body equipment, track rides and rotating play structures were of particular concern, as the children fell from heights exceeding the recommended standard, likely reflecting the degradation and compaction of the surfacing material over time.
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Affiliation(s)
- Jennifer Smith
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Harpreet Chhina
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Pardeep Sidhu
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Mariana Brussoni
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, School of Population and Public Health, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.,Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Anthony Cooper
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Orthopaedics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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15
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Marson BA, Manning JC, James M, Ikram A, Bryson DJ, Ollivere BJ. Trends in hospital admissions for childhood fractures in England. BMJ Paediatr Open 2021; 5:e001187. [PMID: 34786491 PMCID: PMC8587381 DOI: 10.1136/bmjpo-2021-001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Fractures to the axial and appendicular skeleton are common in children causing loss of opportunities and disability. There are relatively few studies available to quantify the number of children who have their fractures diagnosed in the emergency department and are then admitted to hospital for ongoing management. The purpose of this study is to explore trends of frequency, types and age of children sustaining fractures who were admitted for intervention to National Health Service (NHS) hospitals. DESIGN The study uses data from the Hospital Episode Statistics and Office for National Statistics from 2012 to 2019 to calculate the annual incidence of hospital admission for limb, spine, facial and skull fractures per 100 000 children. RESULTS During 2012-2019, 368 120 children were admitted to English NHS hospitals with a fracture. 256 008 (69.5%) were upper limb fractures, 85 737 (23.3%) were lower limb fractures and 20 939 (5.7%) were skull or facial fractures. The annual incidence of upper limb fractures was highest in children aged 5-9 (348.3 per 100 000 children) and the highest incidence of lower limb fractures was in children aged 10-15 (126.5 per 100 000 children). The incidence of skull and facial fractures in preschool (age 0-4) children has been increasing at a rate of 0.629 per 100 000 children per year. IMPLICATIONS The annual incidence of hospital admission for fractures in children has been shown to be consistent for several fracture types between 2012 and 2019. An increasing trend of admissions with preschool skull fractures was observed, though the study data do not have sufficient granularity to demonstrate if this is due to changes in practice or to accidental or non-accidental causes.
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Affiliation(s)
- Ben Arthur Marson
- Orthopaedics and Trauma, University of Nottingham School of Medicine, Nottingham, UK
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Marilyn James
- Clinical Trials Unit, University of Nottingham School of Medicine, Nottingham, UK
| | - Adeel Ikram
- Orthopaedics and Trauma, University of Nottingham School of Medicine, Nottingham, UK
| | - David J Bryson
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Benjamin J Ollivere
- Orthopaedics and Trauma, University of Nottingham School of Medicine, Nottingham, UK
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16
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Lee MS, Kim HS, Park EJ, Bhang SY. Efficacy of the 'Children in Disaster: Evaluation and Recovery (CIDER)' Protocol for Traumatized Adolescents in Korea. J Korean Med Sci 2020; 35:e240. [PMID: 32715670 PMCID: PMC7384899 DOI: 10.3346/jkms.2020.35.e240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/01/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We aimed to evaluate the feasibility of trauma-focused group therapy in adolescents exposed to traumatic events in Korea. METHODS We recruited 22 adolescents (mean age, 16 years; standard deviation, 1.43; range, 13-18 years). Children in Disaster: Evaluation and Recovery (CIDER) V1.0 is a trauma-focused group therapy comprising eight 50-minute-long sessions. The effectiveness of the intervention was evaluated using the Korean version of the Children's Response to Traumatic Events Scale-Revised (K-CRTES-R), the Beck Depression Inventory (BDI), the State Anxiety Inventory for Children (SAIC), and the Pediatric Quality of Life Inventory (PedsQL). The data were analyzed by the Wilcoxon signed-rank test. RESULTS A significant improvement was revealed in trauma-related symptom scores (Z = -2.85, P < 0.01), depressive symptom scores (Z = -2.35, P < 0.05) and quality of life scores (Z = -3.08, P < 0.01). Additionally, a marginally significant improvement was found in anxiety symptom scores (Z = -1.90, P = 0.058). CONCLUSION CIDER is a potentially effective intervention for adolescents exposed to traumatic events. Larger controlled trials are needed. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0004681.
