Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients: A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
3.1. Epidemiological Analysis over Time
3.2. Major Trauma: Trend over Time and Predominant Mechanisms
3.3. Emergency Department Management
3.4. Surgical Intervention
3.5. Subgroup Analysis: 0–12 Years Old vs. 13–18 Years Old
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
PT | pediatric trauma |
VRT | violence-related trauma |
SA | suicide attempt |
NTC | Niguarda Trauma Center |
COVID-19 | COVID-19 |
ED | Emergency Department |
DCS | Damage Control Strategy |
SI | Shock Index |
ISS | Injury Severity Score |
AIS15 | Abbreviated Injury Scale 2015 Revision |
SD | standard deviation |
IQR | interquartile range |
EPP | extraperitoneal pelvic packing |
TBI | traumatic brain injuries |
UNICEF | United Nation International Children’s Emergency Fund |
EAP | European Academy of Pediatrics |
ECPCP | European Confederation of Primary Care Pediatricians |
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2015 (N = 84) | 2016 (N = 98) | 2017 (N = 125) | 2018 (N = 119) | 2019 (N = 114) | 2020 (N = 144) | p | |
---|---|---|---|---|---|---|---|
Sex (male), n (%) | 63 (75) | 70 (71.4) | 83 (66.4) | 77 (64.7) | 70 (61.4) | 90 (62.5) | 0.280 |
Age (years) | 10 (±5.4) | 9.9 (±5) | 9.6 (±5.2) | 10 (±5.2) | 9.8 (±5.1) | 10.1 (±5.2) | 0.977 |
Mechanism of trauma, n (%)
| 45 (53.6) 30 (35.7) 2 (2.4) 7 (8.3) | 56 (57.1) 35 (35.7) 0 (0) 7 (7.1) | 72 (57.6) 42 (33.6) 4 (3.2) 7 (5.6) | 72 (60.5) 33 (27.8) 1 (0.8) 13 (10.9) | 65 (57) 37 (32.5) 1 (0.9) 11 (9.6) | 75 (52.1) 47 (32.6) 6 (4.2) 16 (11.1) | 0.808 0.830 0.168 0.112 |
Type of trauma (blunt), n (%) | 82 (97.6) | 94 (95.9) | 123 (98.4) | 115 (96.6) | 109 (95.6) | 139 (96.5) | 0.847 |
Trauma intentionality, n (%)
| 3 (3.6) 1 (1.2) | 3 (3.1) 2 (2) | 8 (6.5) 5 (4) | 9 (7.6) 5 (4.2) | 9 (7.9) 6 (5.3) | 14 (9.8) 9 (6.2) | 0.020 0.029 |
Type of ED access, n (%)
| 7 (8.3) | 7 (7.1) | 10 (8) | 9 (7.6) | 0 (0) | 19 (13.2) | 0.020 |
Triage code, n (%)
| 7 (8.3) 70 (83.4) 7 (8.3) | 8 (8.2) 82 (83.6) 8 (8.2) | 13 (10.4) 100 (80) 12 (9.6) | 9 (7.6) 95 (79.8) 15 (12.6) | 5 (4.4) 82 (71.9) 27 (23.7) | 36 (25) 89 (61.8) 19 (13.2) | <0.001 <0.001 0.015 |
2015 (N = 84) | 2016 (N = 98) | 2017 (N = 125) | 2018 (N = 119) | 2019 (N = 114) | 2020 (N = 144) | p | |
---|---|---|---|---|---|---|---|
BP-pre (mmHg) | 120 (110–130) | 120 (110–130) | 120 (100–130) | 118 (102–130) | 116 (100–127) | 113 (105–130) | 0.064 |
HR-pre (bpm) | 100 (90–120) | 98 (87–117) | 100 (85–120) | 100 (90–120) | 100 (82–120) | 100 (86–110) | 0.620 |
