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Herrera A, Hall M, Alex Ahearn M, Ahuja A, Bradford KK, Campbell RA, Chatterjee A, Coletti HY, Crowder VL, Dancel R, Diaz M, Fuchs J, Guidici J, Lewis E, Stephens JR, Sutton AG, Sweeney A, Ward KM, Weinberg S, Zwemer EK, Harrison WN. Differences in testing for drugs of abuse amongst racial and ethnic groups at children's hospitals. J Hosp Med 2024; 19:368-376. [PMID: 38383949 DOI: 10.1002/jhm.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/13/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Racial and ethnic differences in drug testing have been described among adults and newborns. Less is known regarding testing patterns among children and adolescents. We sought to describe the association between race and ethnicity and drug testing at US children's hospitals. We hypothesized that non-Hispanic White children undergo drug testing less often than children from other groups. METHODS We conducted a retrospective cohort study of emergency department (ED)-only encounters and hospitalizations for children diagnosed with a condition for which drug testing may be indicated (abuse or neglect, burns, malnutrition, head injury, vomiting, altered mental status or syncope, psychiatric, self-harm, and seizure) at 41 children's hospitals participating in the Pediatric Health Information System during 2018 and 2021. We compared drug testing rates among (non-Hispanic) Asian, (non-Hispanic) Black, Hispanic, and (non-Hispanic) White children overall, by condition and patient cohort (ED-only vs. hospitalized) and across hospitals. RESULTS Among 920,755 encounters, 13.6% underwent drug testing. Black children were tested at significantly higher rates overall (adjusted odds ratio [aOR]: 1.18; 1.05-1.33) than White children. Black-White testing differences were observed in the hospitalized cohort (aOR: 1.42; 1.18-1.69) but not among ED-only encounters (aOR: 1.07; 0.92-1.26). Asian, Hispanic, and White children underwent testing at similar rates. Testing varied by diagnosis and across hospitals. CONCLUSIONS Hospitalized Black children were more likely than White children to undergo drug testing at US children's hospitals, though this varied by diagnosis and hospital. Our results support efforts to better understand and address healthcare disparities, including the contributions of implicit bias and structural racism.
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Affiliation(s)
- Adriana Herrera
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matt Hall
- Department of Analytics, Children's Hospital Association, Lenexa, Kansas, USA
| | - Marshall Alex Ahearn
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Arshiya Ahuja
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen K Bradford
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert A Campbell
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashmita Chatterjee
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hannah Y Coletti
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Virginia L Crowder
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ria Dancel
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Diaz
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Fuchs
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica Guidici
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emilee Lewis
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John R Stephens
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley G Sutton
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alison Sweeney
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelley M Ward
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven Weinberg
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric K Zwemer
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wade N Harrison
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Powell TW, Offiong A, Lewis Q, Prioleau M, Smith B, Johnson RM. "I've smoked weed with my daughter": Cannabis Use within Families Affected by Parental Opioid Misuse. CHILDREN AND YOUTH SERVICES REVIEW 2023; 155:107235. [PMID: 37982095 PMCID: PMC10655551 DOI: 10.1016/j.childyouth.2023.107235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Youth with parents who use opioids are more likely to engage in early substance use, especially cannabis use. The purpose of this study was to describe the context of cannabis use among families affected by parental opioid misuse. We conducted 25 in-depth interviews with families affected by parental opioid misuse. Participants were parents with a history of opioid misuse and young adults (ages 18-24) who had parents with a history of opioid misuse. Interviews were digitally recorded and professionally transcribed. Data were analyzed inductively using a qualitative content analytic approach. Familial cannabis use was common among young people and their parents. Participants described familial cannabis use as a bonding activity that felt safe and lightened the mood. Additional research is needed to understand the complex role that cannabis use may play in families affected by opioid misuse. Strategies for intergenerational substance use prevention are discussed.
