Does preexisting mental illness influence outcome in pediatric trauma?

Abstract

Purpose. According to national estimates, up to 10% of American children suffer from some type of mental illness. Despite this high incidence, few studies have examined the role of a preexisting psychiatric disorder on childhood trauma. We hypothesize that children with such a diagnosis will have more severe injuries and poorer outcomes then other children. Methods. A 5-year (1998–2002) review of the Pennsylvania Trauma Outcome Study database was performed and information regarding children less than or equal to 16 years was abstracted. We evaluated the effects of a preexisting psychiatric diagnosis (not otherwise defined) and attention deficit disorder (ADD) on the type and mechanism of injury, injury severity, and outcome. Statistical analysis was performed using Student’s t-test, chi square, and Fisher’s exact test. Results. Over the study period 19,825 children were admitted to a Trauma Center: 530 (2.7%) had a preexisting psychiatric diagnosis (PD) and 189 (1%) had ADD. Children with ADD and PD were older than their peers (12.1 ± 3.3 versus 9.6 ± 5.6; P < 0.0001 and 13.7 ± 3.2 versus 9.5 ± 5.6; P < 0.0001), but did not differ in injury severity or overall mortality. However, those with PD were more likely to be victims of penetrating trauma (9.6% versus 7%; P < 0.022), and have longer ICU (2.2 versus 1.5 days; P = 0.0003) and hospital (5.7 versus 4.1 days; P < .0001) lengths of stay than unaffected children. Furthermore, children with PD were more likely to be discharged to a location other than home ( P = 0.0006). Both the ADD and the PD groups were less likely to use protective devices ( P < 0.03; P = 0.0011). Conclusions. Despite similar injury severity, children with a preinjury psychiatric history have longer hospitalizations than their nonaffected peers. This may be due in part to difficulty in finding appropriate postdischarge facilities for these children. Injury prevention strategies in this population should address the importance of protective equipment. Finally, the relatively low percentage of children identified as having ADD or PD in this study could be the result of underreporting and thus potentially affect the results.