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Affiliation(s)
- Mi Sun Lee
- Department of Meditation Psychology, Nungin University, Hwaseong, Korea
| | - Hyun Soo Kim
- Department of Psychiatry, Myongji Hospital, Goyang, Korea
| | - Eun Jin Park
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
- Hallym University Suicide and School Mental Health Institute, Anyang, Korea
| | - Soo Young Bhang
- Hallym University Suicide and School Mental Health Institute, Anyang, Korea
- Department of Psychiatry, Eulji University Hospital, Eulji University School of Medicine, Seoul, Korea.
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17
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Geraerds AJLM, Richardson A, Haagsma J, Derrett S, Polinder S. A systematic review of studies measuring health-related quality of life of general injury populations: update 2010-2018. Health Qual Life Outcomes 2020; 18:160. [PMID: 32471430 PMCID: PMC7260776 DOI: 10.1186/s12955-020-01412-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
Background Studies examining the impact of injury on health-related quality of life (HRQL) over time are necessary to understand the short- and long-term consequences of injury for population health. The aim of this systematic review was to provide an evidence update on studies that have measured HRQL over time in general injury populations using a generic (general) health state measure. Methods Studies conducted between 2010 and 2018 that assessed HRQL at more than one time point among general injury populations were eligible for inclusion. Two reviewers independently extracted information from each study on design, HRQL measure used, method of HRQL measure administration, timing of assessment(s), predictive variables, ability to detect change, and findings. Quality appraisals of each study were also completed by two reviewers using items from the RTI Item Bank on Risk of Bias and Precision of Observational Studies and the Guidelines for the Conduction of Follow-up Studies Measuring Injury-Related Disability. Results Twenty-nine studies (44 articles) that met the inclusion criteria were identified. HRQL was measured using 14 different generic measures; the SF-36, SF-12, and EQ-5D were used most frequently. A varying number of follow-up assessments were undertaken, ranging from one to five. Follow-up often occurred 12 months post-injury. Fewer studies (n = 11) examined outcomes two or more years post-injury, and only one to 10 years post-injury. While most studies documented improvements in HRQL over time since the injury event, study populations had not returned to pre-injury status or reached general population norm HRQL values at post-injury follow-ups. Conclusions Since 2010 there has been a substantial increase in the number of studies evaluating the HRQL of general injury populations. However, significant variability in study design continues to impede quantification of the impact of injury on population health over time. Variation between studies is particularly evident with respect to timing and number of follow-up assessments, and selection of instruments to evaluate HRQL.
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Affiliation(s)
- A J L M Geraerds
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
| | - Amy Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
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18
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Burd RS. Improving the outcomes of injured children: New challenges and opportunities Pediatric Trauma Society Sixth Annual Meeting presidential address. J Trauma Acute Care Surg 2020; 89:607-15. [PMID: 32345896 DOI: 10.1097/TA.0000000000002767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Bardón Cancho EJ, Arribas Sánchez C, Rivas García A, Lorente Romero J, Vázquez López P, Marañón Pardillo R. Management and serious risk factors associated with unintentional injuries in paediatric emergencies in Spain. Anales de Pediatría (English Edition) 2020. [DOI: 10.1016/j.anpede.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Johnson L, Messner J, Igoe EJ, Foster P, Harwood P. Quality of life and post-traumatic stress symptoms in paediatric patients with tibial fractures during treatment with cast or Ilizarov frame. Injury 2020; 51:199-206. [PMID: 31703960 DOI: 10.1016/j.injury.2019.10.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare quality of life in children and adolescents with tibial fracture during treatment with either a definitive long-leg cast or Ilizarov frame. METHODS A prospective, longitudinal cohort study was undertaken. Patients aged between 5 and 17 years with tibial fractures treated definitively using a long-leg cast or Ilizarov frame were recruited at first follow-up. Health related quality of life was measured at each clinic appointment during treatment using the Pediatric Quality of Life Inventory (PedsQL) [1]; a validated measure of age-adjusted physical and psychosocial functioning. Psychological trauma symptoms were assessed using the Children's Revised Impact of Events Scale (CRIES) [2]. Results were analysed based on time from injury (less