Childhood Trauma Research Articles

A Co-produced International Qualitative Systematic Review on Lived Experiences of Trauma During Homelessness in Adulthood and Impacts on Mental Health.

Trauma can be both a cause and a consequence of homelessness and has lasting impacts on mental health and wellbeing. Often research focusses on trauma and adversity in childhood leading to homelessness, but understanding traumatic experiences during adulthood homelessness can be just as important for informing intervention development and policies to mitigate and eradicate homelessness. Working with people with lived experience of homelessness, this review aimed to synthesis the qualitative evidence exploring the impact of trauma during homelessness on mental health (including substance use) from the perspective of adults (18 years of age and older) experiencing homelessness. Alongside gray literature, ASSIA, CINAHL, Cochrane, EMBASE, MEDLINE, Proquest theses and dissertations, PsychInfo, Scopus and Web of Science were searched from inception until February 2024. No language, date, or geographical limits were applied. A 'best-fit' framework synthesis of 26 papers, covering the experience of over 900 people, identified three overarching themes linked with the SAMHSA three E's of trauma: 1) making sense of homelessness as a trauma, 2) dealing with the impacts of trauma and 3) responses to repeated exposure to trauma. Trauma rarely takes place in isolation and often prior experiences shape how people experiencing homelessness make sense and cope with trauma. Policy and prevention should prioritise early intervention to reduce the mental health burden of trauma and homelessness. Additionally, creating support that empowers and builds resilience will encourage more positive management strategies.

Assessing the contributions of gender, clinical symptoms, and psychometric traits to non-suicidal self-injury behaviors in Chinese adolescents: a nomogram approach.

Non-suicidal self-injury (NSSI) behaviors among adolescents with mood disorders represent a significant global public health concern. This study aimed to assess the prevalence and identify key predictors of NSSI behaviors in Chinese adolescents diagnosed with depressive or bipolar disorders, addressing a critical gap in the literature. Data from 2343 participants in the Chinese Adolescent Depression Cohort (CADC) were analyzed. The study employed a comprehensive approach, utilizing medical records, clinical assessments, and validated psychometric instruments. Statistical analyses included chi-square tests, logistic regression, and ROC curve analyses, culminating in the development of a predictive nomogram. The prevalence of NSSI behaviors was strikingly high at 73.32%. Significant predictors included female gender (AOR = 2.14, 95% CI [1.70, 2.68]), presence of hallucinations (AOR = 1.52, 95% CI [1.18, 1.97]), borderline personality features (AOR = 1.03, 95% CI [1.01, 1.08]), and childhood trauma (AOR = 1.02, 95% CI [1.01, 1.03]). The study's key contribution is a predictive nomogram with an AUC of 0.74, demonstrating good efficacy in predicting NSSI behaviors. This research reveals an alarmingly high prevalence of NSSI behaviors in Chinese adolescents with mood disorders and identifies critical predictors spanning demographic, clinical, and psychometric domains. The developed nomogram offers a novel approach for risk assessment, highlighting the importance of comprehensive evaluations in adolescent mental healthcare. These findings have significant implications for developing targeted interventions and improving risk assessment strategies in clinical practice.

Screening for Adverse Childhood Experiences: A Critical Appraisal.

Adverse childhood experiences (ACEs) are common and can impact health across the life course. Thus, it is essential for professionals in child- and family-serving roles, including pediatric and adult primary care clinicians, to understand the health implications of childhood adversity and trauma and respond appropriately. Screening for ACEs in health care settings has received attention as a potential approach to ACEs identification and response. Careful examination of the existing evidence on ACEs screening and consideration, from a clinical and ethical perspective, of the potential benefits, challenges, and harms is critical to ensuring evidence-informed practice. In this critical appraisal, we synthesize existing systematic and scoping reviews on ACEs screening, summarize recent studies on the ability of ACEs to predict health outcomes at the individual level, and provide a comprehensive overview of potential benefits, challenges, and harms of ACEs screening. We identify gaps in the existing evidence base and specify directions for future research. We also describe trauma-informed, relational care as an orientation and perspective that can help pediatric and primary care clinicians to sensitively assess for and respond to ACEs and other potentially traumatic experiences. Overall, we do not yet have sufficient evidence regarding the potential benefits, challenges, and harms of ACEs screening in health care and other settings. In the absence of this evidence, we cannot assume that screening will not cause harm and that potential benefits outweigh potential harms.

