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Suicide in Elementary School-Aged Children and Early Adolescents
The Journal of Emergency Medicine, Vol. 52, No. 1, pp. 125–130, 2017 0736-4679/$ - see front matter
Abstracts , GLASGOW COMA SCALE SCORE IN SURVIVORS OF EXPLOSION WITH POSSIBLE TRAUMATIC BRAIN INJURY IN NEED OF NEUROSURGICAL INTERVENTION. Ashkenazi I, Schecter WP, Peleg K, et al, JAMA Surgery. 2016;151:954-958 The purpose of this study was to determine whether the Glasgow Coma Scale (GCS) at presentation can identify survivors of explosion injury who have traumatic brain injuries (TBI) that would benefit from neurosurgical intervention. This is a retrospective cohort study from the Israel National Trauma Registry. One thousand eighty one survivors of terrorist bombings between 1998 and 2005 were included in the study. Data collected included initial GCS, vital signs and injuries sustained from the blast. The Barell matrix was used to classify severe and mild TBI. The need for neurosurgical operation was defined as need for intracranial pressure monitoring or craniotomy. Analysis was performed using Fisher exact probability test. Severe TBI was diagnosed in 48 of 877 (5%) of patients with a GCS of 15 with 9 (1%) needing neurosurgical operation. Of the patients with GCS 3-14, 99 of 171 patients had severe TBI (58%) with fewer than 51 (30%) needing neurosurgical intervention. However 38% of people with abnormal GCS scores had no head injury and there was no difference in the need for neurosurgical procedures in patients with GCS 3-8 compared to GCS 9-14 (30% versus 27%; p=0.83). The authors conclude that GCS early after injury is inadequate to identify TBI patients in need of neurosurgical intervention. They suggest additional research is indicated to identify screening tools that can be used to successfully identify TBI patients early after injury in need of neurosurgical intervention. [Patricia Michelle Troxell Klingenbjerg, MD Denver Health Medical Center, Denver, CO]
regarding suicide has been conducted among adolescents. This study aimed to determine whether the individual characteristics and provoking factors among elementary school children are the same as their adolescent counterparts. This study was a retrospective, cross-sectional study using the National Violent Death Reporting System (NVDSRS) from 2003-2012 which included 693 decedents aged 5-14 from 17 US states. Elementary school students ages 5-11 years were compared to adolescents ages 12-14 years and distinctions were made between black and non-black decedents. Variables assessed between these groups include suicide method, precipitating circumstances, toxicology findings, history of mental illness, substance abuse and time/place of injury. Comparisons were made using c2 analysis and Fisher’s exact test. Between 2003 and 2012 there were 87 suicides among children ages 5-11 years and 606 suicides among adolescents ages 12-14 years. One third of all decedents had a history of mental illness, however Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) was more common than depression in elementary aged children (59.3% versus 29.0%; p=0.0002) and depression/dysthymia was more common than ADD/ADHD in adolescents (65.5% versus 33.3%; p=0.0001). Between 2003 and 2012, 36.1% of elementary suicides were in black children compared to 18.6% between 1993 and 2002. This study concludes that elementary aged children who died by suicide were more likely to be black males who died by strangulation in their home following an argument with friends/family without leaving a suicide note. Of the decedents with prior history of mental illness, ADD/ADHD was more common than depression among elementary students. This differs from adolescents who are more likely to exhibit depressive symptoms and commit suicide after arguments with boyfriends/ girlfriends. There were no significant differences found between individual characteristics of black and non-black decedents. [Patricia Michelle Troxell Klingenbjerg, MD Denver Health Medical Center, Denver, CO]
Comment: Screening tools that will facilitate early recognition of TBI patients who would benefit from neurosurgical intervention are especially important particularly in resource poor and remote areas. Additional investigation into tools that can be rapidly applied at the bedside to TBI patients to expedite transfer to trauma centers to facilitate neurosurgical intervention may help improve TBI outcomes.
Comment: This study draws attention to a group of youth who may be at higher risk for suicide and may benefit from targeted prevention strategies. Healthcare providers who care for elementary school students with ADD/ADHD as well as black youth need to be aware of the rise in suicide rates and careful screening of these at-risk patients is indicated.
