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Mello MJ, Baird J, Spirito A, Lee LK, Kiragu A, Scott K, Zonfrillo MR, Christison-Lagay E, Bromberg J, Ruest S, Pruitt C, Lawson KA, Nasr IW, Aidlen JT, Maxson RT, Becker S. Implementing Screening, Brief Interventions, and Referral to Treatment at Pediatric Trauma Centers: A Step Wedge Cluster Randomized Trial. J Pediatr Surg 2024:S0022-3468(24)00411-1. [PMID: 39097494 DOI: 10.1016/j.jpedsurg.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Pediatric trauma centers have had challenges meeting the American College of Surgeons criteria for screening and intervening for alcohol with adolescent trauma patients. The study objective was to conduct an implementation trial to evaluate the effectiveness of the Science to Service Laboratory (SSL) implementation strategy in improving alcohol and other drugs (AOD) screening, brief intervention, and referral to treatment (SBIRT) delivery at pediatric trauma centers. METHODS Using a stepped wedge cross-over cluster randomized design, 10 US pediatric trauma centers received the SSL implementation strategy to deliver SBIRT with admitted adolescent (12-17 years old) trauma patients. The strategy adapted three core SSL elements: didactic training, performance feedback, and facilitation. The main outcome measured was SBIRT reach. Data were collected from each center's electronic health record (EHR) during pre- and post-implementation wedges (2018-2022). RESULTS EHR data from 8461 adolescent patients were extracted. Aggregated across all sites, the reach of screening with a validated AOD screening tool increased significantly from 25.2% (95% CI: 23.9, 26.5%) of adolescents during pre-implementation to 47.7% (95% CI: 46.3%, 49.2%) post-implementation. There was variability of change across centers. Brief interventions continued to be delivered at high levels to identified adolescents. Referral to primary care providers for further AOD discussion or referral to specialty service for adolescents with high risk use did not improve post-implementation and remained low. CONCLUSIONS The SSL implementation strategy can be successfully utilized by pediatric trauma centers to improve AOD screening, but challenges exist in connecting adolescents for continuation of AOD discussions after discharge. LEVEL OF EVIDENCE Level II, Therapeutic.
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Affiliation(s)
- Michael J Mello
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA.
| | - Janette Baird
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 111 Richmond Street, Providence, RI, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Andrew Kiragu
- Department of Pediatrics, Hennepin County Medical Center, 30 S 8th St, Minneapolis, MN 55415, USA
| | - Kelli Scott
- Northwestern University Feinberg School of Medicine, Center for Dissemination and Implementation Science, 633 N. Saint Clair St., Chicago, IL 60611, USA
| | - Mark R Zonfrillo
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA
| | - Emily Christison-Lagay
- Yale School of Medicine/Yale New Haven Children's Hospital, Division of Pediatric of Surgery, 1 Park St, New Haven, CT 06510, USA
| | - Julie Bromberg
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA
| | - Stephanie Ruest
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA
| | - Charles Pruitt
- Pediatric Emergency Medicine, Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, USA
| | - Karla A Lawson
- Dell Children's Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas, 4900 Mueller Blvd, Austin, TX 78723, USA
| | - Isam W Nasr
- Division of Pediatric Surgery, Johns Hopkins Children's Center, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Jeremy T Aidlen
- Division of Pediatric Surgery, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - R Todd Maxson
- Department of Pediatric Surgery, Arkansas Children's Hospital 1 Children's Way, Little Rock, AR 72202, USA
| | - Sara Becker
- Northwestern University Feinberg School of Medicine, Center for Dissemination and Implementation Science, 633 N. Saint Clair St., Chicago, IL 60611, USA
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2
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Mello MJ, Baird J, Bromberg JR, Spirito A, Zonfrillo MR, Lee LK, Christison-Lagay ER, Ruest SM, Pruitt CW, Lawson KA, Kiragu AW, Nasr I, Aidlen JT, Ebel BE, Maxson RT, Scott K, Becker SJ. Variability in opioid pain medication prescribing for adolescent trauma patients in a sample of US pediatric trauma centers. Trauma Surg Acute Care Open 2022; 7:e000894. [PMID: 35558645 PMCID: PMC9045113 DOI: 10.1136/tsaco-2022-000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/05/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives The primary objective of this study was to examine opioid prescription frequency and identify differences across a national cohort of pediatric trauma centers in rates of prescribing opioids to injured adolescents at discharge. Methods This was a