Behavioral aspects of trauma in children and youth

Pediatric emergency department visits for pedestrian and bicyclist injuries in the US

Background

Despite reductions in youth pedestrian and bicyclist deaths over the past two decades, these injuries remain a substantial cause of morbidity and mortality for children and adolescents. There is a need for additional information on non-fatal pediatric pedestrian injuries and the role of traumatic brain injury (TBI), a leading cause of acquired disability.

Methods

Using a multi-year national sample of emergency department (ED) records, we estimated annual motorized-vehicle related pediatric pedestrian and bicyclist (i.e. pedalcyclist) injury rates by age and region. We modeled in-hospital fatality risk controlling for age, gender, injury severity, TBI, and trauma center status.

Results

ED visits for pediatric pedestrian injuries declined 19.3% (95% CI 16.8, 21.8) from 2006 to 2012, with the largest decreases in 5-to-9 year olds and 10-to-14 year olds. Case fatality rates also declined 14.0%. There was no significant change in bicyclist injury rates.

TBI was implicated in 6.7% (95% CI 6.3, 7.1) of all pedestrian and bicyclist injuries and 55.5% (95% CI 27.9, 83.1) of fatalities. Pedestrian ED visits were more likely to be fatal than bicyclist injuries (aOR = 2.4, 95% CI 2.3, 2.6), with significant additive interaction between pedestrian status and TBI.

Conclusions

TBI in young pedestrian ED patients was associated with a higher risk of mortality compared to cyclists. There is a role for concurrent clinical focus on TBI recovery alongside ongoing efforts to mitigate and prevent motor vehicle crashes with pedestrians and bicyclists. Differences between youth pedestrian and cycling injury trends merit further exploration and localized analyses, with respect to behavior patterns and interventions. ED data captures a substantially larger number of pediatric pedestrian injuries compared to crash reports and can play a role in those analyses.

Electronic supplementary material

The online version of this article (10.1186/s40621-017-0128-5) contains supplementary material, which is available to authorized users.

The Relationship Between Traumatic Injury in Children and Long-Term Use of Health and Social Services by Children and Their Families

To increase understanding of relationships between general traumatic injury in children and long-term use of resources in the health care and social services (HSS) sectors by these children and their families 8-10 years after traumatic injury. This study was a cross-sectional retrospective cohort study of prognosis from 2001 to 2003 that quantified recent expenditures on and use of HSS by children and also by their parents. Forty-eight cases of children were selected from the Hamilton Health Sciences pediatric trauma database in the period from January 2001 to December 2003 after incurring a traumatic injury with Injury Severity Score greater than 12. The average total cost to the HSS system per child's family was $4,326.62 during the preceding 6 months. During the same period, average use of HSS was 7 visits. Total service costs incurred by caregivers of injured children increased with severity of the traumatic injury (p= .009). Caregiver HSS use was higher when the injury was caused by a motor vehicle accident than by other types of accidents (p< .001) and increased with the injury severity (p< .001). HSS use by children was related to gender (p< .001), injury mechanism (p< .001), age at accident (p< .001), and time since accident (p= .012), among other factors. Pediatric trauma appears to have long-term effects on expenditures on and use of HSS by the affected children and their families. The findings emphasize the need for long-term assessment and possible delivery of services to the families of the injured children.

Effectiveness of a safe routes to school program in preventing school-aged pedestrian injury

BACKGROUND

In 2005, the US Congress allocated $612 million for a national Safe Routes to School (SRTS) program to encourage walking and bicycling to schools. We analyzed motor vehicle crash data to assess the effectiveness of SRTS interventions in reducing school-aged pedestrian injury in New York City.

METHODS

Using geocoded motor vehicle crash data for 168 806 pedestrian injuries in New York City between 2001 and 2010, annual pedestrian injury rates per 10 000 population were calculated for different age groups and for census tracts with and without SRTS interventions during school-travel hours (defined as 7 am to 9 am and 2 pm to 4 pm, Monday through Friday during September through June).

RESULTS

During the study period, the annual rate of pedestrian injury decreased 33% (95% confidence interval [CI]: 30 to 36) among school-aged children (5- to 19-year-olds) and 14% (95% CI: 12 to 16) in other age groups. The annual rate of school-aged pedestrian injury during school-travel hours decreased 44% (95% CI: 17 to 65) from 8.0 injuries per 10 000 population in the preintervention period (2001-2008) to 4.4 injuries per 10 000 population in the postintervention period (2009-2010) in census tracts with SRTS interventions. The rate remained virtually unchanged in census tracts without SRTS interventions (0% [95% CI: -8 to 8]).

CONCLUSIONS

Implementation of the SRTS program in New York City has contributed to a marked reduction in pedestrian injury in school-aged children.

Trauma and diverse child populations

It has been estimated that as many as two-thirds of American youth experience a potentially life-threatening event before 18 years of age and that half have experienced multiple potentially traumatic events. Race, ethnicity, and culture influence the frequency and nature of these traumas and also the ways in which children react to traumatic events. The authors discuss the varied influences of cultural background on these reactions to trauma, the varying presentations of diverse children experiencing troubling reactions, and the need to provide treatment to children and their families in a fashion that is culturally sensitive and acceptable to diverse families.

Knowing kids dying of HIV: a traumatic event for AIDS orphans

Data from 755 AIDS orphans living in a rural area of China with high rates of HIV infection were used to examine the association between a child's trauma symptoms and knowing a peer with HIV infection or one who had died of HIV. Trauma symptoms were measured by the Traumatic Symptoms Checklist for Children-Chinese Version (TSCC-CV). About 47% of participants reported they knew a child with HIV or one who had died of HIV. More orphans living in family-based care reported such knowledge, and trauma symptoms were significantly higher in children who reported such knowledge. Multivariate analysis showed that such knowledge was significantly associated with traumatic symptoms, controlling for gender, age, family socioeconomic status, orphan status (double vs. single), and care arrangement (family-based vs. institutional care). The results underscored the importance of psychosocial support and counseling to orphans in communities with high levels of HIV-related mortality.

The effects of gender on the coping outcomes of young children following an unanticipated critical care hospitalization

PURPOSE

A prior evaluation of the predictors of child coping outcomes following an unanticipated critical hospitalization revealed gender differences, which were explored in this study to examine patterns of behavioral change over time.

DESIGN AND METHODS

Data from 163 mother-child (2-7 years) dyads were extracted for this study. Measures of child coping obtained 3 and 6 months following hospitalization included the Behavioral Assessment System for Children and the Post-Hospitalization Behavior Questionnaire.

RESULTS

Maladaptive behaviors in girls increased throughout the 6-month post-hospitalization period. Boys demonstrated a peak and then decline of those same behaviors.

PRACTICE IMPLICATIONS

Given this information, gender-specific child coping information can be developed for parents, which may lead to improved child outcomes.