Trauma Visits Research Articles

Using an Emergency Department Syndromic Surveillance System to Assess the Impact of Cyclone Bejisa, Reunion Island

On January 2, 2014 the cyclone Bejisa struck Reunion Island. In anticipation, an epidemiological surveillance was set up in order to assess the impact in the aftermath of the cyclone. Short-term health effects were assessed using a syndromic surveillance system based on data of EDs and EMS. A peak of calls to the EMS was observed the day of the cyclone and an increase of ED visits over the next two days. At the same time, a significant increase of visits for trauma, burns, conjunctivitis was detected. The reactivity and the flexibility of the syndromic surveillance system allowed to rapidly assess the health impact of the cyclone.

Laparoscopic surgery for trauma: the realm of therapeutic management

BackgroundThe use of laparoscopy in trauma is, in general, limited for diagnostic purposes. We aim to evaluate the therapeutic role of laparoscopic surgery in trauma patients. MethodsWe analyzed the National Trauma Data Bank (2007 to 2010) for all patients undergoing diagnostic laparoscopy. Patients undergoing a therapeutic laparoscopic surgical procedure were identified and tabulated. Mortality and hospital length of stay for patients with isolated abdominal injuries were compared between the open and laparoscopic groups. ResultsOf a total of 2,539,818 trauma visits in the National Trauma Data Bank, 4,755 patients underwent a diagnostic laparoscopy at 467 trauma centers. Of these, 916 (19.3%) patients underwent a therapeutic laparoscopic intervention. Common laparoscopic operations included diaphragm repair, bowel repair or resection, and splenectomy. Patients undergoing laparoscopic surgery had a significantly shorter length of stay than the open group (5 vs 6 days; P < .001). ConclusionTherapeutic laparoscopic surgery for trauma is feasible and may provide better outcomes.

Prednisone for Emergency Department Low Back Pain: A Randomized Controlled Trial

BackgroundAlthough oral corticosteroids are commonly given to emergency department (ED) patients with musculoskeletal low back pain (LBP), there is little evidence of benefit. ObjectiveTo determine if a short course of oral corticosteroids benefits LBP ED patients. MethodsDesign: Randomized, double-blind, placebo-controlled trial. Setting: Suburban New Jersey ED with 80,000 annual visits. Participants: 18–55-year-olds with moderately severe musculoskeletal LBP from a bending or twisting injury ≤ 2 days prior to presentation. Exclusion criteria were suspected nonmusculoskeletal etiology, direct trauma, motor deficits, and local occupational medicine program visits. Protocol: At ED discharge, patients were randomized to either 50 mg prednisone daily for 5 days or identical-appearing placebo. Patients were contacted after 5 days to assess pain on a 0–3 scale (none, mild, moderate, severe) as well as functional status. ResultsThe prednisone and placebo groups had similar demographics and initial and discharge ED pain scales. Of the 79 patients enrolled, 12 (15%) were lost to follow-up, leaving 32 and 35 patients in the prednisone and placebo arms, respectively. At follow-up, the two arms had similar pain on the 0–3 scale (absolute difference 0.2, 95% confidence interval [CI] −0.2, 0.6) and no statistically significant differences in resuming normal activities, returning to work, or days lost from work. More patients in the prednisone than in the placebo group sought additional medical treatment (40% vs. 18%, respectively, difference 22%, 95% CI 0, 43%). ConclusionWe detected no benefit from oral corticosteroids in our ED patients with musculoskeletal LBP.

Abstract 39: Infection, Vaccination, and Childhood Stroke: Preliminary Results of the Vascular Effects of Infection in Pediatric Stroke (VIPS) Study

