Characteristics of family violence victims presenting to emergency departments in Hong Kong

Male Survivors of Domestic Violence, Challenges in Cultural Response, and Impact on Identity and Help-Seeking Behaviors: A Systematic Review

Male experiences of domestic and relational violence have been only marginally explored in the literature. In connection to this, attitudes in the community and among service providers and criminal justice system entities can vary dramatically. This variance in attitudes creates an instability which has a differential impact on the help-seeking behaviors of victims. Additionally, help-seeking behaviors are often influenced by internalized shame and confusion on the part of the survivors themselves when their social constructions of masculinity do not align with lived experience. More is needed to understand the nature of male survivorship in situations of relational violence. A systematic review was conducted to begin organizing the data on the topic. This review started with 15,547 peer-reviewed articles. Those were systematically narrowed to a total of 16 of the most recent pieces of empirical science on the topic. The final articles were thematically analyzed. Findings suggest (a) cultural stigma around constructions of masculinity, (b) fear of disclosure, and (c) negative experiences with criminal justice and support system responses, among the highest drivers for the disparate experience and hesitation to seek help.

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

Importance

Elder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment.

Objective

To examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults.

Design, Setting, and Participants

This retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022.

Main Outcomes and Measures

We used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses.

Results

This study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P < .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P < .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P < .001).

Conclusions and Relevance

In this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.

Elder abuse and hospitalization in rural Malaysia

Our study aims to describe and determine factors associated with hospitalization among victims of elder abuse and neglect (EAN) in rural Malaysia. A cross sectional study based on the baseline data of the Malaysian Elder Mistreatment Project (MAESTRO) collected from November 2013 until July 2014 involving 1927 older adults in Kuala Pilah, Negeri Sembilan was conducted. EAN was determined using the modified Conflict Tactics Scale (CTS) and hospitalization rates were determined based on self-report. The prevalence of overall EAN was 8.1% (95%CI 6.9–9.3). Among male respondents, 9.5% revealed history of abuse and among female respondents, 7.2% reported experiencing EAN. The annual hospitalization rates per 100 persons within the past one year among EAN victims and non-victims were 18 per 100 persons (SD = 46.1) and 15 per 100 persons (SD = 64.1) respectively. Among respondents with history of EAN, 16.0% (n = 21) had been hospitalized in the past 12 months while among respondents with no EAN experience, 10.2% (n = 153) were hospitalized. Multivariable analyses using Poisson regression did not show any significant association between EAN and hospitalization. This could be due to the complex interactions between medical and social circumstances that play a role in hospital admissions, factors affecting the health care system, and access to health care among EAN victims.

Injury patterns and associated demographics of intimate partner violence in men presenting to U.S. emergency departments

Research suggests that there are differences between sexes in physical intimate partner violence (IPV) victimization that could lead to different injury patterns. In addition, research shows that men under-report their injuries yet may suffer grave consequences. It is, thus, vital to establish physical injury patterns in male IPV victims. A retrospective review of prospectively collected data was performed using the National Electronic Injury Surveillance System-All Injury Program data from 2005 to 2015 for all IPV-related injuries in both male and female patients. Sex differences by demographics, mechanism, anatomic location, and diagnoses of IPV injuries were analyzed using statistical methods accounting for the weighted stratified nature of the data. IPV accounted for 0.61% of all emergency department visits; 17.2% were in males and 82.8% in females. Male patients were older (36.1% vs. 16.8% over 60 years), more likely to be Black (40.5% vs. 28.8%), sustained more injuries due to cutting (28.1% vs. 3.5%), more lacerations (46.9% vs. 13.0%), more injuries to the upper extremity (25.8% vs. 14.1%), and fewer contusions/abrasions (30.1% vs. 49.0%), compared to female IPV patients (p < .0001). There were also more hospitalizations in men (7.9% vs. 3.7% p = .0002). Knowledge of specific IPV-related injury characteristics in men will enable healthcare providers to counteract underreporting of IPV.

