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Post-injury Outcomes of Children With Behavioral Health Disorders
Michael D. Traynor, Jr., Ryan D. Watkins, Martin D. Zielinski, D. Dean Potter, Jr., *Christopher R. Moir, Michael B. Ishitani, *Denise B. Klinkner
Mayo Clinic, Rochester, MN

Background: The impact of Behavioral Health Disorders (BHDs) on pediatric injury is poorly understood. We investigated the relationship between BHDs and outcomes following pediatric trauma.
Methods: We analyzed injured children (age 5-15) from 2014-2016 using the Pediatric Trauma Quality Improvement Program. The primary outcome was in-hospital mortality. Univariable and multivariable analyses compared children with and without a comorbid BHD.
Results: Of 69,305 injured children, 3,448 (5%) had a BHD. These 3,448 children had a median of 1 [IQR: 1, 1] BHD diagnosis: ADHD (n=2491), major psychiatric disorder (n=1037), drug use disorder (n=250), and alcohol use disorder (n=29). A higher proportion of injured children with BHDs suffered intentional and penetrating injury, Table. Firearm injuries were more common for BHD patients (3% vs 1%, p<0.001). Children with BHDs were more likely to have an ISS>25 compared to children without (5% vs 3%, p<0.001). While median LOS was longer for BHD patients (2 [1, 3] vs 2 [1, 4], p<0.001), mortality was similar (1% vs 1%, p=0.76) and complications were less frequent (7% vs 8%, p=0.002). BHD was associated with lower risk of mortality (OR 0.45, 95%CI [0.30, 0.69]) after controlling for age, sex, race, trauma type, and injury intent and severity.
Conclusion: Children with BHDs experienced lower mortality risk after traumatic injury despite more severe injury upon presentation. Intentional and penetrating injuries are particularly concerning, and future work should assess prevention efforts in this vulnerable group.

Demographics and Injury Characteristics for Children with and without Behavioral Health Disorders
FactorLevelNo Behavioral Health DisorderBehavioral Health Disorderp-value
N658573448p-value
Age, median [IQR]10 (7, 13)13 (10, 14)<0.001
Male sex, n (%)42374 (64%)2575 (75%)<0.001
Race, n (%)White39763 (60%)2300 (67%)<0.001
Black or African American10255 (16%)597 (17%)
Hispanic or Latino10035 (15%)347 (10%)
Other4785 (7%)138 (4%)
Unknown1019 (2%)66 (2%)
Intent, n (%)Unintentional64327 (97%)3138 (91%)<0.001
Assault1296 (2%)211 (6%)
Self-inflicted117 (<1%)84 (2%)
Other/Undetermined114 (<1%)15 (<1%)
Trauma type, n (%)Blunt63787 (97)3221 (94%)<0.001
Penetrating1941 (3%)212 (6%)
Other102 (<1%)10 (<1%)

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