Background: Acute minor infection was associated with childhood arterial ischemic stroke (AIS) in a retrospective study. In a prospective study, we tested the hypothesis that acute infection increases stroke risk, while vaccination against infection is protective. Methods: VIPS is an international multi-center prospective case-control study with a target enrollment of 350 cases of AIS (28 days-18 years old); parental interviews were conducted within 3 weeks of stroke occurrence in cases. Unmatched controls were identified and interviewed within 3 weeks of routine clinic visits for annual check-ups, migraine, or developmental delay, or urgent visits for trauma. Data were collected on recent infections and routine childhood vaccines. We explored attitudes toward vaccination by asking if the child had received all, most, some, few, or none of the routine vaccines expected for his/her age. Results: Data were available for 310 cases and 289 controls. Median (IQR) age was 7.5 (2.8, 14.2) and 8.2 (3.3, 12.8) years respectively (p=0.96). Infection ≤1week prior to stroke/interview date conferred a 6.5-fold risk of AIS (p&lt;0.0001); the most common type of infection reported in this time period was upper respiratory (75% of controls and 50% of cases). In general, cases were under-vaccinated compared to controls (Table). Children reported to have had some/few/no routine vaccinations were at higher risk of AIS than those receiving all or most (OR 6.72, 95% CI 2.30, 19.6, p&lt;0.0001). In logistic regression adjusted for age, ever having received an MMR, polio, or pneumococcus vaccine were each significantly protective against stroke. Conclusions: Recent infection confers an increased risk of childhood AIS, while routine vaccinations appear protective. This finding has positive implications for both primary and secondary stroke prevention.

Risk Factors of Significant Pain Syndrome 90 Days After Minor Thoracic Injury: Trajectory Analysis

The objective was to identify the risk factors of clinically significant pain at 90 days in patients with minor thoracic injury (MTI) discharged from the emergency department (ED). A prospective, multicenter, cohort study was conducted in four Canadian EDs from November 2006 to November 2010. All consecutive patients aged 16 years or older with MTI were eligible at discharge from EDs. They underwent standardized clinical and radiologic evaluations at 1 and 2 weeks, followed by standardized telephone interviews at 30 and 90 days. A pain trajectory model characterized groups of patients with different pain evolutions and ascertained specific risk factors in each group through multivariate analysis. In this cohort of 1,132 patients, 734 were eligible for study inclusion. The authors identified a pain trajectory that characterized 18.2% of the study population experiencing clinically significant pain (>3 of 10) at 90 days after a MTI. Multivariate modeling found two or more rib fractures, smoking, and initial oxygen saturation below 95% to be predictors of this group of patients. To the authors' knowledge, this is the first prospective study of trajectory modeling to detect risk factors associated with significant pain at 90 days after MTI. These factors may help in planning specific treatment strategies and should be validated in another prospective cohort.

Tdap vaccination during pregnancy—no signal of safety concerns for infants

Taking advantage of a robust electronic medical record system at Intermountain Healthcare facilities in Utah, Shakib et al performed a retrospective cohort study assessing pregnancy, birth, and infancy outcomes for 138 women who were given tetanus and reduced-content diphtheria toxoids and reduced-content acellular pertussis vaccine (Tdap) compared with 552 randomly selected nonvaccinated pregnant women controls. The study, ending in 2009, was performed before routine recommendation for Tdap administration during pregnancy. The most common reason for Tdap was prophylaxis for open wounds or during acute care visits for trauma. Of pregnant women receiving Tdap, 63% received the vaccine during the first trimester. For all outcomes assessed (ie, preterm delivery, low gestational age or weight, congenital anomaly, or diagnosis of complex conditions in the first 12 months of life), there was no signal of excess occurrence in vaccinated versus unvaccinated cohorts. In light of nationwide increase of pertussis and deaths in infants too young to be protected by the current Tdap schedule, the Centers for Disease Control and Prevention now recommends Tdap administration during every pregnancy. Implementation, however, has been woefully poor to date. This study provides reassurance regarding safety for mothers, their pregnancy, and their infants—even when Tdap was given earlier than the optimal window currently recommended (for maximized antibody level in offspring at birth) of 27 to 36 weeks of gestation. We pediatricians need to encourage obstetricians, family physicians, and internists to immunize pregnant women in order to extend lifesaving vaccines, such as for influenza for mothers and pertussis for neonates, to all people. Article page 1422▶ Tetanus, Diphtheria, Acellular Pertussis Vaccine during Pregnancy: Pregnancy and Infant Health OutcomesThe Journal of PediatricsVol. 163Issue 5PreviewTo assess pregnancy and birth outcomes in infants born to women who did or did not receive tetanus, diphtheria, acellular pertussis (Tdap) vaccine during pregnancy. Full-Text PDF