Clinical Features of Heterosexual Intimate Partner Violence Victims With Escalating Injury Severity

Intimate partner violence (IPV) is largely recognized to have a cyclical pattern and violence escalation in terms of frequency and intensity over time. However, there is a lack of systematic investigation of the profiles of victims and quantification of the patterns of injury of the victims associated with the first time versus repeated violence episodes. This study aimed to fill this knowledge gap by medical chart review of 878 victims in a 5-year period from 2010 to 2014 in Accident and Emergency Department (AED) of two public general hospitals in Hong Kong. The differences in injury patterns between the first IPV episode (FE) and recurrent IPV episodes (REs) experienced by male and female victims in heterosexual relationship were evaluated. The results indicated the violence escalation occurred in recurrent IPV in both genders. In female victims, there was significant increase in the number of injury locations (mean [M] = 2.0 vs. 2.2, p < .05), number of causes of injury (M = 1.7 vs. 2.2, p < .001) and police escort (15.2% vs. 22.1%, p < .05) in RE compared to FE. In male victims, however, only the increase in the number of causes of injury was significant (M = 1.6 vs. 2.1, p < .05) in RE compared to FE. In summary, our results highlight the escalation in the severity of harm of IPV victims in heterosexual relationship, and the gender differences in severity aggression and injury and help-seeking behavior change in recurrent IPV. Preventive measures are indicated to intervene the IPV occurrence and recurrence with rising morbidity and a potential of mortality.

Identifying patterns of health care utilisation among physical elder abuse victims using Medicare data and legally adjudicated cases: protocol for case-control study using data linkage and machine learning

INTRODUCTION

Physical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research suggests elder abuse victims may have different patterns of healthcare utilisation than other older adults, with increased rates of emergency department use, hospitalisation and nursing home placement. Little is known, however, about the patterns of this increased utilisation and associated costs. To help fill this gap, we describe here the protocol for a study exploring patterns of healthcare utilisation and associated costs for known physical elder abuse victims compared with non-victims.

METHODS AND ANALYSIS

We hypothesise that various aspects of healthcare utilisation are differentially affected by physical elder abuse victimisation, increasing ED/hospital utilisation and reducing outpatient/primary care utilisation. We will obtain Medicare claims data for a series of well-characterised, legally adjudicated cases of physical elder abuse to examine victims' healthcare utilisation before and after the date of abuse detection. We will also compare these physical elder abuse victims to a matched comparison group of non-victimised older adults using Medicare claims. We will use machine learning approaches to extend our ability to identify patterns suggestive of potential physical elder abuse exposure. Describing unique patterns and associated costs of healthcare utilisation among elder abuse victims may improve the ability of healthcare providers to identify and, ultimately, intervene and prevent victimisation.

ETHICS AND DISSEMINATION

This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #1807019417, with initial approval on 1 August 2018. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.

Chinese Male Survivors of Intimate Partner Violence: A Three-Pillar Approach to Analyze Men's Delayed Help-Seeking Decisions

Intimate partner violence (IPV) literature has addressed differential socialization for designing interventions, mainly helping female victims and male perpetrators. From a gender-specific perspective, this study examines the abused men's postponed decisions to disclose victimization or seek help. Through individual interviews, 10 Chinese male IPV survivors in Hong Kong described their help-seeking journey. A three-pillar approach is applied to guide the analysis in terms of psychological factors, cultural barriers, and decisional challenges when men are seeking help. Results reveal negative influences bearing on male survivors' help-seeking behaviors and support how men can rebuild positive personal strengths after experiencing the impact of abuse on oneself and the family. Service providers must identify barriers of delayed help-seeking decisions and treat IPV survivors with respect and acceptance to facilitate abuse disclosure.

Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases

STUDY OBJECTIVE

Elder abuse is common and has serious health consequences but is underrecognized by health care providers. An important reason for this is difficulty in distinguishing between elder abuse and unintentional trauma. Our goal was to identify injury patterns associated with physical elder abuse in comparison with those of patients presenting to the emergency department (ED) with unintentional falls.