retrospective observational study using electronic health records of injured adolescents (12–17 years) admitted to one of 10 pediatric trauma centers. Results Of the 1345 electronic health records abstracted, 720 (53.5%, 95% CI 50.8 to 56.2) patients received opioid prescriptions at discharge with variability across sites (28.6%–72%). There was no association between patient factors and frequency of prescribing opioids. Center’s trauma volume was significantly positively correlated with a higher rate of opioid prescribing at discharge (r=0.92, p=0.001). There was no significant difference between the frequency of opioid prescriptions at discharge among alcohol and other drugs (AOD)-positive patients (53.8%) compared with AOD-negative patients (53.5%). Conclusions Across a sample of 10 pediatric trauma centers, just over half of adolescent trauma patients received an opioid prescription at discharge. Prescribing rates were similar for adolescent patients screening positive for AOD use and those screening negative. The only factor associated with a higher frequency of prescribing was trauma center volume. Consensus and dissemination of outpatient pain management best practices for adolescent trauma patients is warranted. Level of evidence III—prognostic. Trial registration number NCT03297060.
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Affiliation(s)
- Michael J Mello
- Emergency Medicine, Brown University, Providence, Rhode Island, USA.,Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Janette Baird
- Emergency Medicine, Brown University, Providence, Rhode Island, USA.,Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Julie R Bromberg
- Emergency Medicine, Brown University, Providence, Rhode Island, USA.,Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Anthony Spirito
- Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Mark R Zonfrillo
- Emergency Medicine, Brown University, Providence, Rhode Island, USA.,Emergency Medicine, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Lois K Lee
- Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Stephanie M Ruest
- Emergency Medicine, Brown University, Providence, Rhode Island, USA.,Emergency Medicine, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Charles W Pruitt
- Pediatrics, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Karla A Lawson
- Dell Children's Trauma and Injury Research Center, Austin, Texas, USA
| | - Andrew W Kiragu
- Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Isam Nasr
- Surgery, Johns Hopkins Children's Center, Baltimore, Maryland, USA
| | - Jeremy T Aidlen
- Pediatric Surgery, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Beth E Ebel
- Pediatrics, Harborview Medical Center, Seattle, Washington, USA
| | - R Todd Maxson
- Pediatric Surgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Kelli Scott
- Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Sara J Becker
- Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
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3
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Hink AB, Killings X, Bhatt A, Ridings LE, Andrews AL. Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. CURRENT TRAUMA REPORTS 2022; 8:41-53. [PMID: 35399601 PMCID: PMC8976221 DOI: 10.1007/s40719-022-00223-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/21/2022]
Abstract
Purpose of Review This provides up-to-date epidemiology of adolescent suicide and risk factors for suicide and highlights the overlap of risks for suicide and injury. It reviews signs and symptoms, and the up-to-date evidence on screening for depression, post-traumatic stress disorder (PTSD), suicide, substance abuse, and lethal means, and offers strategies of implementation in trauma centers. Recent Findings The incidence of adolescent suicide has continued to rise in the USA to 6.5 per 100,000, with notable racial disparities. The risk factors are complex, but many pre-existing risk factors and sequela after injury such as exposures to violence, suicidal behaviors, substance abuse, depression and post-traumatic stress disorder, and specific injuries including traumatic brain injury and spinal cord injury have further emerged as risks. Studies show rates of suicidality as high as 30% in the acute care setting. There are short screening instruments that can be used to universally screen for depression and suicidality in adolescent trauma patients. Step-up models of care for PTSD are promising to increase screening and services after injury. Lethal means counseling, secure firearm storage practices, and firearm safety policies can reduce the risk of suicide. Summary Suicide is the second leading cause of death in US adolescents, and trauma patients have significant risk factors for mental illness and suicidality before and after injury. Trauma centers should strongly consider screening adolescents, establish strategies for mental health support and referrals, and provide lethal means counseling to help prevent suicide.
