Measuring Resilience in the Adolescent Population: A Succinct Tool for Outpatient Adolescent Health.

OBJECTIVE: To create a valid tool to measure adolescent resilience, and to determine if this tool correlates with current participation in risk behaviors and prior adverse childhood events. STUDY DESIGN: One hundred adolescents were recruited from primary care clinics in New Jersey for this cross-sectional study. A "7Cs tool" was developed to measure resilience using the 7Cs model of resilience. All participants completed the 7Cs tool, the Adverse Childhood Events Survey, and the Health Survey for Adolescents to identify current risk behaviors. Demographic and background data were also collected. To assess the validity of the 7Cs tool, Cronbach alpha, principal factor analysis, Spearman coefficients, and sensitivity analyses were conducted. The χ2 test and ORs were used to determine if any relationships exist between resilience and prior adverse childhood events and risk taking behaviors. RESULTS: Participants ranged from 13 to 21 years old (65% female). Internal consistency was established using Cronbach alpha (0.7). Lower resilience correlated with higher adverse childhood events (P = .008) and Health Survey for Adolescents scores (P < .001). Lower resilience was associated with increased problems in school (OR 2.6; P = .021), drug use (OR 4.0; P = .004), violent behavior (OR 3.7; P = .002), recent depression (OR 5.0; P < .001), and suicidality (OR 4.1; P = .009). Higher resilience was associated with participation in exercise (P = .001) and activities (P = .01). CONCLUSIONS: The 7Cs tool is an internally validated tool that may be used to screen adolescent resilience and guide pediatricians' counseling against risk behaviors. Further studies will evaluate resilience-building interventions based on results from this study.

Topical anesthetic cream is associated with spontaneous cutaneous abscess drainage in children.

OBJECTIVE: The objective of the study was to determine whether use of topical anesthetic cream increases spontaneous drainage of skin abscesses and reduces the need for procedural sedation. METHODS: A retrospective multicenter cohort study from 3 academic pediatric emergency departments was conducted for randomly selected children with a cutaneous abscess in 2007. Children up to 18 years of age were eligible if they had a skin abscess at presentation. Demographics, abscess characteristics, and use of a topical analgesic were obtained from medical records. RESULTS: Of 300 subjects, 58% were female and the median age was 7.8 years (interquartile range, 2-15 years). Mean abscess size was 3.5 ± 2.4 cm, most commonly located on the lower extremity (30%), buttocks (24%), and face (12%). A drainage procedure was required in 178 children, of whom 9 underwent drainage in the operating room. Of the remaining 169 children who underwent emergency department-based drainage, 110 (65%) had a topical anesthetic agent with an occlusive dressing placed on their abscess before drainage. Use of a topical anesthetic resulted in spontaneous abscess drainage in 26 patients, of whom 3 no longer required any further intervention. In the 166 patients who underwent additional manipulation, procedural sedation was required in 26 (24%) of those who had application of a topical anesthetic and in 24 (41%) of those who had no topical anesthetic (odds ratio, 0.45; 95% confidence interval, 0.23-0.89). CONCLUSIONS: Topical anesthetic cream application before drainage procedures promotes spontaneous drainage and decreases the need for procedural sedation for pediatric cutaneous abscess patients.