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Affiliation(s)
- Terrinieka W. Powell
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 North Wolfe St., Baltimore, MD 21205
| | - Asari Offiong
- Child Trends, 12300 Twinbrook Pkwy suite 235, Rockville, MD 20852, United States
| | - Quiana Lewis
- Child Trends, 12300 Twinbrook Pkwy suite 235, Rockville, MD 20852, United States
| | - Morgan Prioleau
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 North Wolfe St., Baltimore, MD 21205
| | - Bianca Smith
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 North Wolfe St., Baltimore, MD 21205
| | - Renee M. Johnson
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N. Broadway, Baltimore, Maryland 21205
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3
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Petska HW, Yin S, Lindberg DM, Beal SJ, Drendel AL, Greiner MV, Wang GS. Drug exposures in young children - The next frontier in occult injury testing. CHILD ABUSE & NEGLECT 2022; 127:105575. [PMID: 35276533 DOI: 10.1016/j.chiabu.2022.105575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Hillary W Petska
- Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Shan Yin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Daniel M Lindberg
- University of Colorado - Anschutz Medical Campus, Aurora, CO, United States of America
| | - Sarah J Beal
- University of Cincinnati College of Medicine, Cincinnati, OH, United States of America; University of Colorado - Anschutz Medical Campus, Aurora, CO, United States of America
| | - Amy L Drendel
- Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Hospital of Wisconsin, Milwaukee, WI, United States of America
| | - Mary V Greiner
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - George Sam Wang
- University of Colorado - Anschutz Medical Campus, Aurora, CO, United States of America
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Wang GS, Buttorff C, Wilks A, Schwam D, Metz TD, Tung G, Pacula RL. Cannabis legalization and cannabis-involved pregnancy hospitalizations in Colorado. Prev Med 2022; 156:106993. [PMID: 35150750 PMCID: PMC8956031 DOI: 10.1016/j.ypmed.2022.106993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/09/2021] [Accepted: 02/06/2022] [Indexed: 11/16/2022]
Abstract
The primary objective of this study was to evaluate the association between presence of recreational cannabis dispensaries and prevalence of cannabis-involved pregnancy hospitalizations in Colorado. This was a retrospective cohort study of pregnancy-related hospitalizations co-coded with cannabis diagnosis codes in the Colorado Hospital Association from January 1, 2011, through December 31, 2018 (recreational cannabis began January 1, 2014). Our primary outcome was cannabis-involved pregnancy hospitalizations per 10 k live births per county. The primary exposure measure was county variation in the number of recreational dispensaries. We controlled for counties' baseline exposure to medical cannabis dispensaries and used Poisson regression to evaluate the association between exposure to recreational cannabis and hospitalizations. During the study period, cannabis-involved pregnancy hospitalizations increased from 429 to 1210. Mean hospitalizations per county (1.7 to 4.7) and per 10 k live births (13.2 to 55.7) increased. Overall, increasing recreational dispensaries were associated with increases in hospitalizations (1.02, CI: 1.00,1.04). When comparing counties with different densities of baseline medical cannabis market, low and high exposure counties had fewer hospitalizations than those counties with no exposure (low: IRR 0.97, CI: 0.96-0.99; high: 0.98, CI: 0.96-0.99). In Colorado, there was more than a two-fold increase in cannabis-involved pregnancy hospitalizations between 2011 and 2018. Counties with no baseline exposure to medical cannabis had a greater increase than other counties, suggesting the recreational market may influence cannabis use among pregnant individuals.
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Affiliation(s)
- George Sam Wang
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Department of Pediatrics, 13123 East 16th Ave B251, Aurora, CO 80045, United States of America.
| | - Christine Buttorff
- RAND Corporation, 1200 S. Hayes St, Arlington, VA 22202, United States of America.
| | - Asa Wilks
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America.
| | - Daniel Schwam
- RAND Corporation, 1200 S. Hayes St, Arlington, VA 22202, United States of America.
| | - Torri D Metz
- University of Utah Health, 50 Medical Dr N, Salt Lake City, UT 84132, United States of America.
| | - Gregory Tung
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Health Systems, Management & Policy, Program for Injury Prevention, Education and Research (PIPER), Colorado School of Public Health, 13001 E. 17th Place, MS B119, United States of America.
| | - Rosalie Liccardo Pacula
- University of Southern California, Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, 635 Downey Way, VPD 514J, Los Angeles, CA 90089-3333, United States of America.
