Recovery of Pediatric Patients After Firearm Injury: Can Health Systems Do More?

2021 ◽  
pp. 000313482110242
Author(s):  
Rachel M. Borthwell ◽  
Samuel Olanrewaju ◽  
Brant A. Putnam ◽  
Dennis Y. Kim ◽  
Vincent E. Chong
Keyword(s):  
Health Systems ◽  
Pediatric Patients ◽  
The United States ◽  
Outpatient Services ◽  
Structural Determinants ◽  
Post Injury ◽  
Firearm Injury ◽  
Firearm Injuries ◽  
Biopsychosocial Assessment

Background Firearm injuries are the second leading cause of death among youth in the United States. Nonfatal firearm injuries far outnumber fatalities, yet data detailing the recovery and post-injury needs of pediatric patients after hospital discharge are limited. This study evaluated health system support of pediatric patients after firearm injury, from acute hospitalization to outpatient follow-up. Methods We conducted a retrospective chart review of patients <18 years who presented to an urban level 1 trauma center between 2014 and 2019. Cases were categorized as accidental or intentional (stratified as assault-related or “crossfire” injuries). Outcomes included biopsychosocial assessment (BA) utilization, trauma psychology service consultation, and linkage to outpatient services. Results Among 115 patients, 94% were victims of community violence. Black (50%) and Latinx (44%) patients were disproportionately affected, as were males aged 15-16 years (71%). Overall mortality was 8%. Biopsychosocial assessment and trauma psychology consultations occurred in 43% and 20% of cases, respectively. Of eligible patients, 71% received referral to post-hospitalization support services. The most commonly identified needs were counseling, gang intervention, and help with the carceral system. Conclusion Health systems should support long-term recovery of pediatric patients after firearm injury, particularly addressing social and structural determinants of health. Inpatient-to-outpatient linkages should be strengthened, and prospective follow-up is needed.

scholarly journals Incidence and Outcomes of Pediatric Myelodysplastic Syndrome in the US

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1285-1285
Author(s):  
Ana Xavier ◽  
Matthew A. Kutny ◽  
Luciano J Costa
Keyword(s):  
Overall Survival ◽  
Myelodysplastic Syndrome ◽  
Pediatric Patients ◽  
De Novo ◽  
The United States ◽  
Refractory Anemia ◽  
Histological Subtype ◽  
Risk Of Death

Background There is lack of epidemiological data on pediatric myelodysplastic syndrome (p-MDS) in the literature. MDS became reportable to the Surveillance, Epidemiology and End Results (SEER) Program in 2001, providing an opportunity to estimate the incidence and survival of pediatric patients with MDS in the United States. Methods We utilized data from the National Cancer Institute SEER-18 to determine the incidence and long term overall survival (OS) of pediatric patients (ages 0 to 20 years) diagnosed with de novo MDS or therapy-related MDS. Inclusion criteria was diagnosis of MDS (International Classification of Diseases-Oncology, Third Edition, ICD-O-4 codes 9980/3, 9991/3, 9992/3, 9982/3, 9985/3, 9983/3, 9986/3, 9986/3, 9989/3, 9985/3, 9975/3, and 9987/3) between 2001 and 2011. Follow up was updated through the end of 2011 (November 2013 submission). Overall survival was estimated using the method of Kaplan-Meier. A Cox proportional hazard model was used to compare the effects of age, race, gender, histological subtype, and etiology (de novovs. therapy-related) on survival. Results The incidence of p-MDS was 1.16 cases/1 million population*year. A greater incidence occurred in children younger than 1 year of age possibly reflecting congenital bone marrow failure syndromes (Figure 1). A total of 314 p-MDS cases were included in the analysis with median follow up of 31 months (range 0-131). Median age of patients was 9 years; 167 (53.3%) had MDS unclassifiable (NOS), 40 (12.7%) had therapy-related MDS (t-MDS), 44 (14%) had refractory anemia with excess blasts (RAEB), 32 (10.3%) had refractory anemia (RA), 17 (5.4%) had refractory cytopenia with multilineage dysplasia (RCMD), 6 (1.9%) had refractory anemia with ring sideroblasts (RARS), 5 (1.6%) had refractory anemia with excess blasts in transformation (RAEBT), and 3 (0.9%) had MDS associated with isolated del(5q). Male patients comprised 154 (49%) of cases. Racial groups included white (218, 69.4%), 52 (15.7%) black, 37 (11.8%) of other races, and 7 (2.3%) the race was unknown. The 5 year-OS for the entire cohort was 68% (95% C.I.=62.3-73.7). Patients with t-MDS had significantly worse 5 year-OS (41.2%; 95%C.I.=23.8-58.6) compared to those with de novo MDS (71.3%; 95%C.I.=65.3-77.2; P=0.004, Figure 2). In multivariate analysis of age, race, gender, histological subtype, and etiology (de novovs. therapy-related) utilizing Cox regression model, only t-MDS was associated with higher risk of death (HR=2.07, 95% C.I.=1.25-3.42, P=0.005). Conclusions Pediatric MDS is a rare disorder, with higher incidence among children younger than 1 year of age. Over two thirds of p-MDS patients will become long-term survivors, although significantly inferior outcome is seen in t-MDS. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

