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Mental health outcomes in pediatric trauma patients: A 10 year real world analysis using a large database approach
Julia M Chandler1, Katelyn S Chan2, Ryan Han3
1Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, United States.
Insights
Children with traumatic injuries face a higher risk of developing mental health conditions like PTSD. Early recognition and intervention are crucial, as under-diagnosis may be occurring.
Area of Science:
- Pediatric Traumatology
- Child Mental Health
- Public Health Surveillance
Background:
- Traumatic injuries are a leading cause of child morbidity and mortality in the U.S.
- Previous studies indicate a link between pediatric trauma and poor mental health outcomes.
- Population-based data on this association are limited.
Purpose of the Study:
- To assess the risk of mental health conditions in children following traumatic injury.
- To compare mental health outcomes across different injury treatment settings.
- To evaluate the association between hospitalization duration and mental health diagnosis rates.
Main Methods:
- Utilized the IBM MarketScan private insurance claims database (2007-2016).
- Identified children aged 6-17 with traumatic injuries.
- Employed time-to-event analysis comparing injury cohorts to an appendicitis cohort.
Main Results:
- 3.3% of hospitalized children with trauma developed a mental health diagnosis; 1.6% developed PTSD.
- Traumatically injured children had a higher risk of mental health conditions compared to appendicitis patients (HR 1.34).
- Increased risk was also observed for children treated in ED/UC and outpatient settings.
Conclusions:
- Pediatric traumatic injury significantly increases the risk for subsequent mental health conditions.
- Observed PTSD rates are lower than in prospective studies, suggesting potential under-recognition.
- Findings highlight the need for improved mental health screening in pediatric trauma patients.
Introduction:
Traumatic injury is the leading cause of morbidity and mortality among children in the United States. Single institution studies suggest an increased risk of poor mental health outcomes among these patients, but there are few population-based studies assessing this risk.
Methods:
The IBMⓇ MarketScanⓇ private insurance claims database was used to identify children (6-17yo) with traumatic injuries between 2007 and 2016. Time-to-event analysis was performed to compare rates of PTSD, depression, anxiety, and adjustment disorder among children admitted to the hospital compared to children treated in the emergency department (ED), urgent care (UC), or in the outpatient setting, and to children admitted with uncomplicated appendicitis.
Results:
Among children admitted for traumatic injury, 3.3% developed a subsequent mental health diagnosis, and 1.6% developed PTSD. Children admitted for traumatic injury were at increased risk of developing a mental health condition (HR 1.34, p < 0.001) compared to those admitted for appendicitis. Children treated in the ED or UC for traumatic injury and those treated in the outpatient setting were also at increased risk (HR 1.20 and 1.18, p = 0.006 and p = 0.012, respectively). Among those admitted to the hospital, the risk of subsequent mental health diagnosis increased by 1.5% per day; in the first 31 days of hospitalization, the risk of PTSD diagnosis increased by 13% per day.
Conclusion:
Children who sustain a traumatic injury are at increased risk of developing a mental health condition. PTSD rates found in our real world analysis are lower than those found in prospective studies, raising the possibility of under-recognition of PTSD in this population.
Level Of Evidence:
Level II.
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