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Maxwell BG, Lin S, Greene NH, Jafri MA. Kids grow up so fast: national patterns of positive drug/alcohol screens among pediatric trauma patients. Pediatr Res 2021; 89:767-769. [PMID: 32947605 DOI: 10.1038/s41390-020-01163-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/14/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND National guidelines recommend screening all trauma patients for drug and alcohol use beginning at age 12, but no national data have examined rates of screening or positive results in this population. METHODS We examined national testing rates and results among all trauma patients under 21 years old in the 2017 American College of Surgeons Trauma Quality Programs (TQP) database. RESULTS Of a cohort of n = 157,450 pediatric and adolescent trauma patients, n = 45,443 (28.9%) were screened, and n = 16,662 (36.7%) of those had a positive result. While both testing and positive results increased with age, testing rates were only 61.7% by age 20 and the prevalence of positive results was significant even at younger ages. Cannabinoids were the most commonly detected substance, followed by alcohol, and then opioids. CONCLUSIONS These national data support the need for further efforts to increase screening rates and provide structured interventions to mitigate the consequences of substance abuse. IMPACT These data provide the first national evidence of underutilization of drug and alcohol screening in pediatric and adolescent trauma patients, with substantial rates of positive screens among those tested. Cannabinoids were the most commonly detected substance, followed by alcohol and then opioids. These data should guide physicians' and policymakers' efforts to improve screening in this high-risk population, which will amplify the potential benefits of using the trauma admission as a critical opportunity to intervene with structured programs to mitigate the consequences of substance abuse.
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Affiliation(s)
- Bryan G Maxwell
- Department of Anesthesiology, Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR, USA.
| | - Saunders Lin
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Nathaniel H Greene
- Department of Anesthesiology, Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR, USA
| | - Mubeen A Jafri
- Division of Pediatric Surgery, Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR, USA.,Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, OR, USA
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5
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Screening Adolescent Trauma Patients for Substance Use at 10 Pediatric Trauma Centers. J Trauma Nurs 2020; 27:313-318. [PMID: 33156244 DOI: 10.1097/jtn.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American College of Surgeons Committee on Trauma recommends universal alcohol screening be part of the evaluation of admitted trauma patients. Yet, suboptimal screening rates have been reported for admitted adult and adolescent trauma patients. This lack of screening, in turn, has limited the ability of trauma services to provide patients with brief interventions during their hospital admission and subsequent referrals to treatment after discharge. The primary aim of this study was to examine current rates of alcohol and other drug screening with admitted injured adolescents across a national cohort of 10 pediatric trauma centers. METHODS This retrospective observational study was nested within a larger adolescent screening, brief intervention, and referral to treatment implementation study (Clinicaltrials.gov NCT03297060). Ten pediatric trauma centers participated in a retrospective chart review of a random sample of adolescent trauma patients presenting for care between March 1, 2018, and November 30, 2018. RESULTS Three hundred charts were abstracted across the 10 participating trauma centers (n = 30 per site). Screening rates varied substantially across centers from five (16.7%) to 28 (93.3%) of the 30 extracted charts. The most frequent screening type documented was blood alcohol concentration (BAC) (N = 80, 35.2% of all screens), followed by the CRAFFT (N = 79, 26.3%), and then the urine drug screen (UDS) (N = 77, 25.6%). The BAC test identified 11 patients as positive for recent alcohol use. The CRAFFT identified 11 positive patients. CONCLUSIONS Alcohol and drug screening is underutilized for adolescents admitted to pediatric trauma centers. More research is warranted on how best to utilize the teachable moment of the pediatric trauma visit to ensure comprehensive screening of adolescent alcohol or other drug (AOD) use.