Follow-up and Functional Outcomes of Pediatric Patients with Firearm Injuries to the Extremities

2018 ◽  
Author(s):  
Alexa J. Karkenny ◽  
Jonathan Morris ◽  
Kyle Hamm ◽  
Kathleen Maguire ◽  
Jose Toro ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Pediatric Patients ◽  
Firearm Injuries

scholarly journals Cardiac Abnormalities Seen in Pediatric Patients During the SARS‐CoV2 Pandemic: An International Experience

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Bradley C. Clark ◽  
Joan Sanchez‐de‐Toledo ◽  
Carles Bautista‐Rodriguez ◽  
Nadine Choueiter ◽  
Diego Lara ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
The United States ◽  
Left Ventricular ◽  
Medical Community ◽  
Healthy Children ◽  
Av Block ◽  
Coronary Abnormalities ◽  
Cardiac Manifestations ◽  
Inflammatory Syndrome

Abstract Background During the SARS‐CoV2 pandemic, there has been increase in hyperinflammatory presentation in previously healthy children with a variety of cardiac manifestations. Our objective is to describe the cardiac manifestations found in an international cohort of 55 pediatric cases with multi‐system inflammatory syndrome (MIS‐C) during the SARS‐CoV2 pandemic. Methods and Results We reviewed data on previously healthy pediatric patients (≤18 years) with structurally normal hearts who presented at hospitals in the United States, United Kingdom, Spain and Pakistan with MIS‐C and had consultation with a pediatric cardiologist. Data collected included demographics, clinical presentation, laboratory values, electrocardiographic abnormalities, echocardiographic findings and initial therapies. A total of 55 patients presented with MIS‐C. Thirty‐five patients (64%) had evidence of decreased left ventricular function, 17 (31%) had valvulitis, 12 (22%) with pericardial effusion and 11 (20%) with coronary abnormalities. Twenty‐seven (49%) required ICU admission and 24 (44%) had evidence of shock. Eleven patients (20%) fulfilled complete Kawasaki disease criteria and had lower NT pro‐BNP, D‐dimer and ferritin levels compared with those who did not fulfill criteria. Electrophysiologic abnormalities occurred in 6 patients and included complete atrioventricular (AV) block, transient AV block and ventricular tachycardia. Conclusions We describe the first international cohort of pediatric patients with MIS‐C during the SARS‐CoV2 pandemic with a range of cardiac manifestations. This paper brings awareness and alertness to the global medical community to recognize these children during the pandemic and understand the need for early cardiology evaluation and follow‐up.

Retained Bullets After Firearm Injury: A Survey on Surgeon Practice Patterns

2020 ◽  
pp. 088626052091455
Author(s):  
Randi N. Smith ◽  
Brett M. Tracy ◽  
Stephanie Smith ◽  
Sean Johnson ◽  
Niels D. Martin ◽  
...  
Keyword(s):  
Practice Patterns ◽  
Shared Decision ◽  
Trauma Centers ◽  
Index Hospitalization ◽  
Web Based ◽  
Firearm Injury ◽  
Firearm Injuries ◽  
Allot Time ◽  
Level 1

