When should screening of pediatric trauma patients for adult behaviors start?
When should screening of pediatric trauma patients for adult behaviors start?
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DOI：
10.1136/tsaco-2018-000181
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发表时间：
2018
影响因子：
2
通讯作者：
Davis KA
中科院分区：
文献类型：
--
作者：
Maung AA;Becher RD;Schuster KM;Davis KA
对创伤患者的护理不仅限于持续的身体伤害，还需要解决社会问题，如药物滥用和人际暴力，这是造成创伤相关累犯的原因。本研究调查这些问题社会行为是否存在与年龄相关的变化，以分析是否有一个年龄截止点，在这一点上，青少年应该筛查成人社会行为。回顾性审查了2013年2月至2016年4月期间在城市1级成人和儿童创伤中心住院的12-21岁创伤患者。从电子病历中提取人口统计学、损伤机制、损伤严重程度评分、结局、毒理学和社会史评价。在39个月期间，756名患者入院。大多数患者为男性（73.9%），年龄无显著差异。损伤机制因年龄而异（p<0.001），运动和自行车损伤的发生率随着患者年龄的增加而降低，机动车/摩托车碰撞、袭击和枪击损伤的发生率随着患者年龄的增加而增加。在逻辑回归中，阳性毒理学测试，暴力造成的伤害以及药物，烟草和酒精的总体使用的风险也随着年龄的增加而显着增加，从研究中最年轻的年龄开始。随着儿童创伤患者年龄的增长，他们通常与成人相关的社会问题的风险增加。我们的研究强调，即使在青少年中，也需要评估和解决这些问题。第四级----流行病学。
Care of patients with trauma is not only limited to the sustained physical injuries but also requires addressing social issues, such as substance abuse and interpersonal violence, which are responsible for trauma-related recidivism. This study investigates whether there are age-related variations in these problematic social behaviors to analyze whether there is an age cut-off at which point adolescents should be screened for adult social behaviors. Retrospective review of patients with trauma aged 12–21 admitted to an urban Level 1 adult and pediatric trauma center between February 2013 and April 2016. Demographics, mechanisms of injury, Injury Severity Score, outcomes, toxicology and social history evaluations were abstracted from the electronic medical record. 756 patients were admitted during the 39-month period. Most patients were male (73.9%) without significant variation by age. The mechanisms of injury varied by age (p<0.001) with the incidence of sports and bicycle injuries decreasing and the incidence of motor vehicle/motorcycle crashes, assaults and gunshot injuries increasing with increasing patient age. In a logistic regression, risks of positive toxicology tests, injuries due to violence as well as overall use of drugs, tobacco and alcohol also significantly increased with age starting with the youngest age included in the study. As pediatric trauma patients get older, they have increasing risks of social issues typically associated with adults. Our study underscores the need to evaluate and address these issues even in young adolescents. Level IV—epidemiological.