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Smith JR, Hazen EP, Kaminski TA, Wilens TE. Literature review: Substance use screening and co-morbidity in medically hospitalized youth. Gen Hosp Psychiatry 2020; 67:115-126. [PMID: 33129136 DOI: 10.1016/j.genhosppsych.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pediatric and young adult patients frequently present to medical inpatient (MIP) units for treatment of substance use disorder (SUD). Given the risk of lifelong dependence and related complications in early life substance use (SU), a review of the literature is warranted. METHODS We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review of literature published through April, 62,020, which examined incidence, screening, and complications of pediatric and young adult SU in the MIP setting. RESULTS 8843 articles were screened, and 28 articles were included for final qualitative synthesis. The overall prevalence of SU-related discharge diagnoses ranged from 1.3% to 5% for patients aged 0 to 26 years. When compared to adult patients, nearly double the rate of co-morbid psychopathology was observed. Three studies utilized systematic screening tools, with the remainder relying on biologic screens and admission or discharge diagnoses. CONCLUSIONS The results of our review indicate that current screening practices for SU in the MIP clinical setting are subpar and likely result in an underestimation of incidence and morbidity due to limited use of systematic screening tools. Despite this, incidence of SU hospitalizations and related medical and psychiatric complications continue to rise.
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Affiliation(s)
- Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, United States..
| | - Eric P Hazen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, United States..
| | - Tamar A Kaminski
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, United States..
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, United States..
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7
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Noffsinger DL, Wurster LA, Cooley J, Buchanan L, Wheeler KK, Shi J, Xiang H, Groner JI. Alcohol and drug screening of adolescent trauma alert patients at a level 1 pediatric trauma center. Am J Emerg Med 2018; 37:1672-1676. [PMID: 30551939 DOI: 10.1016/j.ajem.2018.11.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescent trauma patients are reported to have increased incidence of alcohol and other drug (AOD) use, but previous studies have included inadequate screening of the intended populations. A Level 1 Pediatric Trauma Center achieved a 94% rate of AOD screening. We hypothesized that a positive AOD screening result is associated with males, increasing age, lower socioeconomic status, violent injury mechanism, higher Injury Severity Score (ISS), lower GCS, need for operation and increased hospital length of stay. METHODS After achieving high rates of screening among admitted trauma alert patients 12-17 years old, we evaluated patients presenting during 2014-2015. Chi-square tests were used to compare the percentage of patients with positive test results across sociodemographic, injury severity measures and patient outcomes. RESULTS Three hundred and one patients met criteria for AOD screening during the study period. Ninety-four percent of these patients received screening and 18% were positive. Males (21.4%) were more often positive than females (11.6%). Increasing age was directly correlated with AOD use. Race was associated with a positive screen. Black patients more often had positive screens (40.9%), as compared with White patients (13.8%) and other races (23.5%). Patients with commercial insurance (6.6%) were less likely to be positive than those with no insurance (19.0%) or Medicaid (30.9%). Lower median household income was associated with positive AOD screening. Patients with violent injury mechanisms were more likely to screen positive (36.2%) than those with non-violent mechanisms (18.0%). No statistical differences were found with injury severity scores, the need for operation, or hospital length of stay. CONCLUSIONS With near universal screening of adolescent trauma alert admissions, positive AOD results were more often found with males, increasing age, lower socioeconomic status, and violent injury mechanism. LEVEL OF EVIDENCE Level III, Retrospective comparative study without negative criteria. STUDY TYPE Prognostic.
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Affiliation(s)
- Dana L Noffsinger
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Lee Ann Wurster
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Jane Cooley
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Department of Social Work, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Lindsay Buchanan
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Department of Social Work, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Krista K Wheeler
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
| | - Henry Xiang
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; The Ohio State University College of Medicine, 370 West 9(th) Avenue, Columbus, OH 43210, United States of America.
| | - Jonathan I Groner
- Trauma Program, Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; The Ohio State University College of Medicine, 370 West 9(th) Avenue, Columbus, OH 43210, United States of America.
