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Olds KL, Tse R, Stables S, Baker AM, Hird K, Langlois NEI, Byard RW. An analysis of child suicide from three centers (2008-2017). Forensic Sci Med Pathol 2022; 18:415-422. [PMID: 35877004 PMCID: PMC9636085 DOI: 10.1007/s12024-022-00505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/14/2022]
Abstract
Although the overall suicide rate worldwide has changed minimally over the past 100 years, different trends have been observed over time in the USA, Australia, and New Zealand (NZ). However, few studies have focused on suicides in children (< 18 years), making evaluation of possible trends difficult. The last 20 years has also seen an increase in childhood obesity, eating disorders, and body image issues for children in many developed nations; however, few studies have shown whether a significant proportion of child suicides have an abnormal BMI. The current study evaluates child suicides (from 2008 to 2017) in South Australia (Australia), compared with the jurisdictions of Auckland (NZ) and Hennepin County (USA). Demographic data (age, sex, ethnicity), body mass index (BMI), the number of cases of youth suicide, and the method of suicide from these three regions were collected and analyzed. Across the 10-year period, the jurisdiction of Auckland had a downward trend, while Hennepin County and South Australia had increasing numbers of cases. The most common method of child suicide in all centers was hanging, occurring in > 80% of cases in South Australia and Auckland and 56% in Hennepin County. Hennepin County had a greater proportion of suicides using firearms (28%), compared to 1.9% in Auckland and 5.1% in South Australia. Unusual means of suicide were used less frequently by youth than previously.
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Affiliation(s)
- Kelly L Olds
- School of Medicine, The University of Notre Dame Australia, Fremantle, Australia
| | - Rexson Tse
- LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Simon Stables
- LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | | | - Kathryn Hird
- School of Medicine, The University of Notre Dame Australia, Fremantle, Australia
| | - Neil E I Langlois
- School of Biomedicine, The University of Adelaide, Adelaide, Australia
- Forensic Science South Australia, Adelaide, Australia
| | - Roger W Byard
- School of Biomedicine, The University of Adelaide, Adelaide, Australia.
- Forensic Science South Australia, Adelaide, Australia.
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3
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Donnelly KA, Badolato GM, Goyal MK. Determining Intentionality of Pediatric Firearm Injuries by International Classification of Disease Code. Pediatr Emerg Care 2022; 38:e306-e309. [PMID: 33105466 DOI: 10.1097/pec.0000000000002272] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Firearm injuries are a leading cause of serious injury and death in childhood. The accuracy of International Classification of Disease (ICD) codes to assign intent is unclear. The objective of this study was to assess the validity of documented ICD codes for firearm injury intent compared with chart review. METHODS We performed a retrospective cohort study of children (<= 18 years) presenting to a tertiary care level 1 pediatric trauma center with firearm injuries between 2006 and 2017. We compared agreement between ICD codes and intent of injury determined by medical record review using Cohen κ. Intent for medical record review was assigned via the injury spectrum of intentionality (suicide attempt, accidental firing, mistaken target, firearm assault and unknown). For comparison with ICD codes, all medical record review cases marked as mistaken target were classified as accidental. A sensitivity analysis was then performed, coding all mistaken targets as assault. RESULTS There were 122 cases identified over the study period. The most common intent by ICD code was assault (n = 80, 65.6%). Medical record review categorized most injuries as mistaken targets. When mistaken target was categorized as accidental, most firearm injuries were coded as accidental (n = 89, 72.9%) Similar results were seen when mistaken target was categorized as assault, most injuries were categorized as assault (n = 79, 79.5%) Cohen κ was 0.15 when mistaken targets were categorized as accident and 0.30 when categorized as assault. CONCLUSIONS The ICD codes do not fully describe the intent of firearm injury. Revising ICD codes to account for mistaken targets could help to improve the validity of ICD codes for intent.
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Affiliation(s)
- Katie A Donnelly
- From the Children's National Hospital, George Washington University, Washington, DC
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Babl FE, Lyttle MD, Bressan S, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Donath S, Hearps S, Arpone M, Crowe L, Dalziel SR, Barker R, Oakley E. Penetrating head injuries in children presenting to the emergency department in Australia and New Zealand: A PREDICT prospective study. J Paediatr Child Health 2018; 54:861-865. [PMID: 29579354 DOI: 10.1111/jpc.13903] [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: 12/23/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 11/27/2022]
Abstract
AIM Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand. METHODS This was a planned secondary analysis of a prospective observational study of children <18 years who presented with a head injury of any severity at any of 10 predominantly paediatric Australian/New Zealand emergency departments (EDs) between 2011 and 2014. We reviewed all cases where clinicians had clinically suspected pHI as well as all cases of clinically important traumatic brain injuries (death, neurosurgery, intubation >24 h, admission >2 days and abnormal computed tomography). RESULTS Of 20 137 evaluable patients with a head injury, 21 (0.1%) were identified to have sustained a pHI. All injuries were of non-intentional nature, and there were no gunshot wounds. The mechanisms of injuries varied from falls, animal attack, motor vehicle crashes and impact with objects. Mean Glasgow Coma Scale on ED arrival was 10; 10 (48%) had a history of loss of consciousness, and 7 (33%) children were intubated pre-hospital or in the ED. Fourteen (67%) children underwent neurosurgery, two (10%) craniofacial surgery, and five (24%) were treated conservatively; four (19%) patients died. CONCLUSIONS Paediatric pHIs are very rare in EDs in Australia and New Zealand but are associated with high morbidity and mortality. The absence of firearm-related injuries compared to North America is striking and may reflect Australian and New Zealand firearm regulations.
