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Hale ME, Pinkman K, Quinoy AM, Schoffner KR. Identifying mental health outcomes and evidence-based psychological interventions for supporting pediatric gunshot wound patients: A systematic review and proposed conceptual model. BMC Pediatr 2024; 24:397. [PMID: 38890635 PMCID: PMC11184880 DOI: 10.1186/s12887-024-04878-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Accidental and assault gunshot wounds (GSWs) are the second leading cause of injury in the United States for youth ages 1- to 17-years-old, resulting in significant negative effects on pediatric patients' mental health functioning. Despite the critical implications of GSWs, there has yet to be a systematic review synthesizing trends in mental health outcomes for pediatric patients; a gap the present review fills. Additionally, this review identifies evidence-based psychological interventions shown to be effective in the treatment of subclinical symptoms of psychological disorders in the general population. METHODS A comprehensive search was conducted using five databases: American Psychological Association (APA) PsycInfo, APA PsycArticles, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resource Information Center (ERIC), and Medical Literature Analysis and Retrieval Systems Online (MEDLINE). Twenty-two articles met inclusion criteria. RESULTS Findings suggest pediatric GSW patients are at a significantly elevated risk for mental health disorders when compared to other- (e.g., motor vehicle collision) and non-injured youth. Disorders include post-traumatic stress, disruptive behavior, anxiety, depression, and substance use. Hospital-based violence intervention programs, cultivating supportive relationships with adults in one's community, and trauma-focused outpatient services were identified as effective interventions for treating subclinical psychological symptoms. CONCLUSIONS Depicted in the proposed conceptual model, the present study delineates a direct association between pediatric GSWs and subsequent onset of mental health disorders. This relation is buffered by evidence-based psychological interventions targeting subclinical symptoms. Results suggest brief psychological interventions can help treat mental health challenges, minimizing risk for significant long-term concerns. Cultural adaptations to enhance the utility and accessibility of interventions for all patients are recommended.
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Affiliation(s)
- Molly E Hale
- Department of Psychology, University of Georgia, Athens, GA, USA.
| | - Kahyah Pinkman
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Alexis M Quinoy
- Department of Neuropsychology and Rehabilitation Services, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Kindell R Schoffner
- Department of Neuropsychology and Rehabilitation Services, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory School of Medicine, Atlanta, GA, USA
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Swendiman RA, Scaife JH, Barnes KL, Bell TM, Roach CM, Iyer RR, Brockmeyer DL, Russell KW. Hanging and Strangulation Injuries: An Institutional Review From a Level 1 Pediatric Trauma Center. J Pediatr Surg 2023; 58:1995-1999. [PMID: 37002058 DOI: 10.1016/j.jpedsurg.2023.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/11/2023] [Accepted: 02/21/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND We sought to define the incidence and outcomes of pediatric hanging and strangulation injuries to inform best practices for trauma triage and management. METHODS A retrospective review was conducted that included all patients who presented after hanging or strangulation to a Level I Pediatric Trauma Center from 2011 through 2021. Patient demographics, injury characteristics, and clinical outcomes were collected. All imaging modalities of the head and neck were reviewed to determine if a bony fracture or vascular injury was present. RESULTS Over the 11-year study period, 128 patients met inclusion criteria. The median age of the cohort was 13 years [IQR: 8.5-15], most patients were male (60.9%), and the median GCS was 11 [3, 15]. There were 96 cases (75%) that were intentional injuries. 76 patients (59.4%) received imaging in the form of plain radiographs, CT, or MRI of the neck and cervical spine. No fractures were identified and there were 0 clinically significant cervical spine injuries. CT angiograms of the neck identified no cerebral vascular injuries. Mortality was high (32%), and 25% of patients with nonaccidental injuries had a documented prior suicide attempt. CONCLUSION We identified no cervical spine fractures and no blunt cerebral vascular injuries after a hanging or strangulation in over 10 years at a Level 1 Pediatric Trauma Center. Use of CT and CT angiography of the neck and cervical spine should be minimized in this patient population without high clinical index of suspicion and/or significant mechanism. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Robert A Swendiman
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Jack H Scaife
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kacey L Barnes
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
| | - Teresa M Bell
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Rajiv R Iyer
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | | | - Katie W Russell
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
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Maina C, Cioffi SPB, Altomare M, Spota A, Virdis F, Bini R, Ragozzino R, Renzi F, Reitano E, Corasaniti L, Macchini F, Chiara O, Cimbanassi S. Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients: A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic. J Pers Med 2023; 13:jpm13010128. [PMID: 36675789 PMCID: PMC9864714 DOI: 10.3390/jpm13010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Background: Trauma is the leading cause of morbidity and mortality in the pediatric population. During the COVID-19 pandemic (COVID-19), different trends for pediatric trauma (PT) were described. This study aims to explore the trend over time of PT in our center, also considering the effects of COVID-19, focusing on trauma mechanisms, violence-related trauma (VRT) and intentionality, especially suicide attempts (SAs). Methods: All PT patients accepted at Niguarda Trauma Center (NTC) in Milan from January 2015 to December 2020 were retrospectively analyzed. We considered demographics and clinical variables and performed descriptive and year comparison analyses. Results: There were 684 cases of PT accepted at NTC: 84 in 2015, 98 in 2016, 125 in 2017, 119 in 2018, 114 in 2019 and 144 in 2020 (p < 0.001), 66.2% male, mean age 9.88 (±5.17). We observed a higher number of traffic-related, fall-related injuries and an increasing trend for VRT and SAs, peaking in 2020. We report an increasing trend over time for head trauma (p = 0.002). The Injury Severity Score did not significantly change. During COVID-19 we recorded a higher number of self-presenting patients with low priority codes. Conclusions: NTC is the adult level I referral trauma center for the Milan urban area with pediatric commitment. During COVID-19, every traumatic emergency was centralized to NCT. In 2020, we observed an increasing trend in SAs and VRT among PT patients. The psychological impact of the COVID-19 restriction could explain this evidence. The long-term effects of COVID-19 on the mental health of the pediatric population should not be underestimated. Focused interventions on psychological support and prevention of SAs and VRT should be implemented, especially during socio-demographic storms such as the last pandemic.
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Affiliation(s)
- Cecilia Maina
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- General Surgery, I.R.C.C.S. San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Stefano Piero Bernardo Cioffi
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-3386032519
| | - Michele Altomare
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Andrea Spota
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesco Virdis
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Roberto Bini
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Roberta Ragozzino
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Federica Renzi
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Eastern Piedmont, Corso Giuseppe Mazzini 18, 28100 Novara, Italy
| | - Lucia Corasaniti
- Department of Pediatric Surgery, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Osvaldo Chiara
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Stefania Cimbanassi
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Pathophysiology and Transplantation-State University of Milan-Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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