Retained bullets are common after firearm injuries, yet their management remains poorly defined. Surgeon members of the Eastern Association for the Surgery of Trauma ( N = 427) were surveyed using an anonymous, web-based questionnaire during Spring 2016. Indications for bullet removal and practice patterns surrounding this theme were queried. Also, habits around screening and diagnosing psychological illness in victims of firearm injury were asked. Most respondents were male (76.5%, n = 327) and practiced at urban (84.3%, n = 360), academic (88.3%, n = 377), Level 1 trauma centers (72.8%, n = 311). Only 14.5% ( n = 62) of surgeons had institutional policies for bullet removal and 5.6% ( n = 24) were likely to remove bullets. Half of the surgeons (52.0%, n = 222) preferred to remove bullets after the index hospitalization and pain (88.1%, n = 376) and a palpable bullet (71.2%, n = 304) were the most frequent indications for removal. Having the opportunity to follow-up with patients to discuss bullet removal was significantly predictive of removal (odds ratio (OR) = 2.25, 95% confidence interval (CI) = [1.05, 4.85], p = .04). Furthermore, routinely asking about retained bullets during outpatient follow-up was predictive of new psychological illness screening (OR = 1.94, 95% CI [1.19, 3.16], p = .01) and diagnosis (OR = 1.86, 95% CI = [1.12, 3.09], p = .02) in victims of firearm injury. Thus, surgeons should be encouraged to allot time for patients concerning retained bullet management so that a shared decision can be reached.

scholarly journals Firearm Injuries Cause Disproportionate Mortality in Pediatric Traumatic Brain Injury

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Saksham Gupta ◽  
Blake M Hauser ◽  
Mark M Zaki ◽  
David J Cote ◽  
Saef Izzy ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Suicide Attempts ◽  
Pediatric Population ◽  
Cohort Analysis ◽  
Data Bank ◽  
Firearm Injury ◽  
Firearm Injuries ◽  
The Impact

Abstract INTRODUCTION Traumatic brain injury is a major cause of mortality and long-term morbidity in the pediatric population. Given renewed legislative efforts aimed at reducing firearm violence and harm, we sought to investigate the impact of firearms on mortality associated with TBI. METHODS A multicentric, retrospective cohort analysis of pediatric patients with TBI was conducted using the National Trauma Data Bank from 2011 to 2014. The primary outcome was mortality within the hospital; the primary exposure was firearm-related vs. non-firearm-related TBI. RESULTS Pediatric patients with firearm-related TBI (n = 1,417; median [IQR] age 16 [13-17]) and non-firearm-related TBI (n = 123,740; median [IQR] age 11 [5-15]) were included. Firearm injuries included intentional harm by others (56%), suicide attempts (29%), and accidental harm by others (15%). The majority of African-American firearm-related TBIs presented after assault (79.6%), whereas the majority of White cases presented after suicide attempts (55.6%). Firearm-related cases presented with an average adjusted GCS 3.4 points lower than non-firearm-related TBI. 50.0% of firearm-related cases died while in the hospital compared to 2.8% of non-firearm cases. The firearm injury type with the highest rate of mortality was self-harm/suicide attempts (69.8%). Relative to non-firearm cases, firearm injuries were identified to be an independent predictor of in-hospital mortality (OR 8.3; 95% CI 7.1-9.7); firearm suicide attempt injuries were the most lethal (OR 13.0; 95% CI 9.9-17.0). Although firearm injuries comprised only 1.1% of all TBIs, they were the cause of injury in 16.7% of all deaths. Male sex, Black race, and public and self-pay insurance predicted firearm injuries. CONCLUSION Firearm-related injuries are associated with disproportionately high mortality in pediatric TBI, especially in suicide attempts. African-Americans are at disproportionately high risk of firearm assault relative to Whites. Public health and policy interventions could target youth firearm injuries and potentially prevent a significant portion of TBI deaths.