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8
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Falvo F, Schmid A. Bridging the Gap: Drug and Alcohol Screening in Adolescent Trauma Patients. J Emerg Nurs 2018; 44:325-330. [DOI: 10.1016/j.jen.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/23/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
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9
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Maung AA, Becher RD, Schuster KM, Davis KA. When should screening of pediatric trauma patients for adult behaviors start? Trauma Surg Acute Care Open 2018; 3:e000181. [PMID: 29766143 PMCID: PMC5905833 DOI: 10.1136/tsaco-2018-000181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background Care of patients with trauma is not only limited to the sustained physical injuries but also requires addressing social issues, such as substance abuse and interpersonal violence, which are responsible for trauma-related recidivism. This study investigates whether there are age-related variations in these problematic social behaviors to analyze whether there is an age cut-off at which point adolescents should be screened for adult social behaviors. Methods Retrospective review of patients with trauma aged 12–21 admitted to an urban Level 1 adult and pediatric trauma center between February 2013 and April 2016. Demographics, mechanisms of injury, Injury Severity Score, outcomes, toxicology and social history evaluations were abstracted from the electronic medical record. Results 756 patients were admitted during the 39-month period. Most patients were male (73.9%) without significant variation by age. The mechanisms of injury varied by age (p<0.001) with the incidence of sports and bicycle injuries decreasing and the incidence of motor vehicle/motorcycle crashes, assaults and gunshot injuries increasing with increasing patient age. In a logistic regression, risks of positive toxicology tests, injuries due to violence as well as overall use of drugs, tobacco and alcohol also significantly increased with age starting with the youngest age included in the study. Conclusions As pediatric trauma patients get older, they have increasing risks of social issues typically associated with adults. Our study underscores the need to evaluate and address these issues even in young adolescents. Level of evidence Level IV—epidemiological.
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Affiliation(s)
- Adrian A Maung
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert D Becher
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kevin M Schuster
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Davis
- Department of Surgery, Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
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Doupnik SK, Henry MK, Bae H, Litman J, Turner S, Scharko AM, Feudtner C. Mental Health Conditions and Symptoms in Pediatric Hospitalizations: A Single-Center Point Prevalence Study. Acad Pediatr 2017; 17:184-190. [PMID: 28259340 DOI: 10.1016/j.acap.2016.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children and adolescents necessitating hospitalization for physical health conditions are at high risk for mental health conditions; however, the prevalence of mental health conditions and symptoms among hospitalized children and adolescents is uncertain. The objective of this study was to determine the proportion of hospitalized children and adolescents who have diagnosed mental health disorders or undiagnosed mental health problems. METHODS In this single-center point prevalence study of hospitalized children between the ages of 4 and 21 years, patients or their parents reported known mental health diagnoses and use of services using the Services Assessment for Children and Adolescent, and they reported patient mental health symptoms using the Pediatric Symptom Checklist, 17-item form (PSC-17). RESULTS Of 229 eligible patients, 119 agreed to participate. Demographic characteristics of patients who enrolled were not statistically significantly different from those of patients who declined to participate. Among participants, 26% (95% confidence interval [CI], 18%-35%) reported a known mental health diagnosis. On the PSC-17, 29% (95% CI, 21%-38%) of participants had a positive screen for mental health symptoms. Of those with a positive screen, 38% (95% CI, 21%-55%) had no known mental health diagnosis, and 26% (95% CI, 12%-43%) had not received ambulatory mental health services in the 12 months before hospitalization. CONCLUSIONS Mental health conditions and symptoms are common among patients hospitalized in a tertiary children's hospital, and many affected patients are not receiving ambulatory mental health services.
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Affiliation(s)
- Stephanie K Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pa; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pa; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa.