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Affiliation(s)
- Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark D Lyttle
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Bristol Children's Hospital, Bristol, United Kingdom.,Academic Department of Emergency Care, University of the West of England, Bristol, United Kingdom
| | - Silvia Bressan
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Meredith L Borland
- Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Natalie Phillips
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Sarah Dalton
- Emergency Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - John A Cheek
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Yuri Gilhotra
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jeremy Furyk
- Emergency Department, Townsville Hospital, Townsville, Queensland, Australia
| | - Jocelyn Neutze
- Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Susan Donath
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marta Arpone
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Louise Crowe
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ruth Barker
- Queensland Injury Surveillance Unit, Brisbane, Queensland, Australia
| | - Ed Oakley
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Pilla M, van den Heuvel C, Musgrave I, Byard RW. Increasing incidence of nonlethal inflicted injuries in paediatric homicides: A 45-year study. J Forensic Leg Med 2018; 59:4-7. [PMID: 30036763 DOI: 10.1016/j.jflm.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/06/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
Abstract
A retrospective study was undertaken at Forensic Science South Australia of all homicides in individuals aged <18 years from January 1970 to December 2014. 166 cases were identified (M:F = 1.5:1). The number of cases steadily declined, with the highest numbers and death rate occurring between 1970 and 1974 (N = 26; 0.37/100,000 population), and the lowest between 2010 and 2014 (N = 8; 0.1/100,000) (p < 0.01). Deaths were due to blunt force trauma (37%), gunshot wounds (19%), asphyxiation (18%), sharp force trauma (8%), poisoning (8%), burns (3%) and neglect (1%), or were undetermined (6%). There was a significant increase in numbers of accompanying nonfatal injuries (3.46 per case for 1970 and 1974, compared to 18.88 per case for 2010 and 2014). Thus, while both the absolute numbers and the rates of paediatric homicides declined significantly, numbers of nonlethal injuries increased. Whatever the underlying reason(s) for the increase in nonlethal injuries, fatal attacks on children in South Australia appear to be becoming more violent.
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Affiliation(s)
- Mark Pilla
- Adelaide Medical School, The University of Adelaide, Frome Rd, Adelaide, Australia; Forensic Science SA, 21 Divett Place, Adelaide, Australia
| | | | - Ian Musgrave
- Adelaide Medical School, The University of Adelaide, Frome Rd, Adelaide, Australia
| | - Roger W Byard
- Adelaide Medical School, The University of Adelaide, Frome Rd, Adelaide, Australia; Forensic Science SA, 21 Divett Place, Adelaide, Australia.
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Allareddy V, Nalliah RP, Rampa S, Kim MK, Allareddy V. Firearm related injuries amongst children: estimates from the nationwide emergency department sample. Injury 2012; 43:2051-4. [PMID: 22104700 DOI: 10.1016/j.injury.2011.10.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 10/03/2011] [Accepted: 10/29/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study is to provide estimates of firearm related injuries in children seeking care in hospital based emergency departments. METHODS The Nationwide Emergency Department Sample (NEDS) for the year 2008 was used for the current study. All ED visits occurring amongst children aged less than or equal to 18 years and that had an External Cause of Injury (E-Code) for any of the firearm related injuries were selected for analysis. RESULTS A total of 14,831 ED visits (in children) in the United States had a firearm injury. The average age of the ED visits was 15.9 years. Males constituted a predominant proportion of all ED visits (89.2%). A total of 494 patients died in the emergency departments (3.4% of all ED visits) whilst 323 died following in-patient admission into the same hospital (6% of all inpatient admissions). The most frequently documented firearms were assaults by firearms and explosives (55% of all ED visits), accidents caused by firearms and air gun missiles (33.6%), and injuries by firearms that were undetermined (7.4%). The average charge for each ED visit was $3642 (25th percentile is $1146, median is $2003, and 75th percentile is $4404). The mean charge for those visits that resulted in in-patient admission into the same hospital was $70,164 (25th percentile is $16,704, median is $36,111, and 75th percentile is $74,165) and the total charges for the entire United States was about $371.33 million. CONCLUSIONS The current study used the largest all-payer hospital based emergency department dataset to provide national estimates of firearm related injuries amongst children in the United States during the year 2008 and highlights the public health impact of such injuries.
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Affiliation(s)
- Veerajalandhar Allareddy
- Department of Pediatric Critical Care and Pharmacology, Rainbow Babies and Children's Hospital, University Hospitals, Case Medical Center, United States
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