METHODS

We partnered with a large, urban district attorney's office and examined medical, police, and legal records from successfully prosecuted cases of physical abuse of victims aged 60 years or older from 2001 to 2014.

RESULTS

We prospectively enrolled patients who presented to a large, urban, academic ED after an unintentional fall. We matched 78 cases of elder abuse with visible injuries to 78 unintentional falls. Physical abuse victims were significantly more likely than unintentional fallers to have bruising (78% versus 54%) and injuries on the maxillofacial, dental, and neck area (67% versus 28%). Abuse victims were less likely to have fractures (8% versus 22%) or lower extremity injuries (9% versus 41%). Abuse victims were more likely to have maxillofacial, dental, or neck injuries combined with no upper and lower extremity injuries (50% versus 8%). Examining precise injury locations yielded additional differences, with physical elder abuse victims more likely to have injuries to the left cheek or zygoma (22% versus 3%) or on the neck (15% versus 0%) or ear (6% versus 0%).

CONCLUSION

Specific, clinically identifiable differences may exist between unintentional injuries and those from physical elder abuse. This includes specific injury patterns that infrequently occur unintentionally.

Elder Abuse in the Out-of-Hospital and Emergency Department Settings: A Scoping Review

This scoping review aimed to synthesize the available evidence on the epidemiology, patient- and caregiver-associated factors, clinical characteristics, screening tools, prevention, interventions, and perspectives of health care professionals in regard to elder abuse in the out-of-hospital or emergency department (ED) setting. Literature search was performed with MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health, PsycINFO, and the Cochrane Library. Studies were eligible if they were observational or experimental and reported on elder abuse in the out-of-hospital or ED setting. A qualitative approach, performed independently by 2 reviewers, was used to synthesize and report the findings. A total of 413 citations were retrieved, from which 55 studies published between 1988 and 2019 were included. The prevalence of elder abuse reported during the ED visit was lower than reported in the community. The most commonly detected type of elder abuse was neglect, and then physical abuse. The following factors were more common in identified cases of elder abuse: female sex, cognitive impairment, functional disability, frailty, social isolation, and lower socioeconomic status. Psychiatric and substance use disorders were more common among victims and their caregivers. Screening tools have been proposed, but multicenter validation and influence of screening on patient-important outcomes were lacking. Health care professionals reported being poorly trained and acknowledged numerous barriers when caring for potential victims. There is insufficient knowledge, limited training, and a poorly organized system in place for elder abuse in the out-of-hospital and ED settings. Studies on the processes and effects of screening and interventions are required to improve care of this vulnerable population.

Mortality Among Children with Down syndrome in Hong Kong: A Population-Based Cohort Study from Birth

OBJECTIVES

To describe the mortality patterns, comorbidities, and attendance at accident and emergency departments among children with Down syndrome in Hong Kong.

STUDY DESIGN

This is a population-based, retrospective cohort study of live births of children with Down syndrome delivered between 1995 and 2014, as identified from territory-wide hospitalization data in Hong Kong. The Kaplan-Meier product limit method was adopted to estimate the survival probabilities of children with Down syndrome by selected demographic and clinical characteristics. Cox regression analyses were conducted to examine associations of comorbidities and accident and emergency department accident and emergency departments attendances with mortality patterns.

RESULTS

There were 1010 live births of children with Down syndrome in Hong Kong within the study period and the average rate of live births with Down syndrome was 8.0 per 10 000 live births (95% CI, 6.8-9.30). The rate of live births with Down syndrome over the past 2 decades decreased from 11.8 per 10 000 live births in 1995 to 3.4 per 10 000 in 2014. Eighty-three patients with Down syndrome died during this period. The overall 6-month and 1- and 5-year survival probabilities were 95.8%, 94.4%, and 92.6%, respectively. There was a significant decrease in mortality rates over the study period, particularly among those born between 2000-2004 and 2005-2009 compared with those born between 1995 and 1999 (P < .05). Patients with Down syndrome without congenital cardiovascular anomalies and without low birth weight had lower mortality rates than those with these diagnoses.