than 30 days, 30 to 120 days). Data regarding injury and treatment was recorded from the clinical records. Statistical analysis was undertaken using a Kruksal-Wallis test with a Tukey-Kramer subgroup analysis. RESULTS Twenty-five patients from each group were included in the final analysis. Injuries were more severe in the frame patients based on the AO/OTA classification and number of open fractures. No statistically significant differences were detected in any of the outcome scores between treatment groups at either time point. A significant improvement was found in the child reported physical and total domains in both treatment groups based on time from application (<30 days vs. >30 days, frame: p < 0.0001, cast: p = 0.003). There were no differences in the child reported psychosocial domain scores at any time point or between treatment groups. Parent reported scores only showed a significant physical improvement in the frame group (p < 0.0001). CRIES scores for psychological trauma in the intrusion and avoidance domain improved significantly in the cast group between time points (p < 0.05), Multivariate analysis identified polytrauma, mechanism of injury and time from injury but not treatment modality (cast or frame) as significant predictors of quality of life scores (PedsQL) and severity of post-traumatic symptoms (CRIES). CONCLUSION We found no difference in health-related quality of life during treatment between our patients treated for tibial fractures using a cast or an Ilizarov frame.
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Affiliation(s)
- L Johnson
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom.
| | - J Messner
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - E J Igoe
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - P Foster
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - P Harwood
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
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Woods-Jaeger BA, Sexton CC, Branch C, Bolenbaugh M, Roth L, Stelson EA, Braaten N, Ramirez M. Engaging parent-child dyad and healthcare provider stakeholders in a patient-centered comparative effectiveness study. J Comp Eff Res 2019; 8:721-732. [PMID: 31290702 DOI: 10.2217/cer-2018-0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Describe engagement activities in a comparative effectiveness study evaluating two interventions for promoting psychosocial health among youth ages 10-17 who have recently experienced a nonintentional injury. Methods: Institutional, community and patient stakeholders from four children's hospitals were engaged through consultation meetings, individual interviews and a collaborative meeting. Results: 67 engagement activities were conducted across four hospitals. Feedback to improve recruitment, retention and continuous engagement in the study was obtained. Finally, disseminating study interventions to school and healthcare settings, and adding alternative delivery formats were identified as priority next steps. Conclusion: Results highlight diverse methods of engaging patient and professional stakeholders, critical recommendations for improving study engagement and retention, and future directions for this patient-engaged comparative effectiveness research.
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Affiliation(s)
- Briana A Woods-Jaeger
- Developmental and Behavioral Sciences, Children's Mercy Hospital, Kansas City, MO 64108, USA.,Emory University, GA 30322, USA
| | - Chris C Sexton
- Developmental and Behavioral Sciences, Children's Mercy Hospital, Kansas City, MO 64108, USA.,Kansas Center for Anxiety Treatment (KCCAT), KS 66212, USA
| | | | | | - Lisa Roth
- University of Iowa, IA 52242, USA.,Blank Children's Hospital, IA 50309, USA
| | | | | | - Marizen Ramirez
- University of Iowa, IA 52242, USA.,University of Minnesota, MN 55455, USA
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22
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Bardón Cancho EJ, Arribas Sánchez C, Rivas García A, Lorente Romero J, Vázquez López P, Marañón Pardillo R. [Management and serious risk factors associated with unintentional injuries in paediatric emergencies in Spain]. An Pediatr (Barc) 2019; 92:132-140. [PMID: 31266733 DOI: 10.1016/j.anpedi.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Thirty-eight million patients with injuries are treated in Emergency Departments every year, 90% of them being in the form of unintentional injuries (UIs). There are currently no global records of its management in Spain, or the risk factors that may be associated with them. The objective of this study is to describe the management of UIs in Spanish paediatric emergency departments, and to analyse factors related to the presence of serious injuries. MATERIAL AND METHODS A sub-study of a prospective multicentre observational study conducted over 12months in 11hospitals of the Spanish Paediatric Emergency Research Group (RiSEUP-SPERG), including children from 0 to 16years of age consulting for UIs. Epidemiological data, circumstances of the injury, and data on emergency care and discharge destination were recorded on the 