意外枪击导致骨折的儿童患精神疾病和精神障碍的风险更高吗?倾向匹配研究。

IF 4.2 2区 医学 Q1 ORTHOPEDICS
Mehul M Mittal, Aaron Singh, Rishi Gonuguntla, David Momtaz, Pooya Hosseinzadeh
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引用次数: 0

摘要

背景:在美国,枪支暴力是导致儿童死亡的主要原因,也是儿童发病的主要原因。众所周知,枪伤(GSWs)除了对身体造成伤害外,还会造成持久的心理影响,但与对身体造成的影响相比,这些影响并没有得到很好的记录。我们的研究探讨了儿童意外枪伤相关骨折与后续精神状况之间的关联:与非 GSW 相关骨折相比,遭受 GSW 相关意外骨折的儿童患精神疾病和精神障碍的风险是否更高?本研究利用了 TriNetX 美国协作网络,因为该网络提供了全面的住院和门诊数据、纵向随访以及不同机构间的完整医疗记录,密切反映了骨科实践中患者的实际治疗效果。我们回顾性地评估了被诊断为与GSW相关的意外骨折的儿童,并将心理健康诊断结果与非GSW相关骨折的儿童进行了比较。据报道,在 2003 年 1 月 1 日至 2023 年 3 月 1 日期间,美国共有 5071 名儿童在没有焦虑、情绪、精神病、药物使用或失眠症的情况下发生了与 GSW 相关的意外骨折。在这些患者中,55%(2773 人)的随访时间至少为 1 年,符合暴露人群的纳入标准。在非 GSW 相关骨折队列中,1,613,891 名儿童中有 61% (985,070 人)在没有上述疾病的情况下接受了至少 1 年的随访,并符合纳入标准。采用贪婪近邻倾向得分匹配算法,每个队列中共有 2769 名儿童成功配对。匹配基于年龄、性别、种族、骨折位置和体重指数,因为通过回归分析发现这些特征可能与精神疾病结果有关(p < 0.01)。平均(± SD)年龄为 15 ± 4 岁,GSW 队列中有 16% (451 人)为女孩。在非 GSW 群体中,女孩占 17%(474 人)。在种族和民族方面,62%(GSW 队列中有 1709 人;非 GSW 队列中有 1679 人)为黑人,14%(GSW 队列中有 384 人;非 GSW 队列中有 386 人)为西班牙裔。相关结果记录在指数事件发生后长达 3 年的时间内:结果:与 GSW 相关的意外骨折队列出现焦虑症(HR 3.8 [95% 置信区间 (CI) 3.2 至 4.6];P < 0.001)、药物使用障碍(HR 3.6 [95% CI 3.0至4.2];P < 0.001)、情绪障碍(HR 2.4 [95% CI 1.9至3.1];P < 0.001)、非情绪性精神障碍(HR 2.4 [95% CI 1.5至3.9];P < 0.001)和失眠(HR 1.8 [95% CI 1.4至2.3];P < 0.001):矫形外科医生应为枪击相关骨折患儿实施早期精神疾病筛查并整合心理健康支持,以应对焦虑症、精神疾病、情绪障碍、药物滥用和失眠症的高风险。未来的研究应侧重于确定可减轻这些长期心理后果的有效干预措施,重点是临床护理中实用的、有针对性的方法:证据等级:三级,预后研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Do Children With Accidental Gunshot-related Fractures Experience Greater Risk of Mental Illness and Psychiatric Disorders? A Propensity-matched Study.

Background: Firearm violence is the leading cause of death and is a major source of morbidity for children in the United States. While gunshot wounds (GSWs) are known to cause lasting psychological repercussions beyond physical injury, these effects are not well documented compared with the physical implications. Our study explores the association between accidental gunshot-related fractures in children and subsequent psychiatric outcomes.

Question/purpose: Relative to non-GSW-related fractures, do children sustaining an accidental GSW-related fracture experience higher risk of mental illness and psychiatric disorders?

Methods: This study utilized the TriNetX US Collaborative Network as it provides comprehensive inpatient and outpatient data, longitudinal follow-up, and complete medical records across different facilities, closely reflecting real-world patient outcomes in orthopaedic practice. We retrospectively evaluated children diagnosed with an accidental GSW-related fracture and compared mental health diagnoses to children who experienced non-GSW-related fractures. Between January 1, 2003, and March 1, 2023, a total of 5071 children in the United States without preexisting anxiety, mood, psychotic, substance use, or insomnia disorders were reported to have experienced an accidental GSW-related fracture. Among these patients, 55% (2773) had a follow-up period of at least 1 year and met the inclusion criteria for the exposure cohort. In the non-GSW-related fracture cohort, a total of 61% (985,070) of children among 1,613,891 without the preexisting aforementioned conditions had a minimum follow-up period of 1 year and met the inclusion criteria. A total of 2769 children were successfully matched in each cohort using a greedy nearest neighbor propensity score-matching algorithm. Matching was based on age, gender, race, fracture location, and BMI, as these characteristics were identified through a regression analysis as potentially associated with psychiatric outcomes (p < 0.01). The mean ± SD age was 15 ± 4 years, and 16% (451) in the GSW cohort were girls. In the non-GSW cohort 17% (474) were girls. With respect to race and ethnicity, 62% (1709 in the GSW cohort; 1679 in the non-GSW cohort) were Black and 14% (384 in the GSW cohort; 386 in the non-GSW cohort) were Hispanic. Outcomes of interest were recorded for up to 3 years after the index event.

Results: The accidental GSW-related fracture cohort experienced a greater hazard of developing anxiety disorders (HR 3.8 [95% confidence interval (CI) 3.2 to 4.6]; p < 0.001), substance use disorders (HR 3.6 [95% CI 3.0 to 4.2]; p < 0.001), mood disorders (HR 2.4 [95% CI 1.9 to 3.1]; p < 0.001), non-mood psychotic disorders (HR 2.4 [95% CI 1.5 to 3.9]; p < 0.001), and insomnia (HR 1.8 [95% CI 1.4 to 2.3]; p < 0.001).

Conclusion: Orthopaedic surgeons should implement early psychiatric screenings and integrate mental health support for children with gunshot-related fractures to address elevated risk of anxiety disorders, psychotic disorders, mood disorders, substance abuse, and insomnia. Future studies should focus on identifying effective interventions that mitigate these long-term psychological outcomes, with an emphasis on practical, targeted approaches in clinical care.

Level of evidence: Level III, prognostic study.

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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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