CONCLUSIONS

Over the past 2 decades, the early life mortality of children with Down syndrome in Hong Kong has improved significantly along with a reduction in Down syndrome live births.

Continuation of domestic violence and changes in the assessment of family functioning, health, and social support in Finland

Our aim in this comparison study was to describe the continuation of domestic violence and to assess changes in the association among family functioning, health, and social support for participants who have or have not experienced violence for the years 2012 and 2015. We collected the data using a family functioning, health, and social support (FAFHES) questionnaire. We collected the baseline questionnaires (N = 188) from patients who visited a Finnish central hospital and mailed the follow-up survey (N = 71). The prevalence of violence remained constant. However, the violence varied and changed. Our findings should encourage health care professionals to better identify and intervene in violence.

Exploring South Asian Women's Experiences of Domestic Violence and Help-Seeking Within the Sociocultural Context in Hong Kong

Data are reported from a survey of 49 South Asian women who self-identified as having experienced domestic violence from an intimate partner within the past 12 months. Logistic regression analysis reveals that perceived social support and having children emerged as the strongest predictors for seeking help. This study also demonstrates that women's approach to help-seeking is shaped and embedded by a combination of individual and structural factors. The findings of this study may be used to help enhance efforts to promote and provide resources and support for victims of domestic violence from an intimate partner.

Intimate partner violence victims' acceptance and refusal of on-site counseling in emergency departments: Predictors of help-seeking behavior explored through a 5-year medical chart review

Healthcare services constitute the first formal support that many intimate partner violence (IPV) victims receive and a link to formal welfare and psychological support. The help-seeking behavior for psychosocial support, e.g., Accident and Emergency Departments (AED) onsite counseling, is key to developing effective support for IPV victims. This study aimed to strengthen the health-welfare support link to aid IPV prevention in AEDs by investigating the acceptance and refusal of on-site counseling by IPV victims. A retrospective cohort study retrieved and reviewed all records of IPV victims presenting at the AEDs of two Hong Kong hospitals between 2010 and 2014. A total of 157 male and 823 female IPV victims were identified, 295 of whom refused on-site counseling. Bivariate and multivariate analyses were performed to examine the association between help-seeking and demographic and violent injury-related factors. The odds of help-seeking via on-site counseling were significantly lower for victims with mental illness (aOR=0.49; 95% CI=0.27, 0.88). After controlling for all demographic characteristics, mental illness, and drug abuse information, sex remained an independent predictor of help-seeking (aOR=2.62; 95% CI=1.45, 4.74); victims who had experienced >2 abuse incidents were more likely to seek help than those who had experienced ≤2 abuse incidents (aOR=1.90; 95% CI=1.11, 3.26). The factors associated with help-seeking from on-site services by IPV victims reflect the need for multidisciplinary collaborative work aimed at IPV prevention. Healthcare professionals require training on how to promote help-seeking behavior targeted specifically for male and female IPV victims according to their needs and preferences.

Prevalence and pattern of domestic violence at the Center for Forensic Medical Services in Pekanbaru, Indonesia

Background: Domestic violence (DV) is still a significant public health problem, especially in women’s health. Few studies have reported the prevalence and domestic violence in Indonesia. The aim of this study was to identify the prevalence, type of violence, and forensic examination on domestic violence victims in emergency departments.Methods: This study was a retrospective analysis of domestic violence victims observed in the Emergency Department at the Bhayangkara Hospital, Pekanbaru, Indonesia, between 2010 and 2014. The determinations of DV cases are based on the medico-legal reports (visum et repertum) and the police’s official inquiry letters.Results: Out of 6,876 medico-legal injury reports of living victims were reviewed, and 755 (10,9%) cases were DV. The majority of victims in DV were women (93.8%) with childbearing age group as the highest frequency (77.9%). Most of the DV victims were housewives (67.0%). Moreover, physical assault was the most common DV types (98.7%). Bruise was the predominant type of wound among the DV victims (76.2%), and almost half of the victims had abrasions (48.1%). Head and limbs were the predominant sites of wound. Blunt injury was found in more than three-quarters of the victims (88.5%).Conclusion: The prevalence of domestic violence was high among living victims in the emergency department, with women as the majority of victims.