Traumatic Intracranial Injury in Intoxicated Patients With Minor Head Trauma

Studies focusing on minor head injury in intoxicated patients report disparate prevalences of intracranial injury. It is unclear if the typical factors associated with intracranial injury in published clinical decision rules for computerized tomography (CT) acquisition are helpful in differentiating patients with and without intracranial injuries, as intoxication may obscure particular features of intracranial injury such as headache and mimic other signs of head injury such as altered mental status. This study aimed to estimate the prevalence of intracranial injury following minor head injury (Glasgow Coma Scale [GCS] score ≥14) in intoxicated patients and to assess the performance of established clinical decision rules in this population. This was a prospective cohort study of consecutive intoxicated adults presenting to the emergency department (ED) following minor head injury. Historical and physical examination features included those from the Canadian CT Head Rule, National Emergency X-Radiography Utilization Study (NEXUS), and New Orleans Criteria. All patients underwent head CT. A total of 283 patients were enrolled, with a median age of 40 years (interquartile range [IQR] = 28 to 48 years) and median alcohol concentration of 195 mmol/L (IQR = 154 to 256 mmol/L). A total of 238 of 283 (84%) were male, and 225 (80%) had GCS scores of 15. Clinically important injuries (injuries requiring admission to the hospital or neurosurgical follow-up) were identified in 23 patients (8%; 95% confidence interval [CI] = 5% to 12%); one required neurosurgical intervention (0.4%, 95% CI = 0% to 2%). Loss of consciousness and headache were associated with clinically important intracranial injury on CT. The Canadian CT Head Rule had a sensitivity of 70% (95% CI = 47% to 87%) and NEXUS criteria had a sensitivity of 83% (95% CI = 61% to 95%) for clinically important injury in intoxicated patients. In this study, the prevalence of clinically important injury in intoxicated patients with minor head injury was significant. While the presence of the common features associated with intracranial injury in nonintoxicated patients should raise clinical suspicion for intracranial injury in intoxicated patients, the Canadian CT Head Rule and NEXUS criteria do not have adequate sensitivity to be applied in intoxicated patients with minor head injury.

Treatment course and outcomes following drug and alcohol-related traumatic injuries

BackgroundAlcohol and drug use is known to be a major factor affecting the incidence of traumatic injury. However, the ways in which immediate pre-injury substance use affects patients' clinical care and outcomes remains unclear. The goal of the present study is to determine the associations between pre-injury use of alcohol or drugs and patient injury severity, hospital course, and clinical outcome.Materials and methodsThis study used more than 200,000 records from the National Trauma Data Bank (NTDB), which is the largest trauma registry in the United States. Incidents in the NTDB were placed into one of four classes: alcohol related, drug related, alcohol-and-drug related, and substance negative. Logistic regression models were used to determine comorbid conditions or treatment complications that were significantly associated with pre-injury substance use. Hospital charges were associated with the presence or absence of drugs and alcohol, and patient outcomes were assessed using discharge disposition as delimited by the NTDB.ResultsThe rates of complications arising during treatment were 8.3, 10.9, 9.9 and 8.6 per one hundred incidents in the alcohol related, drug related, alcohol-and-drug related, and substance-negative classes, respectively. Regression models suggested that pre-injury alcohol use is associated with a 15% higher risk of infection, whereas pre-injury drug use is associated with a 30% higher risk of infection. Pre-injury substance use did not appear to significantly impact clinical outcomes following treatment for traumatic injury, however.ConclusionThis study suggests that pre-injury drug use is associated with a significantly higher complication rate. In particular, infection during hospitalization is a significant risk for both alcohol and drug related trauma visits, and drug-related trauma incidents are associated with increased risk for additional circulatory complications. Although drug and alcohol related trauma incidents are not associated with appreciably worse clinical outcomes, patients experiencing such complications are associated with significantly greater length of stay and higher hospitalization costs. Therefore significant benefits to trauma patients could be gained with enhanced surveillance for pre-injury substance use upon admission to the ED, and closer monitoring for infection or circulatory complications during their period of hospitalization.

Ratification of IATSIC/WHO’s Guidelines for Essential Trauma Care Assessment in the South American Region