13th day of each month. RESULTS A total of 10,175 episodes were recorded, of which 1,941 were UIs (19.1%), including 1,673, of which 257 (15.4%) were severe. The most frequent complementary test was simple radiography (60.0%), and the most frequent procedure was limb immobilisation (38.6%). A significant relationship was found between presenting with a severe UI and age >5 years (OR2.24; 95%CI: 1.61-3.16), history of fracture (OR2.05; 95%CI: 1.22-3.43), or sports activity as a mechanism of injury (OR1.76; 95%CI: 1.29-2.38), among others. CONCLUSION In Spain, most UIs are not serious. X-rays and immobilisation of extremities are the most frequently performed tests and procedures. Severe UIs were associated with individual factors, such as age >5years or history of fracture, and with sports activity as a mechanism associated with severity. It is vital to implement measures to improve the prevention of these injuries and to support the training of caregivers through educational programmes.
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Affiliation(s)
- Eduardo J Bardón Cancho
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Cristina Arribas Sánchez
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Arístides Rivas García
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Jorge Lorente Romero
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Paula Vázquez López
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Rafael Marañón Pardillo
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
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Abstract
Injury is a major public health crisis contributing to more than 4.48 million deaths annually. Trauma registries have proven highly effective in reducing injury morbidity and mortality rates in high income countries. They are a critical source of information for injury prevention, benchmarking care, quality improvement, and resource allocation. Historically, low and middle income countries (LMICs) have largely been excluded from trauma registry development due to limited resources. Recently, this has begun to change with low-resource hospitals adopting innovative strategies to implement trauma registries. Nonetheless, dissemination of these strategies remains fragmented. Hospitals looking to develop their own trauma registries have no current, comprehensive resource that summarises the implementation decisions of other registries in similar contexts. This scoping review aims to identify where trauma registries are located in LMICs, bringing up to date previous estimates, and to identify the most common approaches to registry implementation and operation in these settings.
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Affiliation(s)
- Leah Rosenkrantz
- Department of Geography, Simon Fraser University , Burnaby , Canada
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University , Burnaby , Canada
| | - Morad Hameed
- Divisions of General Surgery, Vancouver General Hospital, University of British Columbia , Vancouver , Canada
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24
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Ishikawa T, Mâsse LC, Brussoni M. Changes in parents' perceived injury risk after a medically-attended injury to their child. Prev Med Rep 2019; 13:146-152. [PMID: 30591856 PMCID: PMC6305837 DOI: 10.1016/j.pmedr.2018.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/31/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022] Open
Abstract
Unintentional injuries are a major cause of hospitalization and death for children worldwide. Since children who sustain a medically-attended injury are at higher risk of recurrence, it is crucial to generate knowledge that informs interventions to prevent re-incidence. This study examines when, in the year following a medically-attended injury, parents perceive the greatest risk of injury recurrence. Since perception of injury risk is associated with parental preventive behavior, this can inform decisions on the timing of parent-targeted interventions to prevent re-injury. Study participants were 186 English-fluent parents of children 0 to 16 years, presenting at the British Columbia Children's Hospital for an unintentional pediatric injury. Parents were excluded if their child had a disability or chronic health condition. Perceived risk of the same and of any injury recurring were elicited from parents, when they sought treatment at the hospital, as well as one, four, and twelve months later. The study ran between February 2011 and December 2013. Mixed-effects models were used to analyze changes in parents' responses. Analysis indicates that perceived risk of the same injury recurring did not change. However, perceived risk of any injury recurring increased from baseline to first follow-up, then decreased during the rest of the year. Overall, perceived risk of any injury was higher for parents whose child had a history of injuries. Visits to the Emergency Department for a pediatric injury may not be optimal timing to deploy injury prevention interventions for parents. Follow-up visits (when parents' perceived risk is highest) may be better.
