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Frequency and predictors of medically attended injuries in HIV-infected children
B J Turner1, J Cocroft, W W Hauck
1Division of General Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107-5083, USA.
Insights
Medically attended injuries are slightly more common in children with HIV (human immunodeficiency virus) infection compared to peers. Maternal substance abuse and younger maternal age are key predictors of these injuries in HIV-exposed infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Medically attended injuries can complicate the health of children with HIV.
- The frequency and severity of these injuries in HIV-infected children are not well understood.
Purpose of the Study:
- To determine the incidence and severity of medically attended injuries in HIV-infected children.
- To identify predictors of medically attended injuries in this population.
Main Methods:
- A cohort of HIV-infected children (aged <60 months, delivered 1985-1990) was studied using linked New York State Medicaid claims and birth certificates (1986-1992).
- Injury rates and Injury Severity Scores (ISS) were compared to a control group of non-HIV-infected children from emergency room records.
- Predictors of injury were analyzed using regression models.
Main Results:
- HIV-infected children experienced slightly higher injury rates (19.3 vs. 16.8 per 100 child-years) but similar ISS compared to controls.
- Younger maternal age and delivery outside New York City predicted higher injury rates in HIV-infected children.
- Maternal illicit drug and alcohol use correlated with higher ISS; cocaine use was linked to potentially intentional injuries.
Conclusions:
- Approximately one in five HIV-infected children experienced medically attended injuries annually, exceeding the comparison group.
- Maternal characteristics, including substance abuse and younger age, are crucial for identifying at-risk children for injury prevention interventions.
Abstract:
The extent to which medically attended injuries complicate the clinical course of HIV-infected (HIV+) children is unknown. In a cohort of HIV+ children delivered from 1985 to 1990 and aged less than 60 months, we determined medically attended injuries per 100 child-years, Injury Severity Scores (ISS), and predictors of medically attended injuries by using New York State Medicaid claims from 1986 to 1992 linked to birth certificates. Injury rates and ISS were compared to those of a population of black, inner city children aged less than 60 months from emergency room records. HIV+ children had slightly more injuries (19.3 vs. 16.8/100 child-years) but similar ISS (2.4 vs. 2.3). Predictors of injuries in HIV+ children included younger maternal age (24/100 child-years, p = 0.008) and delivery outside of New York City (29/100 child-years, p = 0.02). Illicit drug use and alcohol use were associated with greater ISS while cocaine use was associated with a higher rate of possibly intentional injuries. Medically attended injuries affected one in five HIV+ children in our cohort annually, slightly more than the comparison population. Specific maternal and birth characteristics such as substance abuse and younger age at delivery may help target at-risk children.