Network analysis of childhood maltreatment and internet addiction in adolescents with major depressive disorder.

Childhood maltreatment (CM) is closely linked to internet addiction (IA), especially in adolescents with Major Depressive Disorder (MDD). Previous studies have shown that adolescents who experience CM are more likely to develop IA and other psychological problems. This study aims to explore the complex relationship between CM and IA through network analysis, particularly identifying the core symptoms and bridge symptoms to better understand the development of IA in these adolescents. A cross-sectional study was conducted in seven hospitals in Anhui Province, China, involving 332 adolescents diagnosed with MDD using DSM-5 criteria. The Childhood Trauma Questionnaire - Short Form (CTQ-SF) and the Internet Addiction Test (IAT) were used to assess CM and IA symptoms, respectively. Gender-based network analysis was also performed. Network analysis constructed a CM-IA network and identified core and bridge symptoms. "Depress/moody/nervous being offline", "Request an extension for longer time", "Sleep loss due to late-night logins", and "emotional abuse" emerged as central symptoms within the CM-IA network. Additionally, "emotional abuse", "sexual abuse", and "complaints about online time" were identified as key bridge symptoms linking CM and IA. These symptoms demonstrated significant connectivity, underscoring their critical role in linking CM and IA. The findings highlight the complex relationship between CM and IA in adolescents with MDD. Specific symptoms, such as emotional abuse and online-related symptoms, play important roles in understanding and intervening in adolescent IA. Future interventions should target these core and bridge symptoms for more effective prevention and treatment.

The role of childhood trauma and attachment state of mind in mothers' birth experiences.

Negative birth experiences are common. It is yet unclear which women may be most at risk already before pregnancy. Childhood trauma and non-autonoumous/unresolved attachment state of mind may affect how women experience giving birth. This study used longitudinal data to test childhood trauma and attachment state of mind as predictors of birth experience in at-risk sample of primipara women (N = 193). The Adverse Childhood Experiences questionnaire and the Adult Attachment interview were administered during pregnancy, and women reported about their birth experience three months postpartum. Partial Least Square Structural Equation Modelling was applied to answer the research questions. Childhood physical neglect and parental substance abuse were predictive of a more negative birth experience, while attachment state of mind was not associated with how women experienced giving birth. Cross-validation suggests that these findings may be considered externally valid. Further research using validated measures on birth experience are needed.

Childhood Trauma as a Mediator of Intergenerational PTSD Symptom Transmission in Rwanda: A Cross-Sectional Study

Childhood Trauma as a Mediator of Intergenerational PTSD Symptom Transmission in Rwanda: A Cross-Sectional Study

Development and evaluation of the Trauma Screener-Intellectual Disability: a post-traumatic stress disorder screening tool for adults with mild intellectual disability or borderline intellectual functioning.

This study aimed to evaluate the validity and reliability of the adult self-report and proxy version of the Trauma Screener-Intellectual Disability (TS-ID) in adults with mild intellectual disability or borderline intellectual functioning (MID-BIF). An optimal cut-off value was determined for the ratio of specificity to sensitivity for predicting the diagnosis of post-traumatic stress disorder (PTSD). The TS-ID was adapted from a Dutch Child and Adolescent Trauma Screener, for use with adults with MID-BIF. Outcomes based on the TS-ID were compared with the presence of PTSD, as classified using the Diagnostic Interview Trauma and Stressors-Intellectual Disability (Mevissen et al. 2018). The TS-ID adult version was administered to 97 participants with MID-BIF who lived in supported housing, whereas the TS-ID proxy version was administered to 92 family members or professional caregivers. The TS-ID adult version showed high internal consistency (Cronbach's α=.94) and excellent validity (AUC=.94) for distinguishing PTSD in adults with MID-BIF. Optimal specificity and sensitivity was found at a cut-off score of 18. Although the TS-ID proxy version demonstrated excellent internal consistency (Cronbach's α=.93), it showed no validity in statistically distinguishing PTSD in adults with MID-BIF. The TS-ID showed favourable psychometric qualities as a screening instrument of PTSD in the case for people with MID-BIF.

Pediatric Trauma - A Silent Epidemic.

