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BACKGROUND: Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the childs environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic. METHODS: This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children

Introduction: The clinical model of screening, providing a brief psychosocial and/or pharmacological intervention, and directly referring patients to treatment (SBIRT) is a compelling model to address drug use among assault-injured individuals in the busy emergency department (ED) setting. Our objective in this study was to examine the current literature and determine ED-based strategies that have been reported that screen, directly refer to drug mis-use/addiction specialized treatment services, or initiate addiction treatment among individuals injured by non-partner assault in the United States. Methods: We conducted a systematic review of ED-based studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. OVID, MEDLINE, OVID Embase, OVID AMED, Web of Science-Core Collection, Cochrane CENTRAL, and CINAHL were systematically searched using keywords and Medical Subject Heading terms. Studies were excluded if they only involved intimate partner assault-injury, tobacco, or alcohol use. We categorized ED-based strategies as screening, direct referral, or treatment initiation.Results: Of the 2,076 non-duplicated studies identified, we included 26 full-text articles in the final analysis. Fourteen studies were cross-sectional, 11 were cohort, and one was case-control in design. The most common drug use screening instrument used was the National Institute on Drug Abuse Quick Screen Question. Cannabis was the most common drug detected upon screening.Conclusion: Drug use, while highly prevalent, is a modifiable risk factor for non-partner assault-injury. The paucity of scientific studies is evidence for the need to intentionally address this area that remains a major challenge for the public’s health. Future research is needed to evaluate ED-based interventions for drug use in this population.

BackgroundViolent injury is the second most common cause of death among 15- to 24-year olds in the US. Up to 58% of violently injured youth return to the hospital with a second violent injury. Hospital-based violence intervention programs (HVIPs) have been shown to reduce injury recidivism through intensive case management. However, no validated guidelines for risk assessment strategies in the HVIP setting have been reported. We aimed to use qualitative methods to investigate the key components of risk assessments employed by HVIP case managers and to propose a risk assessment model based on this qualitative analysis.Materials and methodsAn established academic hospital-affiliated HVIP served as the nexus for this research. Thematic saturation was reached with 11 semi-structured interviews and two focus groups conducted with HVIP case managers and key informants identified through snowball sampling. Interactions were analyzed by a four-member team using Nvivo 10, employing the constant comparison method. Risk factors identified were used to create a set of models presented in two follow-up HVIP case managers and leadership focus groups.ResultsEighteen key themes within seven domains (environment, identity, mental health, behavior, conflict, indicators of lower risk, and case management) and 141 potential risk factors for use in the risk assessment framework were identified. The most salient factors were incorporated into eight models that were presented to the HVIP case managers. A 29-item algorithmic structured professional judgment model was chosen.ConclusionsWe identified four tiers of risk factors for violent reinjury that were incorporated into a proposed risk assessment instrument, VRRAI.

This project explores the beliefs and perspectives of urban adults and youth regarding community violence prevention strategies and identifies points of overlap and differences of opinion that can contribute to the development of successful youth violence prevention programs. We coded transcript data from adults and 10-16-year-old youth from the same community. Research team members, including a community member research partner, created coding terms for theme development and summary statements. Adult and youth responses centered around three distinct themes: activities for youth, barriers to youth participation in activities, and ideal violence prevention strategies. When discussing community violence prevention strategies, adults and youth agreed on the importance of adult supervision, the need to improve safe transit to and egress from common sites of youth activities, and removing trash from the community. Healthcare and social service providers should take these methods and findings into consideration when counseling patients or clients.

Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs. [ABSTRACT FROM AUTHOR]