Epidemiology of Injuries to Early Adolescents from Family Violence Evaluated in an Urban Pediatric Emergency Department.

BACKGROUND: Exposure to family violence during childhood and adolescence increases the risk for experiencing or perpetrating future violence. Social distancing protocols combined with reduction in access to youth/family services during the COVID-19 pandemic may have intensified the risk of exposure to familial violence. OBJECTIVES: This study describes the epidemiology of violence-related injuries to 10- to 15-year-old children from family violence, including child maltreatment and physical fighting, resulting in emergency department (ED) evaluation. METHODS: This retrospective cohort study located in an urban academic pediatric ED in the mid-Atlantic region is a review of electronic medical records between January 2019 and March 2020 (prepandemic period) and March to December 2020 (pandemic period). This review focused on visits for youth aged 10 to 15 years who presented for evaluation of an injury due to a violent event involving a family member. Demographic and clinical data were abstracted, including circumstances of the event. Descriptive statistics were used to summarize data and compare prepandemic to postpandemic proportions. RESULTS: Of 819 youth aged 10 to 15 years evaluated for a violence-related injury, 448 (54.7%) involved a family member. Of these, most involved parents/guardians, 343 (76.6%), and occurred at home (83.9%). Most patients were girls (54.0%), Black/African American (84.4%), and were enrolled in a public insurance plan (71.2%). Most youth were transported to the hospital by police (66.7%). Overall, alcohol, drugs, and weapons were involved in 10.0%, 6.5%, and 10.7% of events, respectively, and their involvement significantly increased during the pandemic period to 18.8%, 14.9%, and 23.8% ( P < 0.001). Most patients (98.7%) were discharged from the ED. CONCLUSIONS: More than half of violence-related injuries treated in the ED in this population resulted from family violence. Family violence is a prevalent and possibly underrecognized cause of injuries during adolescence. Further research should explore the potential of the ED as a setting for preventive interventions.

Factors associated with successful mentor matching in an intervention study of youth violence.

One challenge of conducting intervention studies is ensuring that study participants are exposed to the intervention. For example, in our randomized controlled trial of Take Charge!, a mentor-implemented and research-informed violence prevention program that partners with one-on-one community-based mentoring agencies, only 50% of intervention youth with fight-related injuries were successfully matched with a mentor. We examined the differences between matched (n = 49) and unmatched (n = 49) youth with regard to demographics, time from injury to study enrollment, perceived seriousness of injury, belief that future injury can be avoided, and household chaos. Youth who were successfully matched with a mentor were more likely to perceive the injury as very serious or somewhat serious compared with unmatched youth (95.9% vs. 79.6%, p = .028). All other factors were not significantly associated with successful mentor matching. Future violence prevention interventions should consider youth perceptions as a factor that may influence the completion of desired interventions.

Assessment of a quality improvement intervention to improve the consistency of total body surface area burn estimates between referring facilities and a pediatric burn center.

BACKGROUND: Burns are a significant source of pediatric morbidity and frequently result in transfer of care to a pediatric burn center. Data suggest that referring facilities often overestimate the total body surface area (%TBSA) of burns in comparison to the subsequent assessment at the pediatric burn center. Such discrepancies may trigger inappropriately aggressive interventions with potential for patient harm. Our baseline assessment of data from 106 patients transferred to our pediatric burn center over a one-year period showed that 59/106 (56%) patients had a %TBSA recorded at the time of transfer and 18/59 (31%) had clinically significant differences (>5% difference) in estimates between the referring facility and the pediatric burn center. METHODS: Informed by this clinical audit and a root cause analysis, we implemented practices to enhance consistency of clinical assessments between referring facilities and our pediatric burn center. These practices included the use of a common clinical assessment instrument (a standardized Lund and Browder form) that was integrated into the interfacility transfer process as well as educational outreach at referring facilities for providers who treat children with burns, prioritizing facilities with the highest number of discrepancies. RESULTS: Follow up data was reviewed 16-23 months after initiating the intervention. Cumulatively, we found significant improvement in the proportion of patients with %TBSA recorded (94% vs 56%, p < 0.001) that achieved our goal to exceed 90% and a reduction in clinically significant discrepancies that exceeded our goal of 15% (10% vs 31%, p = 0.002). CONCLUSIONS: Referring facilities often overestimate the %TBSA in comparison to the subsequent assessment at the pediatric burn center. The consistency of the %TBSA estimates can be improved by interventions that utilize the sharing of a common clinical assessment instrument and standardization of the transfer intake process.

The Association Between Weight Status and Pediatric Forearm Fractures Resulting From Ground-Level Falls.

OBJECTIVE: The purpose of our study was to evaluate the hypothesis that pediatric forearm fractures resulting from ground-level falls are associated with increased weight status (weight for age/sex percentile ≥ 95th) in comparison with those resulting from major trauma. METHODS: This is a retrospective case-control study nested within a case series of 929 children, ages 0 to 17 years, with self-identified residence in Washington, DC, who were treated for isolated forearm fractures in an urban, academic pediatric emergency department between 2003 and 2006. Multivariable logistic regression was performed to test for the association of weight status with mechanism of injury while controlling for sex, age, race/ethnicity, bone fractured, and season. RESULTS: Of 929 forearm fractures, there were 226 (24.3%) with ground-level falls and 54 (5.8%) with major trauma. Compared with children with forearm fractures resulting from major trauma, ground-level fall cases were significantly older (10.4 [3.4] vs 7.4 [4.2] years, P < 0.05), had greater adjusted odds of having a weight for age/sex of 95th percentile or higher (odds ratio, 2.7; 95% confidence interval, 1.2-6.5), and had significantly more radius-only fractures (odds ratio, 2.3; 95% confidence interval, 1.2-4.7). These groups did not differ in sex, race/ethnicity, or injury season. CONCLUSIONS: Ground-level falls are a common mechanism of pediatric forearm fracture and are significantly associated with increased weight status and radius-only fractures. These results suggest the need for further investigation into obesity and bone health in pediatric patients with forearm fractures caused by ground-level falls.