A 10-Year Review of Spatio-Temporal Patterns of Firearm Injury in a Rural Setting

2021 ◽  
pp. 000313482110545
Author(s):  
Tiffany Lasky ◽  
Bryan K Richmond ◽  
Damayanti Samanta ◽  
Frank Annie
Keyword(s):  
United States ◽  
Low Income ◽  
Hot Spots ◽  
The United States ◽  
Rural Setting ◽  
Firearm Injury ◽  
Firearm Injuries ◽  
Situational Variables ◽  
Lower Education Level ◽  
Spatio Temporal

Introduction West Virginia (WV) had the ninth highest rate of firearm mortality of all states in the United States according to the CDC in 2018. Gun violence in WV has been a steady problem over the last decade. The rural population is more vulnerable to unintentional firearm injuries and suicides. Previously published literature from urban settings has demonstrated a link between firearm injuries and modifiable situational variables such as crime, unemployment, low income, and low education. There are very few studies that have utilized geospatial analytic techniques as a tool for injury mapping, surveillance, and primary prevention in rural and frontier zones of the United States. Methods We performed a 10-year retrospective single-institution review of firearm injuries at a rural WV level 1 trauma center between January 2010 and December 2019. The AIS World Geocoding Service was then used to identify specific areas of emerging firearm-related injuries within the service area. Results Specific hot spots of emerging firearm injury were identified in both intentional and unintentional populations. These were located in geographically distinct areas of the WV unincorporated rural and frontier population. These rural WV hotspots were associated with the modifiable variables of crime, unemployment, lower income, and lower education level. Conclusions Emerging hot spots of firearm injury in rural and frontier locations were associated with modifiable social determinants. These areas represent an opportunity for targeted injury prevention efforts addressing these disparities. Further prospective study of these findings is warranted.

The Effect of a Home Exercise Program on Visio-Vestibular Function in Concussed Pediatric Patients

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S18.2-S19
Author(s):  
Patricia Rhys Roby ◽  
Eileen Storey ◽  
Christina Master ◽  
Kristy Arbogast
Keyword(s):  
Smooth Pursuit ◽  
Pediatric Patients ◽  
Exercise Program ◽  
Vestibular Function ◽  
Home Exercise ◽  
Initial Visit ◽  
Post Injury ◽  
Home Exercise Program ◽  
Tandem Gait

ObjectiveTo explore if a home exercise program (HEP) affects visio-vestibular function in concussed pediatric patients.BackgroundA HEP can provide an equitable and cost-effective method for therapy targeted towards visio-vestibular deficits that are common following concussion. It is unclear if pediatric patients prescribed a HEP demonstrate improved visio-vestibular function.Design/MethodsThis observational study included 1,041 patients (59% female; age = 14.0 ± 2.5 years) reporting to a specialty care concussion center for an initial visit ≤28 days post-injury and follow-up ≤60 days post-injury. All patients completed a Visio-Vestibular Examination (VVE) at both timepoints consisting of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Patients were prescribed a HEP (1–2 times/day) at initial visit consisting of exercises addressing visio-vestibular deficits. At follow-up, patients reported their progress: (1) has not done the HEP, (2) is currently doing the HEP, or (3) has completed the HEP. Primary outcomes included HEP progress, VVE subtests (normal/abnormal), and total VVE (abnormal = 2 + abnormal subtests). Chi-square tests with Bonferroni corrections were used to determine if abnormal VVE outcomes were associated with HEP status.ResultsAt initial visit, 81 2(77.6%) patients presented with abnormal total VVE. At follow-up, the proportion of abnormal total VVE did not differ among patients not doing the HEP (101 [62.0%]), patients currently doing the HEP (516 [69.0%]), and patients who had completed the HEP (51 [69.0%]). However among VVE subtests, a lower proportion who completed the HEP presented with abnormal smooth pursuit (7.5%), horizontal (3.8%) and vertical (3.8%) saccades, and complex tandem gait (0%) relative to patients currently doing the HEP (p = 0.003) and patients not doing the HEP (p = 0.01).ConclusionsOur findings indicate that patients who completed the HEP presented with improved elements of visio-vestibular function relative to those who did not start or were currently doing the HEP.

scholarly journals Trajectory of Long-Term Outcome in Severe Pediatric Diffuse Axonal Injury: An Exploratory Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Shih-Shan Lang ◽  
Todd Kilbaugh ◽  
Stuart Friess ◽  
Susan Sotardi ◽  
Chong Tae Kim ◽  
...  
Keyword(s):  
Brain Injury ◽  
Pediatric Patients ◽  
Axonal Injury ◽  
Single Institution ◽  
Post Injury ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pediatric Tbi

