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Post-injury outcomes of children with behavioral health disorders
Michael D Traynor1, Ryan D Watkins1, Martin D Zielinski1
1Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester 55905, MN, USA.
Insights
Children with Behavioral Health Disorders (BHDs) had lower mortality after pediatric trauma, even with severe injuries. Intentional and penetrating injuries in this group require further prevention research.
Area of Science:
- Pediatric Trauma Care
- Behavioral Health Research
- Injury Epidemiology
Background:
- Behavioral Health Disorders (BHDs) impact on pediatric injury outcomes is not well-understood.
- This study investigates the association between BHDs and outcomes in pediatric trauma patients.
Purpose of the Study:
- To determine the relationship between comorbid Behavioral Health Disorders (BHDs) and outcomes in children aged 5-15 following traumatic injury.
- To identify specific injury patterns and risk factors associated with BHDs in pediatric trauma.
Main Methods:
- Analysis of injured children (age 5-15) from 2014-2016 using the Pediatric Trauma Quality Improvement Program.
- Comparison of in-hospital mortality and other outcomes between children with and without comorbid BHDs using univariable and multivariable analyses.
Main Results:
- 5% of 69,305 injured children had a BHD, most commonly ADHD.
- Children with BHDs had higher rates of intentional, penetrating, and firearm injuries, and more severe injuries (ISS>25).
- Despite more severe injuries, BHD patients had similar mortality rates and fewer complications, with BHD associated with lower mortality risk (OR 0.45).
Conclusions:
- Children with BHDs exhibit lower in-hospital mortality risk post-trauma, despite presenting with more severe injuries.
- Intentional and penetrating injuries are significant concerns in pediatric trauma patients with BHDs.
- Future research should focus on prevention strategies for this vulnerable pediatric population.
Background:
The impact of Behavioral Health Disorders (BHDs) on pediatric injury is poorly understood. We investigated the relationship between BHDs and outcomes following pediatric trauma.
Methods:
We analyzed injured children (age 5-15) from 2014 to 2016 using the Pediatric Trauma Quality Improvement Program. The primary outcome was in-hospital mortality. Univariable and multivariable analyses compared children with and without a comorbid BHD.
Results:
Of 69,305 injured children, 3,448 (5%) had a BHD. These 3,448 children had a median of 1 [IQR: 1, 1] BHD diagnosis: ADHD (n = 2491), major psychiatric disorder (n = 1037), drug use disorder (n = 250), and alcohol use disorder (n = 29). A higher proportion of injured children with BHDs suffered intentional and penetrating injury. Firearm injuries were more common for BHD patients (3% vs 1%, p<0.001). Children with BHDs were more likely to have an ISS>25 compared to children without (5% vs 3%, p<0.001). While median LOS was longer for BHD patients (2 [1, 3] vs 2 [1, 4], p<0.001), mortality was similar (1% vs 1%, p = 0.76) and complications were less frequent (7% vs 8%, p = 0.002). BHD was associated with lower risk of mortality (OR 0.45, 95%CI [0.30, 0.69]) after controlling for age, sex, race, trauma type, and injury intent and severity.
Conclusion:
Children with BHDs experienced lower in-hospital mortality risk after traumatic injury despite more severe injury upon presentation. Intentional and penetrating injuries are particularly concerning, and future work should assess prevention efforts in this vulnerable group.
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