| | - M Katherine Henry
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Hanah Bae
- The Graduate School of Education, University of Pennsylvania, Philadelphia, Pa; Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pa
| | - Jessica Litman
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pa
| | | | - Alexander M Scharko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Chris Feudtner
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pa; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pa
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11
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Doupnik SK, Lawlor J, Zima BT, Coker TR, Bardach NS, Hall M, Berry JG. Mental Health Conditions and Medical and Surgical Hospital Utilization. Pediatrics 2016; 138:peds.2016-2416. [PMID: 27940716 PMCID: PMC5127076 DOI: 10.1542/peds.2016-2416] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Mental health conditions are prevalent among children hospitalized for medical conditions and surgical procedures, but little is known about their influence on hospital resource use. The objectives of this study were to examine how hospitalization characteristics vary by presence of a comorbid mental health condition and estimate the association of a comorbid mental health condition with hospital length of stay (LOS) and costs. METHODS Using the 2012 Kids' Inpatient Database, we conducted a retrospective, nationally representative, cross-sectional study of 670 161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. Associations between mental health conditions and hospital LOS were examined using adjusted generalized linear models. Costs of additional hospital days associated with mental health conditions were estimated using hospital cost-to-charge ratios. RESULTS A comorbid mental health condition was present in 13.2% of hospitalizations. A comorbid mental health condition was associated with a LOS increase of 8.8% (from 2.5 to 2.7 days, P < .001) for medical hospitalizations and a 16.9% increase (from 3.6 to 4.2 days, P < .001) for surgical hospitalizations. For hospitalizations in this sample, comorbid mental health conditions were associated with an additional 31 729 (95% confidence interval: 29 085 to 33 492) hospital days and $90 million (95% confidence interval: $81 to $101 million) in hospital costs. CONCLUSIONS Medical and surgical hospitalizations with comorbid mental health conditions were associated with longer hospital stay and higher hospital costs. Knowledge about the influence of mental health conditions on pediatric hospital utilization can inform clinical innovation and case-mix adjustment.
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Affiliation(s)
- Stephanie K. Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Lawlor
- Children’s Hospital Association, Washington, District of Columbia;,Children's Hospital Association, Overland Park, Kansas
| | - Bonnie T. Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Tumaini R. Coker
- Department of Pediatrics, UCLA Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Naomi S. Bardach
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, University of California at San Francisco, San Francisco, California; and
| | - Matt Hall
- Children’s Hospital Association, Washington, District of Columbia;,Children's Hospital Association, Overland Park, Kansas
| | - Jay G. Berry
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Sveen J, Öster C. Alcohol Consumption After Severe Burn: A Prospective Study. PSYCHOSOMATICS 2015; 56:390-6. [DOI: 10.1016/j.psym.2014.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 11/27/2022]
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Roberts SP, Siegel MB, DeJong W, Naimi TS, Jernigan DH. Brand preferences of underage drinkers who report alcohol-related fights and injuries. Subst Use Misuse 2015; 50:619-929. [PMID: 25612075 PMCID: PMC4441549 DOI: 10.3109/10826084.2014.997392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A significant body of research has demonstrated an association between adolescent alcohol consumption and subsequent fights and injuries. To date, however, no research has identified which brands are associated with alcohol-related fights and injuries among underage drinkers. OBJECTIVES We aimed to: (1) report the prevalence of alcohol-related fights and injuries among a national sample of underage drinkers in the U.S. and (2) describe the relationship between specific alcohol brand consumption and these alcohol-related negative consequences. METHODS We recruited 1,031 self-reported drinkers (ages 13-20 years) via an internet panel maintained by Knowledge Networks to complete an online survey. Respondents reported their past-month overall and brand-specific alcohol consumption, risky drinking behavior, and past-year alcohol-related fights and injuries. RESULTS Over one-quarter of the respondents (26.7%, N = 232) reported at least one alcohol-related fight or injury in the past year. Heavy episodic drinkers were over six times more likely to report one of these negative alcohol-related consequences (AOR: 6.4, 95% CI: 4.1-9.9). Respondents of black race and those from higher-income households were also significantly more likely to report that experience (AOR: 2.2, 95% CI: 1.3-3.7; AOR: 1.8, 95% CI: 1.1-3.0 and 1.1-3.2, respectively). We identified eight alcohol brands that were significantly associated with alcohol-related fights and injuries. CONCLUSIONS/IMPORTANCE: Alcohol-related fights and injuries were frequently reported by adolescent respondents. Eight alcohol brands were significantly more popular among drinkers who experienced these adverse consequences. These results point to the need for further research on brand-specific correlates of underage drinking and negative health outcomes.