The purpose of the present study was to evaluate the usefulness of the International Association for Trauma Surgery and Intensive Care (IATSIC)/World Health Organization (WHO)'s Guidelines for Essential Trauma Care (EsTC Guidelines) in providing an internationally applicable and standardized template to assess trauma care capabilities in the South American Region. Field assessment was conducted in seven provinces (urban and rural, pop. 2,239,509) and 24 facilities (5 large hospitals (LH); 15 small hospitals (SH); 4 basic hospitals (BH)) in Ecuador using EsTC criteria. A total of 260 individual items in Human Resources (HR- availability, clinical knowledge, skills) and physical resources (PR) were evaluated via inspection, review of local statistics, and administrative and staff interviews. EsTC was evaluated on a scale as follows: 0 (absent); 1(inadequate;<50%); 2 (partly adequate>50%); 3 (adequate-100%). 210,045 Emergency Department (ED) visits and 61,365 (29%) ED trauma visits were recorded (incidence rate 2,740/100,000 population). Deficits were noted in prehospital trauma care (inadequate coordination, communication), education and training (ATLS<30%, TNCC 0%), facility based trauma care (poor physical resources [PR] and human resources [HR]), and quality assurance (1/27 hospitals). The IATSIC/WHO EsTC Guidelines provide a simple and useful template to assess trauma care capability in variable facilities and international settings, and they could serve as a valuable tool for trauma system development. Endorsement of EsTC Guidelines by the Panamerican Health Organization and lead trauma societies (the Panamerican Trauma Society) should be considered.

Gender Differences Among Recidivist Trauma Patients

Gender differences among trauma recidivist patients are not well-understood. We hypothesized that males are more likely to be repeatedly involved in the trauma system and have a shorter time to recurrence between repeat episodes of injury compared with females. A retrospective analysis of trauma patients treated at an urban university-based trauma center was performed. Variables including gender, race, insurance status, age, mechanism of injury, outcomes, and injury secondary to domestic violence were compared. Differences were compared using χ(2) tests and log-rank (Mantel-Cox) Kaplan-Meier cumulative event curves. We identified 689 trauma recidivist patients (4.0% of all trauma visits) over a 10-y period. Compared to single-visit patients, recidivist patients were more likely to be male (87% versus 73%), uninsured (78% versus 66%), and have injuries secondary to assaults (54% versus 37%) (P < 0.05). Time from the first to second trauma visit was shorter for females compared with males (23 ± 2.5 versus 30 ± 1.2 mo, P < 0.02). Additionally, female recidivists were more likely to be involved in blunt trauma than were male recidivists (69% versus 43%, P < 0.001). Furthermore, domestic violence was identified in a higher proportion of female recidivist patients than female single-visit patients (3.5% versus 1.6%, P < 0.0003). Contrary to our hypothesis, female recidivist trauma patients have a much shorter time to recurrence for a second traumatic injury than do males. Female recidivists have a high likelihood of assault-associated injuries and domestic violence. Trauma centers should screen for domestic violence among trauma patients to aid in preventing further repeat episodes of injury.

Prospective monitoring of plasma and platelet transfusions in a large teaching hospital results in significant cost reduction

Plasma and platelets (PLTs) are often transfused to correct mild to moderately abnormal laboratory values. Our objective was to reduce unnecessary plasma and PLT transfusions to nonbleeding patients by prospective triage and education of end users in evidence-based hemostasis and transfusion medicine practices. Using the Parkland Memorial Hospital's transfusion service and admission database as the data source, this study comprises the comparison of transfusion data on plasma and PLT use between pre- (2000-2002) and posttriage (2003-2006) periods. Yearly transfusion and wastage data on red blood cells (RBCs), plasma, and PLTs and yearly hospital admissions, trauma visits, and surgical procedures were extracted retrospectively for the study. The study revealed that implementation of triage resulted in a significant reduction of plasma (60%) and PLT (25%) transfusions, saving more than $3,000,000 over 4 years. Prospective triage and evidence-based transfusion practice education reduced unnecessary plasma and PLT transfusions and health care costs.

Rotavirus Gastroenteritis: Precursor of Functional Gastrointestinal Disorders?

: Abdominal pain-related functional gastrointestinal disorders (AP-FGIDs) following bacterial acute gastroenteritis (AGE) have been demonstrated in adults and children. An adult study demonstrated AP-FGIDs resulting from an outbreak of viral AGE. Viral AGEs are common in children. Thus, the demonstration of AP-FGIDs occurring after a viral infection in children could constitute a significant finding. The aim of the study was to investigate the development of FGIDs following an episode of acute rotavirus gastroenteritis in children. This is the first pediatric multicenter study designed to assess postviral AP-FGIDs. : It is a cohort study. Inclusion criteria of the study are children ages 4 to 18 years with history of AGE secondary to rotavirus. Sample size is 44 exposed and 44 controls (unidirectional alpha of 0.05, power of 0.80). Children consulting at 2 hospitals (Chicago, IL, and Naples, Italy) for AGE (2002-2004) who tested positive for rotavirus were randomly contacted by telephone >2 years after the episode. Each exposed child who visited the emergency department or outpatient site for acute trauma or well-child visit within 4 weeks of the index case was matched with a control of the same age and sex. Gastrointestinal symptoms and disability were evaluated with a validated pediatric questionnaire. : Eighty-eight patients (46 boys, mean age 5.3 years) were recruited. Contacted patients presented with AGE in 2002 (9), 2003 (11), and 2004 (24). Seven (16%) exposed patients and 3 (7%) controls reported AP-FGIDs (P = 0.31). : Our study suggests that rotavirus infection does not seem to place children at increased risk for AP-FGIDs at long-term follow-up. Larger, prospective studies should be conducted to evaluate whether rotavirus gastroenteritis leads to AP-FGIDs in children.