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Affiliation(s)
- Takuro Ishikawa
- Department of Pediatrics, University of British Columbia: Rm 2D19, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- British Columbia Children's Hospital Research Institute, F503, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- BC Injury Research and Prevention Unit, F508, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Louise C. Mâsse
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
- British Columbia Children's Hospital Research Institute, F503, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Mariana Brussoni
- Department of Pediatrics, University of British Columbia: Rm 2D19, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
- British Columbia Children's Hospital Research Institute, F503, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- BC Injury Research and Prevention Unit, F508, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
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25
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Ryder C, Mackean T, Hunter K, Williams H, Clapham K, Holland AJA, Ivers R. Equity in functional and health related quality of life outcomes following injury in children - a systematic review. Critical Public Health 2019. [DOI: 10.1080/09581596.2019.1581918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Courtney Ryder
- The George Institute for Global Health, UNSW, Sydney, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Tamara Mackean
- The George Institute for Global Health, UNSW, Sydney, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Kate Hunter
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Hayley Williams
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kathleen Clapham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Andrew J. A. Holland
- Discipline of Child & Adolescent Health, The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, UNSW, Sydney, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
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26
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Gabbe BJ, Dipnall JF, Lynch JW, Rivara FP, Lyons RA, Ameratunga S, Brussoni M, Lecky FE, Bradley C, Simpson PM, Beck B, Demmler JC, Lyons J, Schneeberg A, Harrison JE. Validating injury burden estimates using population birth cohorts and longitudinal cohort studies of injury outcomes: the VIBES-Junior study protocol. BMJ Open 2018; 8:e024755. [PMID: 30082368 PMCID: PMC6078268 DOI: 10.1136/bmjopen-2018-024755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Traumatic injury is a leading contributor to the global disease burden in children and adolescents, but methods used to estimate burden do not account for differences in patterns of injury and recovery between children and adults. A lack of empirical data on postinjury disability in children has limited capacity to derive valid disability weights and describe the long-term individual and societal impacts of injury in the early part of life. The aim of this study is to establish valid estimates of the burden of non-fatal injury in children and adolescents. METHODS AND ANALYSIS Five longitudinal studies of paediatric injury survivors <18 years at the time of injury (Australia, Canada, UK and USA) and two whole-of-population linked administrative data paediatric studies (Australia and Wales) will be analysed over a 3-year period commencing 2018. Meta-analysis of deidentified patient-level data (n≈2,600) from five injury-specific longitudinal studies (Victorian State Trauma Registry; Victorian Orthopaedic Trauma Outcomes Registry; UK Burden of Injury; British Columbia Children's Hospital Longitudinal Injury Outcomes; Children's Health After Injury) and >1 million children from two whole-of-population cohorts (South Australian Early Childhood Data Project and Wales Electronic Cohort for Children). Systematic analysis of pooled injury-specific cohort data using a variety of statistical techniques, and parallel analysis of whole-of-population cohorts, will be used to develop estimated disability weights for years lost due to disability, establish appropriate injury classifications and explore factors influencing recovery. ETHICS AND DISSEMINATION The project was approved by the Monash University Human Research Ethics Committee project number 12 311. Results of this study will be submitted for publication in internationally peer-reviewed journals. The findings from this project have the capacity to improve the validity of paediatric injury burden measurements in future local and global burden of disease studies.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University, Swansea, UK
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK
| | - Joanna F Dipnall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - John W Lynch
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
- School of Population Health Sciences, University of Bristol, Bristol, UK
| | - Frederick P Rivara
- Departments of Pediatrics and Epidemiology, and the Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Ronan A Lyons
- Health Data Research UK, Swansea University, Swansea, UK
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Mariana Brussoni
- Department of Pediatrics, School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Injury Research and Prevention Unit, Children's Hospital Research Institute, Vancouver, Canada
| | - Fiona E Lecky
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Clare Bradley
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Pam M Simpson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Jane Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | - Amy Schneeberg
