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Caring for Children in the Juvenile Justice System: A Trauma and Surgical Subspecialty-Focused Approach
Jessica Aya Zagory1, Celia Short2, Patrice Evers3
1Children's Hospital New Orleans, New Orleans, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
Insights
Youth in the juvenile justice system frequently need surgical care, primarily for physical trauma sustained during arrest or previously. This highlights a critical need for trauma-focused interventions and highlights the role of pediatric surgeons in this vulnerable population.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Forensic Pediatrics
Background:
- Youth in the juvenile justice system represent a vulnerable, high-risk demographic.
- While medical and mental health needs are studied, surgical requirements remain poorly understood.
- Understanding these surgical needs is crucial for comprehensive care.
Purpose of the Study:
- To characterize the physical trauma and surgical subspecialty needs of youth in the juvenile justice system.
- To identify patterns of injury and healthcare utilization in this population.
Main Methods:
- Retrospective chart review of children in custody transported to an urban children's hospital.
- Analysis of demographic data, inpatient, and outpatient encounter information.
Main Results:
- 74 patients underwent 199 subspecialty evaluations; 65% of encounters were for physical trauma.
- 34% of trauma was incurred at the time of arrest; 85% had prior physical trauma.
- High rates of head trauma (54%), self-harm history (23%), and sexual trauma in girls (60%) were noted.
Conclusions:
- The majority of surgical and emergency encounters for justice-involved youth are due to physical trauma.
- There is a significant opportunity to implement trauma-focused care for this population.
- Pediatric surgeons and emergency physicians are integral to managing the surgical needs of incarcerated youth.
Introduction:
Youth in the juvenile justice system are a vulnerable, high-risk population. While the role of pediatricians and mental health professionals in providing care for these children is well studied, the surgical needs of this population are not well understood. We sought to characterize the physical trauma and surgical subspecialty needs of this population.
Methods:
A retrospective chart review was performed of all children transported under custody to a stand-alone urban children's hospital. Demographic information and inpatient and outpatient encounter data were collected and analyzed.
Results:
Between January 2020 and March 2021, 74 patients were transported for 199 subspecialty evaluations. Sixty-nine (93%) were male, 66 (89%) identified as Black, and the median age was 16 y (range, 13-20). Of all patients, 19% had at least one documented medical condition, 43% had behavioral health history, and 73% had previous arrest. Of the 199 encounters, 137 were for physical trauma (65%). Of these, 47 (34%) were for physical trauma incurred at the time of their arrest. Sixty-three patients (85%) experienced previous physical trauma (69% blunt, 12% penetrating, and 7% both), 54% had documented head trauma, 23% had a history of self-harm, and 60% of girls had experienced sexual trauma. Of the 54 children with a previous arrest, 91% had a history of physical trauma compared to 70% who were not previously incarcerated (P = 0.03).
Conclusions:
Most subspecialty and emergency encounters for incarcerated children are for physical trauma, revealing an opportunity for trauma-focused care in this vulnerable population. Pediatric surgeons and emergency physicians play a major role in the care of incarcerated children.
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