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Wang GS, Reynolds KM, Banner W, Bond GR, Kauffman RE, Palmer RB, Paul IM, Rapp-Olsson M, Green JL, Dart RC. Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children. Pediatr Emerg Care 2022; 38:e100-e104. [PMID: 32576790 DOI: 10.1097/pec.0000000000002166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Previous research has demonstrated that accidental unsupervised ingestions (AUIs) were responsible for the majority of cough and cold medication (CCM) ingestions leading to significant adverse events (AEs) in children. The objective of this analysis was to characterize the role of AUIs in the morbidity associated with CCM exposure in children. METHODS This surveillance study collected data from 5 United States data sources from 2009 to 2016, in children younger than 6 years with an AE from an AUI involving at least 1 CCM over-the-counter pharmaceutical ingredient. An expert panel reviewed each case to determine causality. RESULTS From 4756 total cases reviewed, 3134 (65.9%) had an AE from an AUI determined to be at least potentially related to a CCM ingredient. The majority (61.3%) of cases occurred in children aged 2 to younger than 4 years. Most exposures occurred in the child's own residence (94.9%), and 43.8% were admitted to a health care facility (22.0% to a critical care unit). Dextromethorphan and diphenhydramine, when packaged alone or in combination products, contributed to 96.0% of AUIs. The most common specific products involved were single-ingredient pediatric liquid diphenhydramine (30.1%) and single-ingredient pediatric liquid dextromethorphan (21.4%). There were 3 deaths from solid diphenhydramine formulations. CONCLUSIONS There continues to be opportunities for the implementation of interventions to prevent AUIs of CCM in children. Additional emphasis on engineering controls, such as flow restrictors for liquid formulations targeting diphenhydramine and dextromethorphan products, represent additional opportunities to further reduce AEs from AUIs of CCM.
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Affiliation(s)
| | - Kate M Reynolds
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - William Banner
- Oklahoma Center for Poison and Drug Information, Oklahoma University College of Pharmacy, Oklahoma City, OK
| | - G Randall Bond
- Faculté de Médecine, Hope Africa University, Bujumbura, Burundi
| | - Ralph E Kauffman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Robert B Palmer
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - Ian M Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Malin Rapp-Olsson
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | | | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO
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Krawiec C, Ceneviva GD, Zhou S, Thomas N. Evaluating the Utility of Toxicologic Analysis in Pediatric Out-of-Hospital Cardiac Arrest. J Emerg Med 2020; 59:e167-e174. [PMID: 32917447 DOI: 10.1016/j.jemermed.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/12/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The cause of a pediatric out-of-hospital cardiac arrest (OHCA) may go unexplained in the emergency department setting but can be secondary to a toxicologic etiology. It is unclear how toxicologic screens are used in the postarrest period after a pediatric OHCA. OBJECTIVES The primary objectives are to describe 1) when the toxicology screen (urine and serum) is used, 2) patient characteristics, and 3) toxicology screen results. We hypothesized that toxicology screens are frequently used but that positive results are uncommon. METHODS This was a retrospective study of pediatric OHCA patients admitted to the Penn State Health Children's Hospital pediatric intensive care unit as transfers from the emergency department between January 1, 2011 and May 31, 2018. We reviewed the electronic health record and evaluated for toxicology screen completion, patient characteristics, and toxicology screen results. RESULTS One hundred forty-one patients had a pediatric OHCA. Sixty-three (44.7%) patients did not have a toxicology screen completed. A toxicology screen had a higher completion rate for children >11 years of age (n = 26 [78.8%]; p = 0.0024), and in unwitnessed arrests (n = 48 [66.7%]; p = 0.0052). Four cases (5.1%) revealed the presence of substances that were not administered by a medical provider or were illicit. CONCLUSION Our study found that in pediatric OHCA, toxicologic screens were completed but were not routinely sent in our institution. There may be factors such as clinician bias or the severity of a patient's illness that impact the approach to toxicologic screening in pediatric OHCA. In addition to the history and physical examination, emergency physician and pediatric intensivists should consider routinely sending toxicologic screens to assist in uncovering any accidental or malicious explanation for the event.
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Affiliation(s)
- Conrad Krawiec
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Gary Dominic Ceneviva
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Shouhao Zhou
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Neal Thomas
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
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7
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Graham J, Leonard J, Banerji S, Wang GS. Illicit Drug Exposures in Young Pediatric Patients Reported to the National Poison Data System, 2006-2016. J Pediatr 2020; 219:254-258.e1. [PMID: 31952846 DOI: 10.1016/j.jpeds.2019.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/11/2019] [Accepted: 11/05/2019] [Indexed: 02/08/2023]
Abstract
This retrospective review of poison center calls found that there were 9122 illicit drug exposures reported in children <10 years of age between 2006 and 2016. Marijuana and methamphetamine were reported most frequently, with significant increases over the study period; methamphetamine was associated with the most deaths.