- British Columbia Injury Research and Prevention Unit, Children's Hospital Research Institute, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - James E Harrison
- Research Centre for Injury Studies, Flinders University, Adelaide, South Australia, Australia
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27
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Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, Knoester H, Pollack MM, Rennick J, Curley MAQ. Life after Critical Illness in Children-Toward an Understanding of Pediatric Post-intensive Care Syndrome. J Pediatr 2018; 198:16-24. [PMID: 29728304 DOI: 10.1016/j.jpeds.2017.12.084] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022]
Affiliation(s)
- R Scott Watson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
| | - Karen Choong
- Department of Pediatrics and Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Colville
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sheri Crow
- Department of Pediatrics and Health Services Research, Mayo Clinic, Rochester, MN
| | - Leslie A Dervan
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
| | - Ramona O Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT; Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT; Department of Medicine, Pulmonary & Critical Care Division, Intermountain Medical Center, Murray, UT
| | - Hennie Knoester
- Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Murray M Pollack
- Children's National Health System, George Washington University, Washington, DC
| | - Janet Rennick
- Department of Nursing, Montreal Children's Hospital, Ingram School of Nursing and Department of Pediatrics (Division of Critical Care), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Martha A Q Curley
- Family and Community Health, School of Nursing, Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Critical Care and Cardiovascular Program, Boston Children's Hospital, Boston, MA
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28
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Abstract
Trauma is a major cause of morbidity and mortality in the pediatric population. However, temporal variations of trauma have not been well characterized and may have implications for appropriate allocation of hospital resources. Data from patients evaluated at an ACS-verified Level I pediatric trauma center between 2011 and 2015 were retrospectively analyzed. Date and time of injury, type of injury (blunt vs penetrating), and postemergency department disposition were reviewed. To assess temporal trends, heatmaps were constructed and a mixed poisson regression model was used to assess statistical significance. Pediatric trauma from blunt and penetrating injuries occurred at significantly higher rates between the hours of 1800 and 0100, on weekends compared with weekdays, and from May to August compared with November to February. These data provide useful information for hospital resource utilization. The emergency department, operating room, and intensive care unit should be prepared for increased trauma-related volume between May and August, weekends, and evening hours by appropriately increasing staff volume and resource availability.
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Affiliation(s)
- Eric M. Groh
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Paul L. Feingold
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Barry Hashimoto
- Department of International Studies, American University of Sharjah, Sharjah, United Arab Emirates
| | - Lucas A. McDuffie
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Troy A. Markel
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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29
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Ameratunga S, Ramke J, Jackson N, Tin Tin S, Gabbe B. Disparities in Non-Fatal Health Outcomes in Pediatric General Trauma Studies. Int J Environ Res Public Health 2017; 15:ijerph15010043. [PMID: 29280986 PMCID: PMC5800142 DOI: 10.3390/ijerph15010043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/21/2017] [Accepted: 12/25/2017] [Indexed: 12/01/2022]
Abstract
When prevention efforts fail, injured children require high-quality health services to support their recovery. Disparities in non-fatal injury outcomes, an indicator of health-care quality, have received minimal attention. We evaluated the extent to which general trauma follow-up studies published in the peer-reviewed scientific literature provide evidence of socially patterned inequities in health, functional or disability outcomes ≥4 weeks after childhood injuries. Using a systematic search, we identified 27 eligible cohort studies from 13 high-income countries. We examined the extent to which the reported health outcomes varied across the PROGRESS criteria: place of residence, race/ethnicity, occupation, gender/sex, religion, socio-economic status, and social capital. The available evidence on differential outcomes is limited as many studies were compromised by selection or retention biases that reduced the participation of children from demographic groups at increased risk of adverse outcomes, or the analyses mainly focused on variations in outcomes by sex. Given the limited research evidence, we recommend greater attention to systematic collection and reporting of non-fatal injury outcomes disaggregated by socio-demographic indicators in order to identify disparities where these exist and inform equity-focused interventions promoting the recovery of injured children.