Describing visible acute injuries: development of a comprehensive taxonomy for research and practice

BACKGROUND

Little literature exists classifying and comprehensively describing intentional and unintentional acute injuries, which would be valuable for research and practice. In preparation for a study of injury patterns in elder abuse, our goal was to develop a comprehensive taxonomy of relevant types and characteristics of visible acute injuries and evaluate it in geriatric patients.

METHODS

We conducted an exhaustive review of the medical and forensic literature focusing on injury types, descriptions, patterns and analyses. We then prepared iteratively, through consensus with a multidisciplinary, national panel of elder abuse experts, a comprehensive classification system to describe these injuries.

RESULTS

We designed a three-step process to fully describe and classify visible acute injuries: (1) determining the type of injury, (2) assigning values to each of the characteristics common to all geriatric injuries and (3) assigning values to additional characteristics relevant for specific injuries. We identified nine unique types of visible injury and seven characteristics critical to describe all these injuries, including body region(s) and precise anatomic location(s). For each injury type, we identified two to seven additional critical characteristics, such as size, shape and cleanliness. We pilot tested it on 323 injuries on 83 physical elder abuse victims and 45 unintentional fall victims from our ongoing research to ensure that it would allow for the complete and accurate description of the full spectrum of visible injuries encountered and made modifications and refinements based on this experience. We then used the classification system to evaluate 947 injuries on 80 physical elder abuse victims and 195 unintentional fall victims to assess its practical utility.

CONCLUSIONS

Our comprehensive injury taxonomy systematically integrates and expands on existing forensic and clinical research. This new classification system may help standardise description of acute injuries and patterns among clinicians and researchers.

Abuse-related trauma forward medical care in a randomly sampled nationwide population

Abuse-related trauma remains a global health issue. However, there is paucity in nationwide reports. We aim to estimate the incidence of abuse-related trauma forward medical care and identify its characteristics and clinical course in Taiwan. Patients with trauma between 2005 and 2007 that occurred 3 months before or after a diagnosis of abuse were identified from a randomly sampled nationwide longitudinal health insurance database of 1 million beneficiaries. The patients' demographic data, injury pattern, and medical resource utilization were measured, stratified by age and sex, and compared using chi-square test. Risk factors of next trauma event were identified using Cox regression analysis. Ninety-three patients (65 females) were identified (mean age, 20.6 ± 16.3 years), including 61.3% under 18 years of age. For the first trauma event, 68 patients (73.1%) visited the emergency room, 63 (67.7%) received intervention, and 14 (15.1%) needed hospital care. Seven (7.5%), all less than 11 years old, had intracranial hemorrhage and required intensive care. Thirty-three (35.5%) left with complications or sequelae, or required rehabilitation, but all survived. Of the 34 victims of sexual abuse, 32 were aged less than 18 years. Men received more mood stabilizers or antipsychotics (50.0% vs 10.7%, P = 0.030) and reeducative psychotherapy (25.0% vs 0, P = 0.044). Risk factors for a next trauma event were injury involving the extremities (hazard ratio [HR]: 5.27 [2.45-11.33]) and use of antibiotics (HR: 4.21 [1.45-12.24]) on the first trauma event. Abuse-related trauma has heterogeneous presentations among subgroups. Clinicians should be alert in providing timely diagnosis and individualized intervention.

Screening and detection of elder abuse: Research opportunities and lessons learned from emergency geriatric care, intimate partner violence, and child abuse

This article provides an overview of elder abuse screening and detection methods for community-dwelling and institutionalized older adults, including general issues and challenges for the field. Then, discussions of applications in emergency geriatric care, intimate partner violence (IPV), and child abuse are presented to inform research opportunities in elder abuse screening. The article provides descriptions of emerging screening and detection methods and technologies from the emergency geriatric care and IPV fields. We also discuss the variety of potential barriers to effective screening and detection from the viewpoint of the older adult, caregivers, providers, and the health care system, and we highlight the potential harms and unintended negative consequences of increased screening and mandatory reporting. We argue that research should continue on the development of valid screening methods and tools, but that studies of perceived barriers and potential harms of elder abuse screening among key stakeholders should also be conducted.