Trauma is the leading cause of preventable deaths in children all over the world. In the majority of cases, children are innocent victims of road traffic accidents. They suffer from both short-term and long-term impacts of trauma. Deaths from road traffic accidents can be prevented by adopting simple road safety measures and the use of protective equipment. Worldwide programs have been initiated to curb this ever-rising menace; however, the success of these programs depends on their outreach and acceptance among the population in general. Golden hours in trauma management is the initial hour post-trauma, the success of resuscitation depends on the appropriate management of pediatric trauma victims in hospitals dedicated to the management of pediatric trauma victims. The current review highlights the epidemiology, pattern of injury, road safety measures, and global health initiatives for the prevention of accident-related injury in children. The shortcomings of this review are as follows- Firstly pediatric trauma is an exhaustive topic, it is impossible to cover all aspects of pediatric trauma. Thus, the review might have missed some important aspects of pediatric trauma. Secondly, the concept of a pediatric trauma registry is nonexistent in almost all developing countries; hence a true picture of pediatric trauma epidemiology and injury patterns is missing. Thirdly not much work has been done on pediatric trauma in developing countries leading to insufficient data from these countries.

Dissociation as a mediator of interpersonal trauma and depression: adulthood versus childhood interpersonal traumas3

Extensive research has established that interpersonal trauma is related to depression and dissociation severity. Extending prior research, this study found that childhood and adulthood interpersonal traumas are related to depressive symptoms and examined the role of dissociative process as a mediator. Two hundred eighty-nine adult participants retrospectively reported on traumatic experiences and current symptoms of dissociation and depression, indicating that both childhood and adulthood interpersonal traumas are related to the severity of depression. However, childhood interpersonal trauma was associated with a higher level of dissociative symptoms. Moreover, it was suggested that dissociation serves as a pathway through which childhood interpersonal trauma influences depression, although this relationship was not observed for adulthood interpersonal trauma. In conclusion, this study highlights the potential role of dissociation in the development and maintenance of depression, particularly among individuals who have experienced childhood interpersonal trauma. These findings suggest that interventions targeting dissociation show potential for mitigating retrospective depression, especially for survivors of childhood interpersonal trauma.

The Impact of Maternal Childhood Trauma on Children’s Problem Behaviors: The Mediating Role of Maternal Depression and the Moderating Role of Mindful Parenting

The Impact of Maternal Childhood Trauma on Children’s Problem Behaviors: The Mediating Role of Maternal Depression and the Moderating Role of Mindful Parenting

Risk Factors of Post-Traumatic Stress in Pediatric Solid Organ Transplant Recipients.

Life with end-stage organ failure is accompanied by an accumulation of traumatic medical or surgical experiences. Despite recovery after solid organ transplantation (SOT), many children and adolescents develop post-traumatic stress symptoms (PTSS). PTSS remain underappreciated as a major comorbidity in SOT programs, despite their association with decreased quality of life. We conducted a retrospective, cross-sectional study of 86 pediatric SOT recipients (17 heart, 44 kidney, and 25 liver) to evaluate potential determinants of PTSS. Trauma symptoms were measured by the Child Trauma Screening Questionnaire (CTSQ). Demographic, baseline, and contemporaneous factors were tested for independent association with CTSQ scores. The median post-transplant CTSQ score was 2 (IQR 1-4), and 22% were identified as high risk (score ≥5) for PTSD. Higher CTSQ scores were independently associated with the number of ICU days within the previous 12 months, the number of medications (complexity), and involvement with foster care in the primary model (R2 [adj.] = 0.26). The addition of the Family Impact Module improved the overall model (R2 [adj.] = 0.33), wherein higher family functioning was independently associated with lower CTSQ scores. An exploratory analysis of pre-transplant patients (n = 34) found a median pre-transplant CTSQ of 2 (IQR 1-6), suggesting that PTSS are onset before transplant and persist afterward. PTSS are highly prevalent in the SOT population. Risk factors include recent adverse medical experiences and complexity, whereas family stability may be protective. Additional research is needed to improve early ascertainment and support for patients at high risk of developing PTSS throughout their transplant journey.

Further evidence for the association between childhood trauma and suicidal ideation in young individuals: A twin based study.

