From the Department of Pediatric Surgery (D.F.L., K.D.B.), John R. Oishei Children's Hospital, Buffalo, New York; Department of Surgery (D.F.L., K.D.B.), Jacobs School of Medicine and Biomedical Sciences; Department of Epidemiology and Environmental Health (D.F.L., K.N.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York; Department of Pediatrics (K.M.S.), Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Biostatistics (J.Y.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York; and Department of Pediatrics (D.Z.K.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
J Trauma Acute Care Surg. 2022 Sep 1;93(3):299-306. doi: 10.1097/TA.0000000000003608. Epub 2022 Mar 14.
Children and youth with special health care needs (CYSHCN) have or are at an increased risk for a chronic condition necessitating medical and related services beyond what children usually require. While evidence suggests that CYSHCN are at an increased risk of injury, little is known about this population within the trauma system. This study describes CYSHCN within the pediatric trauma system and examines patterns of injury risk (i.e., intent, place of injury, trauma type, and mechanism of injury) based on special health care need (SHCN) status.
For this cross-sectional study, we used data from the 2018 National Trauma Data Bank to identify pediatric encounters (1-18 years, N = 115,578) and compare demographics (sex, race/ethnicity, insurance status, and age) by CYSHCN status using χ 2 and t tests. Children and youth with special health care needs encounters were compared with non-SHCN encounters using multinomial logistic regression models, controlling for demographics.
Overall, 16.7% pediatric encounters reported an SHCN. Children and youth with special health care needs encounters are older, and a higher proportion is publicly insured than non-SHCN encounters ( p < 0.001). Furthermore, CYSHCN encounters have a higher risk of assault (relative risk, 1.331) and self-inflicted (relative risk, 4.208) injuries relative to unintentional injury ( p < 0.001), as well as a higher relative risk of traumatic injury occurring in a private residence ( p < 0.01) than other locations such as school (relative risk, 0.894). Younger CYSHCN encounters have a higher risk of assault relative to unintentional injury when compared with non-SHCN encounters ( p < 0.01). Pediatric trauma encounters reporting mental health and alcohol/substance use disorder SHCN have a higher probability of self-inflicted and assault injuries than non-SHCN encounters ( p < 0.001).
These findings suggest that CYSHCN have different traumatic injury patterns than their non-SHCN peers, particularly in terms of intentional and private residence injury, and deserve a special focus for traumatic injury prevention.
Prognostic/epidemiologic, level III.
有特殊医疗需求的儿童和青少年（CYSHCN）患有或存在慢性病的风险增加，需要超出儿童通常所需的医疗和相关服务。尽管有证据表明 CYSHCN 受伤的风险增加，但在创伤系统中对这一人群知之甚少。本研究描述了儿科创伤系统中的 CYSHCN，并根据特殊医疗需求（SHCN）状况检查了伤害风险（即意图、受伤地点、创伤类型和受伤机制）的模式。
在这项横断面研究中，我们使用了 2018 年国家创伤数据库的数据，从儿科就诊（1-18 岁，N=115578）中识别出有特殊医疗需求的儿童和青少年，并使用卡方检验和 t 检验比较特殊医疗需求状况下的人口统计学特征（性别、种族/族裔、保险状况和年龄）。使用多变量逻辑回归模型比较有特殊医疗需求的儿童和青少年就诊与无特殊医疗需求就诊，控制人口统计学因素。
总体而言，16.7%的儿科就诊报告有 SHCN。有特殊医疗需求的儿童和青少年就诊年龄较大，公共保险的比例高于无特殊医疗需求的就诊（p<0.001）。此外，CYSHCN 就诊的意外伤害（相对风险，1.331）和自我伤害（相对风险，4.208）的风险高于非意外伤害（p<0.001），以及创伤发生在私人住所（相对风险，0.894）的风险高于其他地点（如学校）（相对风险，0.894）。与非 SHCN 就诊相比，年轻的 CYSHCN 就诊的意外伤害相对风险更高（p<0.01）。报告心理健康和酒精/物质使用障碍 SHCN 的儿科创伤就诊自我伤害和意外伤害的可能性高于非 SHCN 就诊（p<0.001）。
这些发现表明，CYSHCN 的创伤模式与非 SHCN 同龄人不同，特别是在故意伤害和私人住所伤害方面，需要特别关注创伤预防。
预后/流行病学，三级。
