Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester 55905, MN, USA.
Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester 55905, MN, USA.
J Pediatr Surg. 2022 Mar;57(3):462-468. doi: 10.1016/j.jpedsurg.2021.04.008. Epub 2021 Apr 24.
The impact of Behavioral Health Disorders (BHDs) on pediatric injury is poorly understood. We investigated the relationship between BHDs and outcomes following pediatric trauma.
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.
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.
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.
行为健康障碍（BHD）对儿科伤害的影响知之甚少。我们研究了 BHD 与儿科创伤后结局之间的关系。
我们使用儿科创伤质量改进计划分析了 2014 年至 2016 年期间受伤的儿童（年龄 5-15 岁）。主要结局是院内死亡率。单变量和多变量分析比较了有和无合并 BHD 的儿童。
在 69305 名受伤儿童中，有 3448 名（5%）患有 BHD。这些 3448 名儿童的平均 BHD 诊断数为 1 [IQR：1，1]：注意力缺陷多动障碍（n=2491），重大精神障碍（n=1037），药物使用障碍（n=250）和酒精使用障碍（n=29）。患有 BHD 的受伤儿童中，更多的是有意和穿透性损伤。火器伤在 BHD 患者中更为常见（3%比 1%，p<0.001）。与无 BHD 的儿童相比，患有 BHD 的儿童的 ISS>25 的可能性更大（5%比 3%，p<0.001）。虽然 BHD 患者的 LOS 中位数更长（2 [1，3] vs 2 [1，4]，p<0.001），但死亡率相似（1%比 1%，p=0.76），并发症发生率较低（7%比 8%，p=0.002）。在控制年龄，性别，种族，创伤类型以及伤害意图和严重程度后，BHD 与较低的死亡率风险相关（OR 0.45，95%CI [0.30，0.69]）。
尽管受伤时的伤势更为严重，但患有 BHD 的儿童在创伤后经历的院内死亡率风险较低。有意和穿透性伤害尤其令人担忧，未来的工作应评估这一弱势群体的预防措施。