GCS-pre | 15 | 15 | 15 | 15 | 15 | 15 | 1 |
BP-ED (mmHg) | 120 (105–130) | 120 (110–125) | 120 (100–130) | 120 (105–127) | 119 (105–127) | 115 (103–130) | 0.903 |
HR-ED (bpm) | 97 (80–110) | 100 (86–115) | 100 (85–115) | 100 (87–120) | 100 (85–113) | 100 (85–113) | 0.775 |
GCS-ED | 15 | 15 | 15 | 15 | 15 | 15 | 1 |
Head | Chest | Abdomen | Extremities | |
---|---|---|---|---|
Fall (n = 54) | 29 | 31 | 18 | 20 |
Car (n = 11) | 5 | 6 | 1 | 5 |
Motorbike (n = 16) | 3 | 6 | 3 | 7 |
Bicycle (n = 13) | 6 | 5 | 3 | 1 |
Pedestrian (n = 26) | 15 | 14 | 3 | 7 |
Assault (n = 1) | 1 | 0 | 0 | 0 |
Stab wound (n = 1) | 0 | 0 | 1 | 0 |
Sports trauma (n = 4) | 3 | 0 | 1 | 0 |
Miscellaneous (n = 4) | 2 | 0 | 0 | 2 |
2015 | 2016 | 2017 | 2018 | 2019 | 2020 | p | ||||||||
(n = 84) | (n = 98) | (n = 125) | (n = 117) | (n = 119) | (n = 144) | |||||||||
<13 y | ≥13 y | <13 y | ≥13 y | <13 y | ≥13 y | <13 y | ≥13 y | <13 y | ≥13 y | <13 y | ≥13 y | |||
(n = 51) | (n = 33) | (n = 62) | (n = 36) | (n = 79) | (n = 46) | (n = 74) | (n = 43) | (n = 69) | (n = 45) | (n = 80) | (n = 63) | |||
Intentionality, n (%) | Accident | 50 (98) | 31 (93.9) | 61 (98.4) | 34 (94.4) | 77 (97.5) | 40 (87) | 71 (95.9) | 37 (86) | 66 (95.7) | 39 (86.7) | 80 (100) | 49 (77.8) | 0.06 |
VRT | 1 (2) | 2 (6.1) | 1 (1.6) | 2 (5.6) | 2 (2.5) | 6 (13) | 3 (4.1) | 6 (14) | 3 (4.3) | 6 (13.3) | 0 (0) | 14 (22.2) | 0.02 | |
SA | 1 (2) | 0 (0) | 0 (0) | 2 (5.6) | 1 (1.3) | 4 (11.5) | 0 (0) | 5 (11.6) | 1 (1.4) | 5 (11.1) | 0 (0) | 9 (14.3) | 0.03 | |
Mechanisms, n (%) | Car | 11 (21.6) | 1 (3) | 7 (11.3) | 2 (5.6) | 12 (15.2) | 3 (6.5) | 5 (6.8) | 1 (2.3) | 11 (15.9) | 3 (6.7) | 9 (11.3) | 8 (12.7) | 0.86 |
Motorbike | 1 (2) | 6 (18.2) | 0 (0) | 6 (16.7) | 3 (3.8) | 7(15.2) | 1 (1.4) | 14 (32.6) | 0 (0) | 8 (17.8) | 0 (0) | 8 (12.7) | 0.66 | |
Bicycle | 0 (0) | 1 (3) | 6 (9.7) | 7 (19.4) | 6 (7.6) | 12 (26.1) | 6 (8.1) | 8 (18.6) | 7 (10.1) | 7 (15.6) | 13 (16.3) | 8 (12.7) | 0.03 | |
Electric scooter | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (1.3) | 3 (4.8) | 0.01 | |
Pedestrian | 13 (25.5) | 12 (36.4) | 17 (27.4) | 11 (30.6) | 21 (26.6) | 8 (17.4) | 26 (35.1) | 9 (20.9) | 19 (27.5) | 10 (22.2) | 12 (15) | 11 (17.5) | 0.03 | |
Fall | 22 (43.1) | 8 (24.2) | 29 (46.8) | 6 (16.7) | 33 (41.8) | 9 (19.6) | 25 (33.8) | 8 (18.6) | 28 (40.6) | 9 (20) | 30 (37.5) | 17 (27) | 0.49 | |
Stabbing | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 1 (2.2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 4 (6.3) | 0.18 | |