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Affiliation(s)
| | | | - Shireen Banerji
- University of Colorado Denver, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO
| | - George Sam Wang
- University of Colorado Denver, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO
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8
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Howell S, Bailey L, Coffman J. Evaluation of drug-endangered children: The yield of toxicology and skeletal survey screening. CHILD ABUSE & NEGLECT 2019; 96:104081. [PMID: 31344584 DOI: 10.1016/j.chiabu.2019.104081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/01/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Drug endangerment is known to be associated with child maltreatment. However, even with the high association between physical abuse and drug endangerment there is no standard for screening in this population. Skeletal survey screening may facilitate the identification of children in this population who have also been physically abused. OBJECTIVE Our objective was to determine the characteristics of drug endangered children and specifically the yield of skeletal survey screening. PARTICIPANTS AND SETTING The participants in this study were children referred by Child Protective Services (CPS) due to concerns of drug exposure. They were seen in a child abuse outpatient clinic by a child abuse pediatrician or pediatric nurse practitioner. METHODS This study is a retrospective chart review of the Child Advocacy Resource and Evaluation (C.A.R.E.) Team records between January 1, 2011 and December 31, 2017. We measured the yield of toxicology, additional abuse endured, and skeletal survey findings. RESULTS Over the 6-year period, 1252 cases were referred to C.A.R.E. Team for drug endangerment. 1150 cases had hair toxicology performed with 595 cases (52%) testing positive for at least one illegal substance. The compound most frequently identified was methamphetamine followed by marijuana and cocaine. In addition to drug endangerment, other forms of abuse were identified in 162 cases including sexual, physical, and neglect. Using the American Academy of Pediatrics (AAP) and American College of Radiology (ACR) guidelines, 340 skeletal surveys were performed. Twelve cases (4%) had occult skeletal injuries none of which had cutaneous findings. Of those with skeletal injury, 11 cases out of 11 tested by hair toxicology were positive for at least one illegal substance. CONCLUSIONS The application of the AAP and ACR guidelines for skeletal survey screening to those children referred for drug endangerment is useful in identifying children with physical abuse.
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Affiliation(s)
- Sabrie Howell
- Cook Children's Medical Center, Fort Worth, TX, United States; Texas A&M University College of Medicine, Bryan, TX, United States
| | - Laurie Bailey
- Cook Children's Medical Center, Fort Worth, TX, United States
| | - Jamye Coffman
- Cook Children's Medical Center, Fort Worth, TX, United States.
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Petska HW, Porada K, Nugent M, Simpson P, Sheets LK. Occult drug exposure in young children evaluated for physical abuse: An opportunity for intervention. CHILD ABUSE & NEGLECT 2019; 88:412-419. [PMID: 30605795 DOI: 10.1016/j.chiabu.2018.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although screening for drug exposure is an important consideration in the evaluation of suspected child maltreatment, limited data are available on the frequency of drug exposure in children with suspected physical abuse. OBJECTIVE To examine occult drug and pharmaceutical exposure in young children with suspected physical abuse. PARTICIPANTS AND SETTING Children ages 2 weeks -59 months evaluated for physical abuse by a tertiary referral center Child Protection Team. METHODS Cross-sectional study of young children diagnosed with high, intermediate, or low concern for physical abuse and tested for occult drug exposure from 2013-2017. Chart review was performed to determine adherence to recommended testing and drug test results with comparison between groups. RESULTS Occult drug exposures were found in 5.1% (CI 3.6-7.8) of 453 children tested: 6.0% (CI 3.6-10.0) of 232 children with high concern for physical abuse, 5.0% (CI 2.7-9.3) of 179 children with intermediate concern, and 0% of 42 children with low concern. As adherence to protocol-based screening improved during the second half of the study, so did the overall rate of detection of occult drug exposures (7.9%, CI 5.2-11.9) in 252 children with intermediate or high concern for physical abuse. Most exposures were to cocaine, although non-prescribed pharmaceutical exposures were also detected. CONCLUSIONS Up to 7.9% of young children suspected of being physically abused also had an occult drug exposure. Given the adverse health consequences associated with exposure to a drug-endangered environment, screening for occult drug exposure should be considered in the evaluation of young children with intermediate or high concern for physical abuse.