156: Large Increase in Emergency Department Visits for Head Trauma After Natasha Richardson's Death

Actress Natasha Richardson died from a head injury on March 18, 2009. According to some reports, she initially appeared well after sustaining the injury. We hypothesize that the publicity surrounding this tragic event would be associated with an increase in emergency department (ED) visits for evaluation of head trauma.

Commitment to COT Verification Improves Patient Outcomes and Financial Performance

After an unsuccessful American College of Surgery Committee on Trauma visit, our level I trauma center initiated an improvement program that included (1) hiring new personnel (trauma director and surgeons, nurse coordinator, orthopedic trauma surgeon, and registry staff), (2) correcting deficiencies in trauma quality assurance and process improvement programs, and (3) development of an outreach program. Subsequently, our trauma center had two successful verifications. We examined the longitudinal effects of these efforts on volume, patient outcomes and finances. The Trauma Registry was used to derive data for all trauma patients evaluated in the emergency department from 2001 to 2007. Clinical data analyzed included number of admissions, interfacility transfers, injury severity scores (ISS), length of stay, and mortality for 2001 to 2007. Financial performance was assessed for fiscal years 2001 to 2007. Data were divided into patients discharged from the emergency department and those admitted to the hospital. Admissions increased 30%, representing a 7.6% annual increase (p = 0.004), mostly due to a nearly fivefold increase in interfacility transfers. Severe trauma patients (ISS >24) increased 106% and mortality rate for ISS >24 decreased by 47% to almost half the average of the National Trauma Database. There was a 78% increase in revenue and a sustained increase in hospital profitability. A major hospital commitment to Committee on Trauma verification had several salient outcomes; increased admissions, interfacility transfers, and acuity. Despite more seriously injured patients, there has been a major, sustained reduction in mortality and a trend toward decreased intensive care unit length of stay. This resulted in a substantial increase in contribution to margin (CTM), net profit, and revenues. With a high level of commitment and favorable payer mix, trauma center verification improves outcomes for both patients and the hospital.

Post-Infectious Functional Gastrointestinal Disorders in Children

To investigate the development of functional gastrointestinal disorders (FGIDs) after an episode of acute bacterial gastroenteritis (AGE) in children. A cohort study of children 3 to 19 years old with a positive result on a bacterial stool culture. 44 patients in each arm (unidirectional alpha of 0.05, power of 0.80). Children presenting at two pediatric hospitals (United States and Italy) for AGE who tested positive for bacteria on stool culture (2001-2005) were contacted at least 6 months after the episode. Exposed children were matched with control subjects of similar age and sex consulting to the same hospitals for trauma or well-child visit within 4 weeks of the index case. Symptoms were evaluated with a validated questionnaire for FGIDs assessing pain, diarrhea, and disability. 88 patients (46 boys; mean age, 8.1 years; age range, 3-19 years) were recruited. Bacteria included Salmonella (54%), Campylobacter (32%), and Shigella (14%). 36% of exposed patients and 11% of control subjects complained of abdominal pain (P < .01). 87% had irritable bowel syndrome and 24% had dyspepsia. 56% reported onset of pain following the AGE. There is a significant increase in cases of FGIDs after bacterial infections in children.