Introduction: Pediatric severe traumatic brain injury (TBI) is one of the leading causes of disability and death. One of the classic pathoanatomic brain injury lesions following severe pediatric TBI is diffuse (multifocal) axonal injury (DAI). In this single institution study, our overarching goal was to describe the clinical characteristics and long-term outcome trajectory of severe pediatric TBI patients with DAI.Methods: Pediatric patients (&lt;18 years of age) with severe TBI who had DAI were retrospectively reviewed. We evaluated the effect of age, sex, Glasgow Coma Scale (GCS) score, early fever ≥ 38.5°C during the first day post-injury, the extent of ICP-directed therapy needed with the Pediatric Intensity Level of Therapy (PILOT) score, and MRI within the first week following trauma and analyzed their association with outcome using the Glasgow Outcome Score—Extended (GOS-E) scale at discharge, 6 months, 1, 5, and 10 years following injury.Results: Fifty-six pediatric patients with severe traumatic DAI were analyzed. The majority of the patients were &gt;5 years of age and male. There were 2 mortalities. At discharge, 56% (30/54) of the surviving patients had unfavorable outcome. Sixty five percent (35/54) of surviving children were followed up to 10 years post-injury, and 71% (25/35) of them made a favorable recovery. Early fever and extensive DAI on MRI were associated with worse long-term outcomes.Conclusion: We describe the long-term trajectory outcome of severe pediatric TBI patients with pure DAI. While this was a single institution study with a small sample size, the majority of the children survived. Over one-third of our surviving children were lost to follow-up. Of the surviving children who had follow-up for 10 years after injury, the majority of these children made a favorable recovery.

Readmissions after ventricular shunting in pediatric patients with hydrocephalus: a Nationwide Readmissions Database analysis

2021 ◽  
pp. 1-10
Author(s):  
Daniel A. Donoho ◽  
Ian A. Buchanan ◽  
Shivani D. Rangwala ◽  
Arati Patel ◽  
Li Ding ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
The United States ◽  
Population Based ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Hospital Level ◽  
Factors Associated ◽  
Shunt Placement ◽  
Ventricular Shunting

OBJECTIVE Cerebrospinal fluid diversion via ventricular shunting is a common surgical treatment for hydrocephalus in the pediatric population. No longitudinal follow-up data for a multistate population-based cohort of pediatric patients undergoing ventricular shunting in the United States have been published. In the current review of a nationwide population-based data set, the authors aimed to assess rates of shunt failure and hospital readmission in pediatric patients undergoing new ventricular shunt placement. They also review patient- and hospital-level factors associated with shunt failure and readmission. METHODS Included in this study was a population-based sample of pediatric patients with hydrocephalus who, in 2010–2014, had undergone new ventricular shunt placement and had sufficient follow-up, as recorded in the Nationwide Readmissions Database. The authors analyzed the rate of revision within 6 months, readmission rates at 30 and 90 days, and potential factors associated with shunt failure including patient- and hospital-level variables and type of hydrocephalus. RESULTS A total of 3520 pediatric patients had undergone initial ventriculoperitoneal shunt placement for hydrocephalus at an index admission. Twenty percent of these patients underwent shunt revision within 6 months. The median time to revision was 44.5 days. Eighteen percent of the patients were readmitted within 30 days and 31% were readmitted within 90 days. Different-hospital readmissions were rare, occurring in ≤ 6% of readmissions. Increased hospital volume was not protective against readmission or shunt revision. Patients with grade 3 or 4 intraventricular hemorrhage were more likely to have shunt malfunctions. Patients who had private insurance and who were treated at a large hospital were less likely to be readmitted. CONCLUSIONS In a nationwide, population-based database with longitudinal follow-up, shunt failure and readmission were common. Although patient and hospital factors were associated with readmission and shunt failure, system-wide phenomena such as insufficient centralization of care and fragmentation of care were not observed. Efforts to reduce readmissions in pediatric patients undergoing ventricular shunt procedures should focus on coordinating care in patients with complex neurological diseases and on reducing healthcare disparities associated with readmission.

Structural Determinants of Homelessness in the United States

1991 ◽  
Vol 38 (1) ◽  
pp. 113-131 ◽  
Author(s):  
Marta Elliott ◽  
Lauren J. Krivo
Keyword(s):  
United States ◽  
The United States ◽  
Structural Determinants
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