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Affiliation(s)
- Hillary W Petska
- Medical College of Wisconsin, Milwaukee, WI, United States; Children's Hospital of Wisconsin, Milwaukee, WI, United States.
| | - Kelsey Porada
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Melodee Nugent
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Pippa Simpson
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Lynn K Sheets
- Medical College of Wisconsin, Milwaukee, WI, United States; Children's Hospital of Wisconsin, Milwaukee, WI, United States
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Pyle-Eilola AL, Thornton DJ, Hays HL, Casavant MJ. Is This Drug Screen Really Negative? Special Investigation of Drug Screening in Pediatrics. ACTA ACUST UNITED AC 2016; 1:437-440. [DOI: 10.1373/jalm.2016.021162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/14/2016] [Indexed: 11/06/2022]
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Wright J, Edwards J, Walker S. Exposures associated with clandestine methamphetamine drug laboratories in Australia. REVIEWS ON ENVIRONMENTAL HEALTH 2016; 31:329-352. [PMID: 27428841 DOI: 10.1515/reveh-2016-0017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
The clandestine manufacture of methamphetamine in residential homes may represent significant hazards and exposures not only to those involved in the manufacture of the drugs but also to others living in the home (including children), neighbours and first responders to the premises. These hazards are associated with the nature and improper storage and use of precursor chemicals, intermediate chemicals and wastes, gases and methamphetamine residues generated during manufacture and the drugs themselves. Many of these compounds are persistent and result in exposures inside a home not only during manufacture but after the laboratory has been seized or removed. Hence new occupants of buildings formerly used to manufacture methamphetamine may be unknowingly exposed to these hazards. Children are most susceptible to these hazards and evidence is available in the literature to indicate that these exposures may result in immediate and long-term adverse health effects. The assessment of exposure within the home can be undertaken by measuring contaminant levels or collecting appropriate biological data from individuals exposed. To gain a better understanding of the available data and key issues associated with these approaches to the characterisation of exposure, a review of the published literature has been undertaken.
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12
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Berkout OV, Kolko DJ. Understanding child directed caregiver aggression: An examination of characteristics and predictors associated with perpetration. CHILD ABUSE & NEGLECT 2016; 56:44-53. [PMID: 27131453 PMCID: PMC4888370 DOI: 10.1016/j.chiabu.2016.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/03/2016] [Accepted: 04/07/2016] [Indexed: 05/10/2023]
Abstract
Child physical abuse presents a substantial public health concern with lasting negative consequences for victims. Understanding the variables associated with perpetration can help inform prevention and intervention efforts. The current study examined background and clinical variables in a sample of 195 help-seeking caregivers who were at risk for or had been identified as having engaged in child directed aggression or abuse. We found that caregivers who did (vs. did not) report severe child directed aggression had poorer parenting and reported more drug use. Having a recent allegation of child physical abuse (vs. no allegation) based on official child welfare records was unrelated to parenting, drug and alcohol use, negative affect, parenting stress, or neglect. Structural equation modeling was used to examine the influence of parenting stress on child directed aggression and its effects through negative affect and positive parenting. We found that parenting stress predicted higher negative affect, which was related to greater child directed aggression. Additionally, parenting stress predicted lower positive parenting, which in turn predicted lower child directed aggression. A model including drug and alcohol use did not add to the prediction of child directed aggression. Prediction of neglect using similar variables found that only positive parenting was of import and that parenting stress and negative affect did not contribute to neglect. Implications for future prevention and treatment development efforts with abusive/aggressive caregivers are discussed.
