Injury Patterns and Demographics in Child and Adolescent Assault Victims Presenting to US Emergency Departments

Characteristics of non-accidental injuries in children and adolescents in Asia: a cross-national, multicenter cohort study

Children and adolescents are vulnerable to non-accidental injury. Early identification and prevention rely on detailed epidemiological studies, which are limited in Asia. This retrospective study used the registry data of Pan-Asian Trauma Outcome Study (PATOS) from October 1, 2015 to December, 31, 2020. Pediatric patients (aged < 20 years) with non-accidental injuries were enrolled, which were divided by age into preschool (0-6 years), child (7-12 years), and adolescent (13-19 years) groups. Baseline characteristics, injury epidemiology, and excess mortality ratio-adjusted injury severity score (EMR-ISS) were collected. Major trauma was defined as an EMR-ISS score > 24. The study enrolled 451 patients with non-accidental injuries, accounting for 2.81% of pediatric trauma events presented to an emergency department in the PATOS registry. The overall mortality rate was 0.9%, similar to those in Western countries. Mortality rate was high in preschool children (8.7%, p = 0.017) than in other age groups. The sex-specific incidence was higher in boys (3.10% vs. 2.13%, p = 0.001). In adolescents, more events occurred on the street (25.9%), whereas home remained the most common locale in girls of all ages. In the multivariable regression analysis, abdominal and multiple injuries were risk factors for major trauma.

Children from disadvantaged neighborhoods experience disproportionate injury from interpersonal violence

BACKGROUND

Disparities in pediatric injury have been widely documented and are driven, in part, by differential exposures to social determinants of health (SDH). Here, we hypothesized that neighborhood socioeconomic deprivation and specific sociodemographic characteristics would be associated with interpersonal violence-related injury admission.

METHODS

We conducted a retrospective cohort study of all patients ≤16 years, residing in Hamilton County, admitted to our level 1 pediatric trauma center. Residential addresses were geocoded to link admissions with a census tract-level socioeconomic deprivation index. Admissions were categorized as resulting from interpersonal violence or not - based on a mechanism of injury (MOI) of abuse or assault. The percentage of interpersonal violence-related injury admissions was compared across patient demographics and neighborhood deprivation index tertiles. These factors were then evaluated with multivariable regression analysis.

RESULTS

Interpersonal violence accounted for 6.2% (394 of 6324) of all injury-related admissions. Interpersonal violence-related injury admission was associated with older age, male sex, Black race, public insurance, and living in tertiles of census tracts with higher socioeconomic deprivation. Those living in the most deprived tertile experienced 62.2% of all interpersonal violence-related injury admissions but only 36.9% of non-violence related injury admissions (p < 0.001). After adjustment, insurance and neighborhood deprivation accounted for much of the increase in interpersonal violence-related admissions for Black compared to White children.

CONCLUSIONS

Children from higher deprivation neighborhoods, who are also disproportionately Black and publicly insured, experience a higher burden of interpersonal violence-related injury admissions. Level of evidence Level III.

Educational Needs of U.S. Emergency Nurses Related to Forensic Nursing Processes

BACKGROUND

Forensic nursing is a specialty deployed in patient care areas, including emergency departments, intensive care units, labor and delivery suites, and psychiatric units treating persons who have suffered trauma from a violent or criminal act. The recognition of violence-related injuries in patients presenting to health care facilities is critical to an appropriate care trajectory. These patients require specialized resources beyond the treatment of physical injuries to include psychosocial and legal care that supports patient recovery and pursuit of criminal justice.

OBJECTIVE

The purpose of this study is to obtain a broad view of current forensic knowledge and training for emergency nurses working in U.S. emergency departments and to identify gaps in nursing skills and practice such that appropriate education can be developed for this nursing specialty.

METHODS

The study was conducted using a quantitative exploratory, descriptive approach via an emailed cross-sectional survey sent to a convenience sample of U.S. emergency nurses.

RESULTS

A total of 43,775 emails were sent out to members of the Emergency Nurses Association. Of that group, 2,493 recipients opened the email, and 1,824 completed the survey, resulting in a total response rate of 4% and a 73% response rate from those who opened the email. Few respondents self-reported competence in the care of patients who experienced child abuse (13.1%), elder abuse (12.4%), interpersonal violence (17.6%), sexual assault (19.2%), human trafficking (7.4%), developmental challenges (7.2%), strangulation (12.5%), or who were suspected of committing a violent crime (11.4%).

CONCLUSIONS

There is a compelling need to expand forensic education to advance knowledge and skill acquisition in emergency nursing practice and provide staff with additional resources that support a holistic trauma-informed approach to patient care.