TY - JOUR
T1 - Characterizing physical trauma in children and youth with special health care needs
AU - Lillvis, Denise F.
AU - Sheehan, Karen M.
AU - Yu, Jihnhee
AU - Noyes, Katia
AU - Bass, Kathryn D.
AU - Kuo, Dennis Z.
N1 - Funding Information:
D.F.L. received funding for this research from the Health Resources and Services through the Children and Youth with Special Health Care Needs Research Network. D.F.L. and K.D.B. received funding support from the Oishei Children's Hospital Foundation. K.D.B. received funding support from a Medline Industry Grant and is part of the MiMedx speakers bureau. D.Z.K. receives royalty payments from UpToDate. K.M.S., J.Y., and K.N. have no conflicts to report.
Funding Information:
This project is supported by the Health Resources and Services Administration of the US Department of Health and Human Services under UA6MC31101 Children and Youth with Special Health Care Needs Research Network. DISCLOSURE
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - BACKGROUND 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. METHODS 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 χ2 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. RESULTS 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). CONCLUSIONS 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. LEVEL OF EVIDENCE Prognostic/epidemiologic, level III.
AB - BACKGROUND 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. METHODS 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 χ2 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. RESULTS 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). CONCLUSIONS 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. LEVEL OF EVIDENCE Prognostic/epidemiologic, level III.
KW - children
KW - chronic disease
KW - intentional injury
KW - Pediatric trauma
KW - special health care needs
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U2 - 10.1097/TA.0000000000003608
DO - 10.1097/TA.0000000000003608
M3 - Article
C2 - 35293370
AN - SCOPUS:85136683574
SN - 2163-0755
VL - 93
SP - 299
EP - 306
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 3
ER -