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13
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Stauffer SL, Wood SM, Krasowski MD. Diagnostic yield of hair and urine toxicology testing in potential child abuse cases. J Forensic Leg Med 2015; 33:61-7. [DOI: 10.1016/j.jflm.2015.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/20/2015] [Indexed: 02/08/2023]
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14
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Kiblawi ZN, Smith LM, Diaz SD, LaGasse LL, Derauf C, Newman E, Shah R, Arria A, Huestis M, Haning W, Strauss A, DellaGrotta S, Dansereau LM, Neal C, Lester B. Prenatal methamphetamine exposure and neonatal and infant neurobehavioral outcome: results from the IDEAL study. Subst Abus 2015; 35:68-73. [PMID: 24588296 DOI: 10.1080/08897077.2013.814614] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Methamphetamine (MA) use among pregnant women is an increasing problem in the United States. How MA use during pregnancy affects neonatal and infant neurobehavior is unknown. METHODS The Infant Development, Environment, and Lifestyle (IDEAL) study screened 34,833 subjects at 4 clinical centers. Of the subjects, 17,961 were eligible and 3705 were consented, among which 412 were enrolled for longitudinal follow-up. Exposed subjects were identified by self-report and/or gas chromatography/mass spectroscopy (GC/MS) confirmation of amphetamine and metabolites in meconium. Comparison subjects were matched (race, birth weight, maternal education, insurance), denied amphetamine use, and had a negative meconium screen. Both groups included prenatal alcohol, tobacco, and marijuana use, but excluded use of opiates, lysergic acid diethylamide, or phencyclidine. The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale (NNNS) was administered within the first 5 days of life and again at 1 month to 380 enrollees (185 exposed, 195 comparison). Analysis of variance (ANOVA) tested exposure effects on NNNS summary scores at birth and 1 month. General linear model (GLM) repeated-measures analysis assessed the effect of MA exposure over time on the NNNS scores with and without covariates. RESULTS By 1 month of age, both groups demonstrated higher quality of movement (P = .029), less lethargy (P = .001), and fewer asymmetric reflexes (P = .012), with no significant differences in NNNS scores between the exposed and comparison groups. Over the first month of life, arousal increased in exposed infants but decreased in comparison infants (P = .031) and total stress was decreased in exposed infants, with no change in comparison infants (P = .026). CONCLUSIONS Improvement in total stress and arousal were observed in MA-exposed newborns by 1 month of age relative to the newborn period.
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Affiliation(s)
- Zeina N Kiblawi
- a LA Biomed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine , Los Angeles , California , USA
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Abstract
Injuries, other than abrasions, are rare in precruising infants. In this population, a history or observation of a sentinel skin injury, intraoral injury, or musculoskeletal injury without a plausible explanation, is concerning for physical abuse. A precruising infant with a sentinel injury should be medically evaluated for occult injury and predisposing medical conditions, as well as reported to authorities for further investigation. Early identification of sentinel injuries and appropriate interventions can prevent further abuse.
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Affiliation(s)
- Hillary W Petska
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lynn K Sheets
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
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Abstract
Alternative matrices are steadily gaining recognition as biological samples for toxicological analyses. Hair presents many advantages over traditional matrices, such as urine and blood, since it provides retrospective information regarding drug exposure, can distinguish between chronic and acute or recent drug use by segmental analysis, is easy to obtain, and has considerable stability for long periods of time. For this reason, it has been employed in a wide variety of contexts, namely to evaluate workplace drug exposure, drug-facilitated sexual assault, pre-natal drug exposure, anti-doping control, pharmacological monitoring and alcohol abuse. In this article, issues concerning hair structure, collection, storage and analysis are reviewed. The mechanisms of drug incorporation into hair are briefly discussed. Analytical techniques for simultaneous drug quantification in hair are addressed. Finally, representative examples of drug quantification using hair are summarized, emphasizing its potentialities and limitations as an alternative biological matrix for toxicological analyses.
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Lindberg DM, Berger RP, Reynolds MS, Alwan RM, Harper NS. Yield of skeletal survey by age in children referred to abuse specialists. J Pediatr 2014; 164:1268-73.e1. [PMID: 24630357 DOI: 10.1016/j.jpeds.2014.01.068] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/04/2013] [Accepted: 01/29/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine rates of skeletal survey completion and injury identification as a function of age among children who underwent subspecialty evaluation for concerns of physical abuse. STUDY DESIGN This was a retrospective secondary analysis of an observational study of 2609 children <60 months of age who underwent evaluation for possible physical abuse. We measured rates of skeletal survey completion and fracture identification for children separated by age into 6-month cohorts. RESULTS Among 2609 subjects, 2036 (78%) had skeletal survey and 458 (18%) had at least one new fracture identified. For all age groups up to 36 months, skeletal survey was obtained in >50% of subjects, but rates decreased to less than 35% for subjects >36 months. New fracture identification rates for skeletal survey were similar between children 24-36 months of age (10.3%, 95% CI 7.2-14.2) and children 12-24 months of age (12.0%, 95% CI 9.2-15.3) CONCLUSIONS: Skeletal surveys identify new fractures in an important fraction of children referred for subspecialty consultation with concerns of physical abuse. These data support guidelines that consider skeletal survey mandatory for all such children <24 months of age and support a low threshold to obtain skeletal survey in children as old as 36 months.