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Affiliation(s)
- Sarah P Roberts
- 1Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts , USA
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Emergency department alcohol and drug screening for Illinois pediatric trauma patients, 1999 to 2009. Am J Surg 2014; 208:531-5. [PMID: 25096261 DOI: 10.1016/j.amjsurg.2014.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/29/2014] [Accepted: 06/09/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent guidelines recommend universal substance abuse screening for all trauma patients aged 12 years and older because brief interventions can help prevent future trauma. However, little is known about actual rates of screening in this setting. METHODS The Illinois State Trauma Registry was queried for severely injured patients from 1999 to 2009. Multivariate logistic regression was used to characterize, according to demographic and physiologic parameters, which patients were screened with blood alcohol and urine toxicology and which screened positive. RESULTS Of the 12,264 pediatric patients, 40% were tested for alcohol and 37% for drugs. Nine percent of patients screened positive for alcohol and 8% for drugs. Age strongly predicted positive tests, as did male sex. Black and Hispanic patients were screened for alcohol most frequently, but only Hispanics were more likely to test positive. CONCLUSION Although current guidelines recommend screening all trauma patients 12 years and older, current practice falls far short of this goal.
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Cordovilla-Guardia S, Guerrero-López F, Maldonado A, Vilar-López R, Salmerón JM, Romero I, Pose S, Fernández-Modéjar E. Trauma risk perception related to alcohol, cannabis, and cocaine intake. Eur J Trauma Emerg Surg 2014; 40:693-9. [PMID: 26814784 DOI: 10.1007/s00068-014-0384-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A high perception of risk may exert a preventive effect against the initiation of risky activities. The aims of the present study were (1) to analyze the risk perception for traumatic incidents according to drug intake (alcohol, cannabis, cocaine, no consumption) by trauma patients admitted to our hospital, and (2) to explore the influence of drugs on trauma recidivism. METHODS Between 1 November 2011 and 1 April 2012, 404 patients aged between 16 and 70 years were admitted to our hospital for trauma cases. In 363 (89.9 %) of the patients, data were gathered on age, the trauma mechanism, and the consumption of alcohol and other drugs. Out of these 363 patients, 286 (78.8 %) attended a motivational interview and reported their consumption habits and their perception of the risk of trauma after alcohol and/or illegal drug consumption, as well as the antecedents of previous traumatisms. RESULTS Alcohol and/or illegal drugs were detected in 37 % of the sample, with alcohol being the most frequently detected, followed by cannabis, cocaine, and other drugs. Among the trauma patients with no consumption, a high perception of trauma risk was associated with alcohol intake by 95.9 %, with cannabis consumption by 68.4 %, and with cocaine consumption by 53.4 %, whereas these percentages were significantly lower for patients testing positive for substances (79.3, 21.1, and 8.3 % respectively). Among the patients experiencing their first trauma, the mean age was almost 15 years younger in those who were positive for these substances than in those who were negative (p < 0.001). Finally, a history of previous trauma was reported by a majority (64 %) of the trauma patients testing positive for alcohol and/or drugs, but by a minority (36 %) of those testing negative (p < 0.001). CONCLUSIONS The low perception of risk associated with alcohol, cannabis, or cocaine consumption by trauma patients under the influence of these substances on admission may be a predisposing factor for recidivism. Recommendations for both primary and secondary prevention are presented.
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Affiliation(s)
- S Cordovilla-Guardia
- Intensive Care Unit, Critical Care and Emergency Department, Virgen de las Nieves University Hospital, 18200, Granada, Spain
| | - F Guerrero-López
- Intensive Care Unit, Critical Care and Emergency Department, Virgen de las Nieves University Hospital, 18200, Granada, Spain
| | - A Maldonado
- Experimental Psychology Department, University of Granada, Granada, Spain
- Mind, Brain, and Behavior Research Centre, Granada, Spain
| | - R Vilar-López
- Mind, Brain, and Behavior Research Centre, Granada, Spain
- Department of Clinical Psychology, University of Granada, Granada, Spain
| | - J M Salmerón
- Intensive Care Unit, Critical Care and Emergency Department, Virgen de las Nieves University Hospital, 18200, Granada, Spain
| | - I Romero
- Intensive Care Unit, Critical Care and Emergency Department, Virgen de las Nieves University Hospital, 18200, Granada, Spain
| | - S Pose
- Department of Clinical Psychology, University of Granada, Granada, Spain
| | - E Fernández-Modéjar
- Intensive Care Unit, Critical Care and Emergency Department, Virgen de las Nieves University Hospital, 18200, Granada, Spain.
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