Suicide is a major cause of death among youth. Childhood trauma (CT) has emerged as a leading environmental risk factor for suicidal ideation (SI). The present study intends to understand the association between CT and SI in a sample of twins, highlighting the relevance of CT per se, regardless of genetic vulnerability. Data were derived from a general population young twin study, the TwinssCan project (N = 796; mean age = 17.4). Different types of CT (physical, emotional and sexual) were explored with CTQ and SI through SCL-90-R. The discordance within twin-pairs was used to dissect the genetic and CT effects in SI. Total CT and all subdomains were associated with an increased risk for SI. The within-pair differences analysis in monozygotic and dizygotic twins suggested that part of this association is not attributable to genetic predisposition, which points out the relevance of CT itself upon the increase of SI. This result converged with CT subdomain analyses of physical abuse and neglect. While within-pair twin analyses control for genetic risk, additional environmental shared and individual characteristics should be controlled for (such as poverty or protective factors). More detailed information on SI would be of great interest to better capture the complexity of this construct. CT appears to be an important environmental risk factor for SI and at least partly independent of Gene-Environment correlation (rGE). This study highlights the importance of including the history of CT in psychiatric evaluations of patients. The burden of the psychosocial environment on SI could be disentangled by further research on environmental risk and protective factors.

Pediatric Cervical Spine Trauma: A Narrative Review.

Narrative review. To provide an updated overview of pediatric cervical spine trauma. Pediatric cervical spine trauma can cause debilitating morbidity and mortality and neurological impairment. The unique anatomic features of the developing cervical spine can predispose children to injuries. We reviewed the pediatric cervical spine trauma literature in PubMed and EMBASE. Pediatric cervical spine injury occurs in 1%-2% of pediatric trauma. The most frequent cause is motor vehicle collisions, with sports-related injuries being more common in older children. Larger head-to-body ratios and tissue elasticity can predispose young children to a greater risk of injury higher in the craniocervical junction and cervical spine. Standardized protocols and classification systems, such as the Pediatric Cervical Spine Clearance Working Group protocol and the AO Spine Injury and Subaxial Cervical Spine Injury Classifications, are valuable in triage as well as for assessing the need for operative versus nonoperative management. In general, operative approaches and principles are similar to those in adults, with modern instrumentation and fusion techniques achieving high rates of successful arthrodesis. Effective management and treatment of pediatric cervical spine injuries depends on early and accurate diagnosis, a thorough understanding of pediatric spinal anatomy, and a versatile surgical armamentarium.

아동기 대인 간 외상경험이 성인의 외상 후 성장에 미치는 영향

Objectives This study was to determine the effect of interpersonal trauma experience in childhood on post-traumatic growth in adults. Methods 266 adult men and women aged 20 to 59 in Korea were surveyed and analyzed through an Internet questionnaire. The research tool was the Korean version of childhood trauma. It was a questionnaire (Eun-jung Kim, Jin-sook Kim, 2010) and a post-traumatic growth scale (Si-hyung Kim et al., 2020). For the data, skewness and kurtosis were analyzed using the SPSS 22.0 statistical program to confirm whether the assumption of normality was satisfied, and correlation analysis and t-test for differences between major variables, One-way analysis of variance and hierarchical regression analysis were performed. Results First, as a result of verifying the difference in post-traumatic growth according to the background variable, men were significantly higher than women in all post-traumatic growth according to gender. According to marital status, married people were significantly higher than unmarried. Depending on the age, those in their 50s were significantly higher than those in their 40s, 30s, and 20s. In addition, the difference in overall post-traumatic growth was significant according to the type of interpersonal trauma experience in childhood, sexual abuse, physical abuse, neglect, double abuse, and emotional abuse appeared in order. In addition, there was no difference in the factors of trauma perpetrator between trauma period, caregiver, and childhood interpersonal relations. Second, as a result of the correlation analysis of the main variables, it was found that there was no significant correlation between the entire childhood trauma and the entire post-traumatic growth. However, among the sub-factors, emotional neglect and post-traumatic growth were negatively correlated, and sexual abuse and physical abuse were positively correlated with post-traumatic growth. In other words, the higher the emotional neglect, the lower the post-traumatic growth, and the higher the sexual and physical abuse, the higher the post-traumatic growth. Third, it was found that interpersonal trauma experience in childhood had a significant effect on post-traumatic growth. Emotional abuse during childhood trauma was static and emotional neglect was negative. It was found to have an effect. In other words, the higher the emotional abuse among childhood trauma experiences, the more post-traumatic growth. It can be interpreted that the higher the emotional neglect, the lower the likelihood of post-traumatic growth. Conclusions The results suggest that lowering emotional neglect is effective to increase post-traumatic growth.

Mediation of DNA methylation (cg04622888 and cg05037505) in the association between childhood maltreatment and non-suicidal self-injury in early adolescents.