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Affiliation(s)
- Daniel M Lindberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Pediatrics, Kempe Center for the Prevention and Treatment of Child Abuse, Children's Hospital of Colorado, Aurora, CO.
| | - Rachel P Berger
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Maegan S Reynolds
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Riham M Alwan
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI
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Falcão V, Jardim P, Dinis-Oliveira RJ, Magalhães T. Forensic evaluation in alleged sibling incest against children. JOURNAL OF CHILD SEXUAL ABUSE 2014; 23:755-767. [PMID: 25085386 DOI: 10.1080/10538712.2014.949394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Sibling incest is a serious form of intrafamilial sexual abuse with health, social, and legal relevance. A retrospective study was conducted through the analysis of forensic medical reports of the alleged sibling incest of victims under 18 years old (n = 68) from 2004 to 2011 as well as the respective judicial outcomes. Results demonstrated that sibling's sexual abuse is associated with several circumstances that might exacerbate its severity such as vaginal, anal, and/or oral penetration. Moreover, the victim's young age, the proximity between victim and abuser, and the fact that it is committed at the victim's and/or abuser's home and by using physical violence and verbal threats justify a late detection of these cases.
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Oral R, Koc F, Jogerst K, Bayman L, Austin A, Sullivan S, Bayman EO. Staff training makes a difference: improvements in neonatal illicit drug testing and intervention at a tertiary hospital. J Matern Fetal Neonatal Med 2013; 27:1049-54. [DOI: 10.3109/14767058.2013.847418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Occult abusive injuries in infants with apparently isolated skull fractures. J Trauma Acute Care Surg 2013; 74:1553-8. [DOI: 10.1097/ta.0b013e31828b7fc4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dinis-Oliveira RJ, Magalhães T. Forensic toxicology in drug-facilitated sexual assault. Toxicol Mech Methods 2013; 23:471-8. [DOI: 10.3109/15376516.2013.796034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wang GS, Deakyne S, Bajaj L, Yin S, Heard K, Roosevelt G. The limited utility of screening laboratory tests and electrocardiograms in the management of unintentional asymptomatic pediatric ingestions. J Emerg Med 2013; 45:34-8. [PMID: 23561311 DOI: 10.1016/j.jemermed.2012.11.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/21/2012] [Accepted: 11/06/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Suspected ingestions are a common chief complaint to the emergency department although the majority of ingestions by children are insignificant. OBJECTIVE Assess the utility of screening laboratory tests and Electrocardiograms (ECGs) in unintentional asymptomatic pediatric poisonings. METHODS Retrospective chart review at a tertiary care children's hospital and a regional poison center of patients less than 12 years of age using ICD-9 codes from January 2005 through December 2008. Laboratory or ECG results requiring intervention and/or direct treatment, a non-RPC subspecialty consultation, and/or prolonged Emergency Department stay was considered changed management. RESULTS Five hundred ninety five suspected ingestions met our criteria. The median age was 2.6 years (IQR 1.6, 3.0 years) and 56% were male. One laboratory test or ECG was obtained in 233 patients (39%). Of 24 screening ECGs, 32 complete blood counts and 34 blood gases, none were clinically significant. Fifty-two patients received screening metabolic panels, 3 were abnormal and 2 changed management (anion gap metabolic acidosis with unsuspected salicylate ingestions). None of the 127 (21%) screening acetaminophen levels changed management. Two of sixty-five (13%) screening salicylate levels changed management. Three screening urine toxicology tests on patients with altered mental status were positive without ingestion history. No patient under the age of 12 years with normal vital signs and normal mental status had positive screening tests. CONCLUSIONS Screening laboratory tests and ECGs were of limited utility and rarely changed management despite being ordered in a significant number of patients. Screening tests are rarely indicated in unintentional overdoses in children who are asymptomatic.
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Affiliation(s)
- George Sam Wang
- Section of Emergency Medicine, Department of Pediatrics, The University of Colorado Denver, Aurora, Colorado 80045, USA
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Farst K, Bolden BB. Substance-Exposed Infants and Children: Forensic Approach. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2012. [DOI: 10.1016/j.cpem.2012.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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