Post-injury Outcomes of Children with Behavioral Health Disorders

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 to 2016 using the Pediatric Trauma Qual-ity 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 suf-fered intentional and penetrating injury. 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 in-hospital mortality risk after traumatic injury de-spite more severe injury upon presentation. Intentional and penetrating injuries are particularly concern -ing, and future work should assess prevention effort s in this vulnerable group. (c) 2021 Elsevier Inc. All rights reserved.