It is unclear whether DNA methylation underlies the association between childhood maltreatment (CM) and non-suicidal self-injury (NSSI) in early adolescents. We aim to explore the mediation of specific DNA methylation sites in the associations of CM and its subtypes with NSSI, following investigation on the association between specific DNA methylation sites and NSSI. A case-control study was conducted to examine 155 adolescents aged 12-14years who were identified to have engaged in NSSI and 201 controls. CM and its subtypes were evaluated by using the Childhood Trauma Questionnaire. The EPIC 850k Bead Chip was used to discover differential methylation sites (DMSs) in the peripheral blood between 10 NSSI cases and 10 controls. Targeted pyrosequencing was employed to detect the levels of specific DMSs among the total study population, which were selected based on bioinformatics analyses and literature review. We discovered 456 DMSs between NSSI cases and controls, 219 were hypermethylated and 237 were hypomethylated. After controlling for potential confounders, CM or its subtypes, and the methylation of cg04622888 and cg05037505 were all significantly associated with NSSI (all P < 0.05). The total association of CM and its subtypes with NSSI were all significantly (all P < 0.05), with the standardized coefficient (β) ranged from 0.12 for physical neglect to 0.24 for emotional neglect and CM. Significant indirect association of physical neglect with NSSI through methylation of cg04622888 was observed and the mediating proportion was 0.14 (95%CI 0.06-0.23). Significant indirect associations of emotional abuse, emotional neglect, and physical neglect with NSSI through methylation of cg05037505 were also observed, and the mediating proportions were 0.09 (95%CI 0.04-0.14), 0.08 (95%CI, 0.03-0.14) and 0.19 (95%CI 0.07-0.32), respectively. Data of this study suggested thatmethylation of cg04622888 and cg05037505 were independently associated with NSSI among early adolescents, and they partially mediated the associations of emotional abuse, emotional neglect, and physical abuse with NSSI.

A cluster analysis of attachment styles in patients with borderline personality disorder, bipolar disorder and ADHD

BackgroundInsecure adult attachment has been associated with psychiatric disorders characterized by emotional dysregulation, such as borderline personality disorder (BPD), bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD). However, little is known about the differences in attachment patterns between these diagnostic groups. The aim of this study was to identify clusters of adult attachment style in a cross-diagnostic group of patients with BDP and/or BD and/or ADHD and explore the characteristics of these clusters based on temperament profile, childhood trauma and psychiatric diagnoses.MethodsK-means cluster analysis was used to identify subgroups, based on the Attachment Style Questionnaire Short Form dimensions, in a clinical cohort of 150 young adults (113 women and 37 men, mean age ± SD = 23.3 ± 2.1) diagnosed with BPD, and/or BD, and/or ADHD.ResultsThree distinct clusters were identified: a secure, an insecure/avoidant-anxious and an insecure/avoidant cluster. These three clusters differed in temperament profile and related psychiatric diagnoses.ConclusionsThe three clusters of attachment in individuals with BPD, BD and/or ADHD could support differentiation between the disorders as well provide information usable for planning of treatment.

Early childhood trauma and behavioral disorders: The role of healthcare access in breaking the cycle

Early childhood trauma and behavioral disorders: The role of healthcare access in breaking the cycle

Multilevel analysis of factors affecting the interhospital transfer of high-acuity pediatric patients: a focus on severe pediatric emergency patients

Purpose: The authors aimed to identify the factors affecting interhospital transfer (“transfer”) of severe pediatric patients who visited to an emergency department (ED).Methods: Using the Korean National ED Information System, we analyzed high-acuity patients aged 18 years or younger who visited EDs of local or regional emergency centers nationwide. The high acuity was defined as a Korean Triage and Acuity Scale 1-2. To investigate the factors associated with transfer, a multilevel modeling was selected, examining independent variables at both individual- and hospital-levels with transfer as a dependent variable.Results: A model consisting of variables at individual- and hospital-levels showed the factors as follows: mode of arrival(self-transport: odds ratio, 0.48 [95% confidence interval, 0.38-0.61]; other ambulances: 0.41 [0.24-0.71]; compared with firehouse ambulance), visit at 18:00-07:59 (0.75 [0.64-0.88]), intentional injury (1.59 [1.03-2.47]; compared with non-injury), decreased level of consciousness (drowsy: 1.94 [1.33-2.84]; stupor: 4.08 [2.99-5.57]; coma: 1.81 [1.26-2.60]; compared with alert), severe illness diagnosis (1.49 [1.12-1.98]), the number of all beds in EDs (1.02 [1.01-1.04]), and acceptance for treatment (0.92 [0.87-0.98]; with increment of 1%).Conclusion: This study confirms that both individual-level and hospital-level factors affect the transfer risk of severe pediatric patients in EDs. The study suggests the needs for direct transportation to specialized pediatric treatment facilities, and concentrated support for the pediatric emergency medical centers and pediatric trauma centers.

