Background: The association of psychiatric disorders (PDs)-with other PDs and medical disorders (MDs) has been insufficiently explored in children and adolescents.Objectives: To estimate medical and psychiatric comorb...Background: The association of psychiatric disorders (PDs)-with other PDs and medical disorders (MDs) has been insufficiently explored in children and adolescents.Objectives: To estimate medical and psychiatric comorbidity present in children with PDs and to determine the medical service usage of children with PDs.Design: We use administrative health care data to describe the health care provided for study children.Psychiatric disorders were classified into the following 3 categories: psychosis, emotion, and behavior.We used logistic regression to assess medical comorbidity for each category.Psychiatric comorbidity was determined using χ2 test analysis.Health care use was determined by comparing the frequency of visits for MDs and PDs between children with PDs and children without PDs.Setting: We studied 406 640 children (50.6%male) between 6 and 17 years old, living in Alberta, Canada, during the fiscal year April 1, 1995, through March 31, 1996.Results: A PD was diagnosed in 32 214 (60.3%male) children.Psychiatric comorbidity was present in 13.6%of the children; comorbidity existed in all 3 psychiatric groups and peaked in postpubertal children.More girls than boys had significant medical comorbidity.Significant odds ratios (ORs)-for girls varied from 1.2 (behavior and sinusitis, bronchitis, and chronic disorders; psychosis, and menstrual problems) to 15.3 (behavior and developmental delay).Among boys, the highest OR was seen with the combination of behavior and developmental delay (OR, 8.3) and psychosis and poisoning (OR, 8.2).With ORs ranging from 4.6 to 15.3, developmental delay consistently had high ORs for both sexes and all 3 types of PDs.Poisoning also had high ORs (3.3-14.1)with all 3 PDs and both sexes.Among girls, disorders associated with pregnancy and the genitourinary system had modest associations (OR, 1.9-2.2, for behavior) to moderate (OR, 2.5-4.0, for emotion).Children with PDs had significantly greater medical service usage than did children without PDs.Girls had greater medical health care usage than boys.Psychiatric service usage was similar for both sexes.Conclusions: Medical and psychiatric comorbidity exist in children with PDs.Girls are more commonly affected.Health care usage is higher in children with PDs.展开更多
Objective.To describe the clinical features that distinguish accidental from abusive head injury in hospitalized children < 24 months of age.Methods.Prospective study of children < 24 months of age hospitalized ...Objective.To describe the clinical features that distinguish accidental from abusive head injury in hospitalized children < 24 months of age.Methods.Prospective study of children < 24 months of age hospitalized for head injury between August 1, 2000, and October 31, 2002.During hospitalization, children had computed tomographic scans of the brain, serial neurologic examinations, dilated ophthalmoscopic eye examinations, evaluation by a social worker, and, in some cases, a child abuse specialist.Outcome Measures.The main outcome measure was the proportion of children in each group with retinal hemorrhages (RHs).Secondary outcome measures were the proportion of children in each group who had vitreous hemorrhage; abnormal mental status on presentation; seizures; scalp hematomas; need for anticonvulsants; and operative pro-cedures such as subdural tap, craniotomy, ventriculostomy, tracheostomy, and gastrostomy.Results.Eighty-seven children were prospectively enrolled.Fifteen children were classified as having abusive head injury, and 72 were classified as having accidental head injury.Five children, all in the accidental head injury group, were excluded from statistical analysis, because they did not have a dilated ophthalmoscopic examination during their hospitalization.Thus 82 children were included in the statistical analysis.There were no significant differences between the 2 groups with respect to mean age, gender, or ethnicity.RHs were more likely to be seen in children with abusive head injury (60%vs 10%) and were more likely to be bilateral (40%vs 1.5%).Pre-RHs were more likely to be seen in children with abusive head injury (30%vs 0%).Premacular RHs and RHs that extended to the periphery of the retina were alsomore likely to be seen in children with abusive head injury (20%vs 0%and 27%vs 0%, respectively).Of the 7 children with accidental head injury who had RHs, 6 had unilateral RHs.Children with abusive head injury were more likely to have seizures (53%vs 6%) and an abnormal mental status on initial presentation (53%vs 1%).Children with accidental head injury were more likely to have scalp hematomas (6.7%vs 49%).Conclusions.RHs are seen more often in abusive head injury and often are bilateral and involve the preretinal layer.Children with abusive head injury were more likely to have RHs that cover the macula and extend to the periphery of the retina.Unilateral RHs can be seen in children with accidental head injury.Children with abusive head injury were more likely to present with abnormal mental status and seizures, whereas children with accidental head injury were more likely to have scalp hematomas.Such characteristics may be useful to distinguish accidental from abusive head trauma in children < 24 months of age.展开更多