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Affiliation(s)
- Shanthi Ameratunga
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Jacqueline Ramke
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Nicki Jackson
- Alcohol Healthwatch, Office Park Building Level 1, 27 Gillies Ave, Auckland 1023, New Zealand.
| | - Sandar Tin Tin
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, School of Public Health and Preventive Medicine, Level 3, 553 St Kilda Road, Melbourne 3004, Australia.
- Farr Institute, Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK.
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30
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Jagnoor J, Prinja S, Christou A, Baker J, Gabbe B, Ivers R. Health-Related Quality of Life and Function after Paediatric Injuries in India: A Longitudinal Study. Int J Environ Res Public Health 2017; 14:ijerph14101144. [PMID: 28956833 PMCID: PMC5664645 DOI: 10.3390/ijerph14101144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/15/2022]
Abstract
Paediatric injuries can lead to long-term functional impairment and reduced health-related quality of life, and are a growing public health issue in India. To date, however, the burden has been poorly characterized. This study assessed the impact of non-fatal injuries on health-related quality of life in a prospective cohort study of 373 children admitted to three hospitals in Chandigarh and Haryana states in India. The Pediatric Quality of Life Inventory (PedsQL) and King’s Outcome Scale for Childhood Head Injury (KOSCHI) were administered at baseline (pre-injury) and at 1, 2, 4, and 12 months post-injury by telephone interview. Follow-up at all-time points was completed for 277 (77%) of all living participants. Less than one percent reported ongoing disability at 4 months, and no disability was reported at 12 months. PedsQL physical health scores were below healthy child norms (83.4) at 1 month in the cohort for ages 8–12 years and 13–16 years. Although injuries are prevalent, ongoing impact on functioning and disability from most childhood injuries at 12 months was reported to be low. The results raise questions about reliability of generic, Western-centric tools in low- and middle-income settings, and highlight the need for local context-specific tools.
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Affiliation(s)
- Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney 2052, Australia.
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute for Medical Education and Research, Chandigarh 160012, India.
| | - Aliki Christou
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney 2052, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia.
| | - Jannah Baker
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney 2052, Australia.
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia.
- Farr Institute, Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK.
| | - Rebecca Ivers
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney 2052, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia.
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31
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Yates MT, Ishikawa T, Schneeberg A, Brussoni M. Pediatric Canadian Triage and Acuity Scale (PaedsCTAS) as a Measure of Injury Severity. Int J Environ Res Public Health 2016; 13:E659. [PMID: 27399743 DOI: 10.3390/ijerph13070659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/04/2016] [Accepted: 06/15/2016] [Indexed: 11/17/2022]
Abstract
This research explored whether the pediatric version of the Canadian Triage Acuity Scale (PaedsCTAS) represented a valid alternative indicator for surveillance of injury severity. Every patient presenting in a Canadian emergency department is assigned a CTAS or PaedsCTAS score in order to prioritize access to care and to predict the nature and scope of care that is likely to be required. The five-level PaedsCTAS score ranges from I (resuscitation) to V (non-urgent). A total of 256 children, 0 to 17-years-old, who attended a pediatric hospital for an injury were followed longitudinally. Of these children, 32.4% (n = 83) were hospitalized and 67.6% (n = 173) were treated in the emergency department and released. They completed the PedsQL(TM), a validated measure of health related quality of life, at baseline (pre-injury status), one-month, four- to six-months, and 12-months post-injury. In this secondary data analysis, PaedsCTAS was found to be significantly associated with hospitalization and length of stay, sensitive to the differences between PaedsCTAS II and III, and related to physical but not psychosocial HRQoL. The findings suggest that PaedsCTAS may be a useful proxy measure of injury severity to supplement or replace hospitalization status and/or length of stay, currently proxy measures.
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