Association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic

BACKGROUND

Here we aimed to investigate sociodemographic characteristics, psychiatric history, and association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic.

METHODS

This study consists of 73 violence-exposed patients admitted to emergency clinic who were literate and agreed to participate in the study. A sociodemographic data form created by us to investigate alcohol-substance abuse, suicide attempt, previous history of trauma, self and family history of psychiatric disorders and Beck Anxiety Inventory was given to the patients.

RESULTS

Of the patients exposed to violence 63% (n=46) were female and 27% (n=27) were male. Of these patients, 68.5% (n=50) were married, 43.8% (n=25) were workers, 34.2% were housewives, 11% were unemployed, and 11% were civil servants. Of the violence-exposed patients, 56.2% (n=41) were primary school, 21.9% (n=16) were high school, and 21.9% (n=16) were university graduates. Smoking and alcohol use rates were 54.8% (n=40) and 17.8% (n=13), respectively. The most common trauma type was assault using physical force with a ratio of 78.1% (n=57). In addition, anxiety scores were high in 42.5% (n=31) and moderate in 9.6% (n=7) of the patients. Mentioned psychiatric disorder was present in 17.8% (n=13) of the patients and 19.2% (n=14) of the patients' relatives. The correlation between sociodemographic characteristics and anxiety scores revealed that married patients had higher anxiety scores (P<0.01) and patients assaulted by their parents had lower anxiety scores (P<0.00).

CONCLUSION

A total of 63% of the violence-exposed patients admitted to emergency room were females, 56.2% were primary school graduates, and 43.8% were factory workers; this result shows that low socioeconomical status and education level affect exposure to trauma especially in females. In addition, ~20% of the patients and patients' relatives had a psychiatric disorder and 53.4% of perpetrators were parents, spouses, and children; this result shows that psychiatric history and family relations are one of the issues that should be taken into account and treated.

Methylphenidate and the risk of trauma

BACKGROUND AND OBJECTIVE

Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are prone to sustaining trauma that requires emergency department (ED) admission. Methylphenidate (MPH) can reduce ADHD symptoms and may thus theoretically reduce the risk of trauma-related ED admission, but previous studies do not make this association clear. This study examines this association.

METHODS

A total of 17 381 patients aged 6 to 19 years who received MPH prescriptions were identified by using the Clinical Data Analysis & Reporting System (2001-2013). Using a self-controlled case series study design, the relative incidence of trauma-related ED admissions was compared with periods of patient exposure and nonexposure to MPH.

RESULTS

Among 17 381 patients prescribed MPH, 4934 had at least 1 trauma-related ED admission. The rate of trauma-related ED admission was lower during exposed periods compared with nonexposed periods (incidence rate ratio [IRR]: 0.91 [95% confidence interval (CI): 0.86-0.97]). The findings were similar only when the incident trauma episode was assessed (IRR: 0.89 [95% CI: 0.82-0.96]). A similar protective association was found in both genders. In validation analysis using nontrauma-related ED admissions as a negative control outcome, no statistically significant association was found (IRR: 0.99 [95% CI: 0.95-1.02]). All sensitivity analyses demonstrated consistent results.

CONCLUSIONS

This study supports the hypothesis that MPH is associated with a reduced risk of trauma-related ED admission in children and adolescents. A similar protective association was found in both male and female patients. This protective association should be considered in clinical practice.

Medical and laboratory indicators of elder abuse and neglect

Elder abuse and neglect are highly prevalent but woefully underdetected and underreported. The presentation is rarely clear and requires the piecing together of clues that create a mosaic of the full picture. More research needed to better characterize findings that, when identified, can contribute to certainty in cases of suspected abuse. Medical and laboratory data can be helpful in the successful determination of abuse and neglect.