文摘Background: The association of psychiatric disorders (PDs)-with other PDs and medical disorders (MDs) has been insufficiently explored in children and adolescents.Objectives: To estimate medical and psychiatric comorbidity present in children with PDs and to determine the medical service usage of children with PDs.Design: We use administrative health care data to describe the health care provided for study children.Psychiatric disorders were classified into the following 3 categories: psychosis, emotion, and behavior.We used logistic regression to assess medical comorbidity for each category.Psychiatric comorbidity was determined using χ2 test analysis.Health care use was determined by comparing the frequency of visits for MDs and PDs between children with PDs and children without PDs.Setting: We studied 406 640 children (50.6%male) between 6 and 17 years old, living in Alberta, Canada, during the fiscal year April 1, 1995, through March 31, 1996.Results: A PD was diagnosed in 32 214 (60.3%male) children.Psychiatric comorbidity was present in 13.6%of the children; comorbidity existed in all 3 psychiatric groups and peaked in postpubertal children.More girls than boys had significant medical comorbidity.Significant odds ratios (ORs)-for girls varied from 1.2 (behavior and sinusitis, bronchitis, and chronic disorders; psychosis, and menstrual problems) to 15.3 (behavior and developmental delay).Among boys, the highest OR was seen with the combination of behavior and developmental delay (OR, 8.3) and psychosis and poisoning (OR, 8.2).With ORs ranging from 4.6 to 15.3, developmental delay consistently had high ORs for both sexes and all 3 types of PDs.Poisoning also had high ORs (3.3-14.1)with all 3 PDs and both sexes.Among girls, disorders associated with pregnancy and the genitourinary system had modest associations (OR, 1.9-2.2, for behavior) to moderate (OR, 2.5-4.0, for emotion).Children with PDs had significantly greater medical service usage than did children without PDs.Girls had greater medical health care usage than boys.Psychiatric service usage was similar for both sexes.Conclusions: Medical and psychiatric comorbidity exist in children with PDs.Girls are more commonly affected.Health care usage is higher in children with PDs.
文摘Objective.To describe the clinical features that distinguish accidental from abusive head injury in hospitalized children < 24 months of age.Methods.Prospective study of children < 24 months of age hospitalized for head injury between August 1, 2000, and October 31, 2002.During hospitalization, children had computed tomographic scans of the brain, serial neurologic examinations, dilated ophthalmoscopic eye examinations, evaluation by a social worker, and, in some cases, a child abuse specialist.Outcome Measures.The main outcome measure was the proportion of children in each group with retinal hemorrhages (RHs).Secondary outcome measures were the proportion of children in each group who had vitreous hemorrhage; abnormal mental status on presentation; seizures; scalp hematomas; need for anticonvulsants; and operative pro-cedures such as subdural tap, craniotomy, ventriculostomy, tracheostomy, and gastrostomy.Results.Eighty-seven children were prospectively enrolled.Fifteen children were classified as having abusive head injury, and 72 were classified as having accidental head injury.Five children, all in the accidental head injury group, were excluded from statistical analysis, because they did not have a dilated ophthalmoscopic examination during their hospitalization.Thus 82 children were included in the statistical analysis.There were no significant differences between the 2 groups with respect to mean age, gender, or ethnicity.RHs were more likely to be seen in children with abusive head injury (60%vs 10%) and were more likely to be bilateral (40%vs 1.5%).Pre-RHs were more likely to be seen in children with abusive head injury (30%vs 0%).Premacular RHs and RHs that extended to the periphery of the retina were alsomore likely to be seen in children with abusive head injury (20%vs 0%and 27%vs 0%, respectively).Of the 7 children with accidental head injury who had RHs, 6 had unilateral RHs.Children with abusive head injury were more likely to have seizures (53%vs 6%) and an abnormal mental status on initial presentation (53%vs 1%).Children with accidental head injury were more likely to have scalp hematomas (6.7%vs 49%).Conclusions.RHs are seen more often in abusive head injury and often are bilateral and involve the preretinal layer.Children with abusive head injury were more likely to have RHs that cover the macula and extend to the periphery of the retina.Unilateral RHs can be seen in children with accidental head injury.Children with abusive head injury were more likely to present with abnormal mental status and seizures, whereas children with accidental head injury were more likely to have scalp hematomas.Such characteristics may be useful to distinguish accidental from abusive head trauma in children < 24 months of age.