Assault | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 1 (1.3) | 2 (4.3) | 0 (0) | 1 (2.3) | 0 (0) | 1 (2.2) | 1 (1.3) | 1 (1.6) | 0.83 | |
Sport trauma | 0 (0) | 2 (6.1) | 2 (3.2) | 1 (2.8) | 1 (1.3) | 3 (6.5) | 3 (4.1) | 1 (2.3) | 0 (0) | 1 (2.2) | 0 (0) | 1 (1.6) | 0.15 | |
Other | 4 (7.8) | 1 (3) | 1 (1.6) | 3 (8.3) | 2 (2.5) | 1 (2.2) | 8 (10.8) | 1 (2.3) | 4 (5.8) | 6 (13.3) | 14 (17.5) | 1 (1.6) | 0.02 |
0–12 (n = 415) | 13–18 (n = 269) | p | ||
---|---|---|---|---|
Head-AIS15, n (%) | 1 | 99 (23.8) | 28 (10.4) | <0.001 |
2 | 45 (10.8) | 51 (18.9) | ||
3 | 22 (5.3) | 21 (7.8) | ||
4 | 9 (2.2) | 7 (2.6) | ||
5 | 4 (0.9) | 10 (3.7) | ||
Chest-AIS15, n (%) | 1 | 0 (0) | 0 (0) | 0.195 |
2 | 8 (1.9) | 15 (5.6) | ||
3 | 20 (4.8) | 21 (7.8) | ||
4 | 5 (1.2) | 13 (4.8) | ||
5 | 0 (0) | 3 (1.1) | ||
Abdomen-AIS15, n (%) | 1 | 0 (0) | 1 (0.4) | 0.272 |
2 | 15 (3.6) | 25 (9.3) | ||
3 | 8 (1.9) | 10 (3.7) | ||
4 | 3 (0.7) | 6 (2.2) | ||
5 | 0 (0) | 7 (2.6) | ||
Extremity-AIS15. N (%) | 1 | 8 (1.9) | 16 (5.9) | 0.042 |
2 | 64 (15.4) | 50 (18.6) | ||
3 | 18 (4.3) | 32 (11.9) | ||
4 | 5 (1.2) | 8 (2.9) | ||
5 | 1 (0.2) | 4 (1.5) |
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Maina, C.; Cioffi, S.P.B.; Altomare, M.; Spota, A.; Virdis, F.; Bini, R.; Ragozzino, R.; Renzi, F.; Reitano, E.; Corasaniti, L.; et al. Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients: A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic. J. Pers. Med. 2023, 13, 128. https://doi.org/10.3390/jpm13010128
Maina C, Cioffi SPB, Altomare M, Spota A, Virdis F, Bini R, Ragozzino R, Renzi F, Reitano E, Corasaniti L, et al. Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients: A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic. Journal of Personalized Medicine. 2023; 13(1):128. https://doi.org/10.3390/jpm13010128
Chicago/Turabian StyleMaina, Cecilia, Stefano Piero Bernardo Cioffi, Michele Altomare, Andrea Spota, Francesco Virdis, Roberto Bini, Roberta Ragozzino, Federica Renzi, Elisa Reitano, Lucia Corasaniti, and et al. 2023. "Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients: A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic" Journal of Personalized Medicine 13, no. 1: 128. https://doi.org/10.3390/jpm13010128
APA StyleMaina, C., Cioffi, S. P. B., Altomare, M., Spota, A., Virdis, F., Bini, R., Ragozzino, R., Renzi, F., Reitano, E., Corasaniti, L., Macchini, F., Chiara, O., & Cimbanassi, S. (2023). Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients: A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic. Journal of Personalized Medicine, 13(1), 128. https://doi.org/10.3390/jpm13010128