Self-harm presentations to hospital trauma centre emergency departments during the first year of the COVID-19 pandemic.

The COVID-19 pandemic raised concerns regarding increased suicide-related behaviours. We compared characteristics and counts of Emergency Department (ED) presentations for self-harm, an important suicide-related outcome, during versus prior to the pandemic's first year. We included patients presenting with self-harm to the ED of two trauma centres in Toronto, Canada. Time series models compared intra-pandemic (March 2020-February 2021) presentation counts to predictions from pre-pandemic data. The self-harm proportion of ED presentations was compared between the intra-pandemic period and preceding three years. A retrospective chart review of eligible patients seen from March 2019-February 2021 compared pre- vs. intra-pandemic patient and injury characteristics. While monthly intra-pandemic self-harm counts were largely within expected ranges, the self-harm proportion of total presentations increased. Being widowed (OR=9.46; 95 %CI=1.10-81.08), employment/financial stressors (OR=1.65, 95 %CI=1.06-2.58), job loss (OR=3.83; 95 %CI=1.36-10.76), and chest-stabbing self-harm (OR=2.50; 95 %CI=1.16-5.39) were associated with intra-pandemic presentations. Intra-pandemic self-harm was also associated with Intensive Care Unit (ICU) admission (OR=2.18, 95 %CI=1.41-3.38). In summary, while the number of self-harm presentations to these trauma centres did not increase during the early pandemic, their proportion was increased. The association of intra-pandemic self-harm with variables indicating medically severe injury, economic stressors, and being widowed may inform future suicide and self-harm prevention strategies.

External validation and modification of a pediatric trauma triage tool.

BACKGROUND: Simon et al. developed a simple secondary triage tool (mPTS) based on physiologic parameters and physical findings to identify pediatric trauma patients who had a low likelihood of serious injury. Such patients could be treated in the emergency room without full trauma team activation. Our objective was to evaluate the mPTS on the trauma population at our institution, a Level I pediatric trauma center. METHODS: This was a retrospective cohort study of all trauma team activations at The Hospital for Sick Children (Sick Kids) (1999-2002), excluding penetrating trauma and burns. Patients were stratified into high-risk (Injury Severity Score [ISS] >or=12) and low-risk (ISS <12) groups. The mPTS evaluates airway integrity, open wounds, neurologic status, hemodynamics, and skeletal integrity and applies a score of 1 point to each criterion. RESULTS: There were 628 trauma patients (382 boys, mean age of 8 +/- 3.8 years). The mPTS had a sensitivity of 92% and a positive predictive value (PPV) of 47% when applied to our population. The mPTS missed 21 patients with significant injuries, many were intra-abdominal. We modified the mPTS to include contusions to head and/or torso and a history of loss of consciousness and a 7-point score was developed. After modification the sensitivity was 99%, specificity 21%, and PPV of 46% with a 20% reduction in unnecessary trauma team activations. CONCLUSIONS: The original mPTS by Simon et al. was not sensitive enough when applied to our population. The Sick Kids modification to the score improved the sensitivity to 99%. The PPV of 46% indicates a safe level of overtriage is maintained. The Sick Kids mPTS remains easy to apply and would have reduced trauma team activation by 20%.