The relationship between mindfulness and childhood trauma with suicide: The mediating role of cognitive bias

The purpose of this study is to investigate the relationship between mindfulness, childhood trauma, and suicide, specifically focusing on the mediating role of cognitive bias. Suicide is a pressing issue that poses a significant threat to public health in society, and understanding the factors that contribute to it is crucial. The research design employed in this study is a correlation-based structural equation model. A total of 370 students from the second level of secondary school in Iran city were selected as participants using an available sampling method during the academic year of 2023. To gather data, several questionnaires were utilized, including the Kentucky Mindfulness Questionnaire, Bernstein et al.'s Childhood Trauma Questionnaire (1994), Hammachi and Ozturk's Cognitive Bias Questionnaire (2004), and the Multi-attitude Suicidal Tendency Questionnaire (MAST). Data analysis was conducted using SPSS-23 and Amos software, encompassing both descriptive and inferential levels. The findings of this research revealed several significant relationships. Firstly, there is a positive and significant direct path from childhood trauma to cognitive bias. Secondly, mindfulness has a negative and significant direct path to cognitive bias. Thirdly, childhood trauma has a direct and significant path to suicide. Additionally, cognitive bias has a positive and significant path to suicidality, while mindfulness has a negative and significant path to suicide. Moreover, there are positive and significant indirect paths from suicide to childhood trauma and negative and significant indirect paths from suicide to mindfulness. In conclusion, this study highlights the importance of mindfulness and cognitive bias as variables related to adolescent suicide. Adolescents who have experienced childhood trauma are more likely to consider suicide as a solution when faced with life problems. These findings emphasize the need for interventions and support systems that address mindfulness, cognitive bias, and childhood trauma to prevent and mitigate the risk of suicide among adolescents.

Low-Value Clinical Practices in Pediatric Trauma Care

Reducing low-value care has the potential to improve patient experiences and outcomes and decrease the unnecessary use of health care resources. Research suggests that low-value practices (ie, the potential for harm exceeds the potential for benefit) in adult trauma care are frequent and subject to interhospital variation; evidence on low-value practices in pediatric trauma care is lacking. To estimate the incidence of low-value practices in pediatric trauma care and evaluate interhospital practice variation. A retrospective multicenter cohort study in a Canadian provincial trauma system was conducted. Children younger than 16 years admitted to any of the 59 provincial trauma centers from April 1, 2016, to March 31, 2022, were included. Low-value practices were identified from systematic reviews of clinical practice guidelines on pediatric trauma. The frequencies of low-value practices were evaluated by estimating incidence proportions and cases per 1000 admissions (low if ≤10% and ≤10 cases, moderate if >10% or >10 cases, and high if >10% and >10 cases) were identified. Interhospital variation with intraclass correlation coefficients (ICCs) were assessed (low if <5%, moderate if 5%-20%, and high if >20%). A total of 10 711 children were included (mean [SD] age, 7.4 [4.9] years; 6645 [62%] boys). Nineteen low-value practices on imaging, fluid resuscitation, hospital/intensive care unit admission, specialist consultation, deep vein thrombosis prophylaxis, and surgical management of solid organ injuries were identified. Of these, 14 (74%) could be evaluated using trauma registry data. Five practices had moderate to high frequencies and interhospital variation: head computed tomography in low-risk children (7.1%; 33 per 1000 admissions; ICC, 8.6%), pretransfer computed tomography in children with a clear indication for transfer (67.6%; 4 per 1000 admissions; ICC, 5.7%), neurosurgical consultation in children without clinically important intracranial lesions (11.6%; 13 per 1000 admissions; ICC, 15.8%), hospital admission in isolated mild traumatic brain injury (38.8%; 98 per 1000 admissions; ICC, 12.4%), and hospital admission in isolated minor blunt abdominal trauma (10%; 5 per 1000 admissions; ICC, 31%). In this cohort study, low-value practices appeared to be frequent and subject to interhospital variation. These practices may represent priority targets for deimplementation interventions, particularly as they can be measured using routinely collected data.