Alarming Surge in Nonsurvivable Urban Trauma and the Case for Violence Prevention

A growing proportion of urban trauma mortality is characterized by devastating and likely nonsurvivable injuries. Consecutive samples from prospectively collected registry data. University level I trauma center. All trauma patients from January 1, 2000, to March 31, 2005. Data for trauma patients, including locale of death and mechanism of injury, comparing early (years 2000 through 2003) and late (2004 and 2005) periods. A total of 11 051 trauma visits were registered during the study period with 366 deaths for an overall mortality of 3.3%. Penetrating injury occurred in 26.7% of patients; however, 71.9% of trauma mortalities (263 patients) died with penetrating injuries. Of the patients who died, 48.3% demonstrated severe penetrating injuries (Abbreviated Injury Score >/=4) to the head while 32.7% presented with severe penetrating chest injuries. There was a significant increase in the mortality rate over time (3.0% [early] vs 4.3% [late], P<.01). In parallel, emergency department mortality (patients dead on arrival and those not surviving to hospital admission) increased from 1.7% to 3.1% (P<.005), yet postadmission mortality remained constant (1.3% [early] vs 1.2% [late], P = .77). When emergency department mortality and the subsequent hospital mortality of patients with gunshot wounds to the head were combined, this represented 82.6% of all trauma mortalities in the late period. This was increased from 69.7% during the early period (P<.01). While in-hospital mortality has remained the same, the proportion of nonsurvivable traumatic injuries has increased. In a mature trauma system, this provides a compelling argument for violence prevention strategies to reduce urban trauma mortality.

Patterns and Outcomes Among Penetrating Trauma Recidivists: It Only Gets Worse

Trauma recidivism accounts for a significant proportion of visits to urban trauma centers. The current study was designed to characterize injury patterns among individual recidivists and analyze their impact on mortality. Recidivists were identified within a trauma registry from an urban level-one trauma center from a period between 1997 and 2004. Demographic, injury type, and final disposition data were retrospectively reviewed. The primary outcomes measured were all-cause mortality and injury mechanism. The data were analyzed using the chi2 method, and logistic regression analysis. Among 15,973 total trauma visits, 2,511 (15.7%) were by recidivists, representing 1,528 unique patients. Of these recidivists, 794 (52%) had their first trauma admission during the period reviewed (84% male, 87% African-American, mean age 31 +/- 13 years). Blunt injuries only were identified in 43.8% patients, while 21.9% had penetrating injuries only, and 34.3% had a combination of injury patterns. Recidivists presenting with penetrating trauma as their initial injury were more likely to return with penetrating injuries on their second (58% vs. 25% [p < 0.001]) and third (68% vs. 24% [p < 0.001]) visits. The all-cause mortality of a penetrating injury was significantly higher than that of a blunt injury for both second (9.2% vs. 1.0% [p < 0.001]) and third (15.1% vs. 1.3% [p = 0.002]) visits. The likelihood of mortality increased over twofold for each subsequent penetrating trauma visit (odds ratio [OR]; 95% confidence interval [CI]; 2.20 [1.63-2.97], p < 0.001). Individual recidivists with penetrating injuries are likely to return with the same injury pattern, and are at increased risk of death with each subsequent visit.

21. Impact of Adult Trauma Center Certification on Pediatric Emergency Trauma Visits

21. Impact of Adult Trauma Center Certification on Pediatric Emergency Trauma Visits

Putting RBRVS to Work

Putting RBRVS to Work

Abuse of pregnant adolescents: what have we learned?

Purpose: To evaluate 3 years’ experience with abused pregnant adolescents identified in a prenatal clinic population.Methods: Universal screening of all pregnant patients for relationship violence has been performed at the Prenatal Clinic of the Hospital of the University of Pennsylvania since April 1994. Chart review of all adolescent patients younger than the age of 18 years enrolled at our prenatal clinic between July 1995 and June 1998 was carried out to determine the current and lifetime exposure to interpersonal violence. All patients in the clinic population are low income; 90% are African American. We compared abused versus nonabused teens regarding number of antepartum clinic visits, incidence of trauma during pregnancy, sexually transmitted disease diagnosis during pregnancy, age of baby’s father, gestational age at time of delivery, birth weight, and attendance at the postpartum clinic appointment.Results: Lifetime incidence of interpersonal violence for pregnant adolescents at our center was 30%. Overall, 11% gave a history of relationship violence in the year preceding or during the pregnancy. Significant differences between abused and nonabused teens include: abused pregnant adolescents had more antepartum visits (11.0 versus 8.85), were more likely to present to the hospital for trauma visits during pregnancy (25% versus 5%), and were more likely to be diagnosed with a sexually transmitted disease during pregnancy (71% versus 43%).Conclusions: Abuse of pregnant adolescents is common and has serious medical implications. Identification of abuse during pregnancy can positively affect outcomes on several levels for both mother and baby.