, SUICIDE IN ELEMENTARY SCHOOL-AGED CHILDREN AND EARLY ADOLESCENTS. Sheftall AH, Asti L, Horowitz LM, et al. Pediatrics. 2016;138(4):e20160436 Suicide is ranked tenth as cause of death among elementary school students. The rate of suicide is increasing among black elementary school children; however, the majority of research
, RISK FACTORS FOR SLEEP-RELATED INFANT DEATHS IN IN-HOME AND OUT-OFHOME SETTINGS. Kassa H, Moon RY, Colvin JD. Pediatrics. 2016;138(5):e20161124 125
Abstracts , GLASGOW COMA SCALE SCORE IN SURVIVORS OF EXPLOSION WITH POSSIBLE TRAUMATIC BRAIN INJURY IN NEED OF NEUROSURGICAL INTERVENTION. Ashkenazi I, Schecter WP, Peleg K, et al, JAMA Surgery. 2016;151:954-958 The purpose of this study was to determine whether the Glasgow Coma Scale (GCS) at presentation can identify survivors of explosion injury who have traumatic brain injuries (TBI) that would benefit from neurosurgical intervention. This is a retrospective cohort study from the Israel National Trauma Registry. One thousand eighty one survivors of terrorist bombings between 1998 and 2005 were included in the study. Data collected included initial GCS, vital signs and injuries sustained from the blast. The Barell matrix was used to classify severe and mild TBI. The need for neurosurgical operation was defined as need for intracranial pressure monitoring or craniotomy. Analysis was performed using Fisher exact probability test. Severe TBI was diagnosed in 48 of 877 (5%) of patients with a GCS of 15 with 9 (1%) needing neurosurgical operation. Of the patients with GCS 3-14, 99 of 171 patients had severe TBI (58%) with fewer than 51 (30%) needing neurosurgical intervention. However 38% of people with abnormal GCS scores had no head injury and there was no difference in the need for neurosurgical procedures in patients with GCS 3-8 compared to GCS 9-14 (30% versus 27%; p=0.83). The authors conclude that GCS early after injury is inadequate to identify TBI patients in need of neurosurgical intervention. They suggest additional research is indicated to identify screening tools that can be used to successfully identify TBI patients early after injury in need of neurosurgical intervention. [Patricia Michelle Troxell Klingenbjerg, MD Denver Health Medical Center, Denver, CO]
regarding suicide has been conducted among adolescents. This study aimed to determine whether the individual characteristics and provoking factors among elementary school children are the same as their adolescent counterparts. This study was a retrospective, cross-sectional study using the National Violent Death Reporting System (NVDSRS) from 2003-2012 which included 693 decedents aged 5-14 from 17 US states. Elementary school students ages 5-11 years were compared to adolescents ages 12-14 years and distinctions were made between black and non-black decedents. Variables assessed between these groups include suicide method, precipitating circumstances, toxicology findings, history of mental illness, substance abuse and time/place of injury. Comparisons were made using c2 analysis and Fisher’s exact test. Between 2003 and 2012 there were 87 suicides among children ages 5-11 years and 606 suicides among adolescents ages 12-14 years. One third of all decedents had a history of mental illness, however Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) was more common than depression in elementary aged children (59.3% versus 29.0%; p=0.0002) and depression/dysthymia was more common than ADD/ADHD in adolescents (65.5% versus 33.3%; p=0.0001). Between 2003 and 2012, 36.1% of elementary suicides were in black children compared to 18.6% between 1993 and 2002. This study concludes that elementary aged children who died by suicide were more likely to be black males who died by strangulation in their home following an argument with friends/family without leaving a suicide note. Of the decedents with prior history of mental illness, ADD/ADHD was more common than depression among elementary students. This differs from adolescents who are more likely to exhibit depressive symptoms and commit suicide after arguments with boyfriends/ girlfriends. There were no significant differences found between individual characteristics of black and non-black decedents. [Patricia Michelle Troxell Klingenbjerg, MD Denver Health Medical Center, Denver, CO]
Comment: Screening tools that will facilitate early recognition of TBI patients who would benefit from neurosurgical intervention are especially important particularly in resource poor and remote areas. Additional investigation into tools that can be rapidly applied at the bedside to TBI patients to expedite transfer to trauma centers to facilitate neurosurgical intervention may help improve TBI outcomes.
Comment: This study draws attention to a group of youth who may be at higher risk for suicide and may benefit from targeted prevention strategies. Healthcare providers who care for elementary school students with ADD/ADHD as well as black youth need to be aware of the rise in suicide rates and careful screening of these at-risk patients is indicated.
, SUICIDE IN ELEMENTARY SCHOOL-AGED CHILDREN AND EARLY ADOLESCENTS. Sheftall AH, Asti L, Horowitz LM, et al. Pediatrics. 2016;138(4):e20160436 Suicide is ranked tenth as cause of death among elementary school students. The rate of suicide is increasing among black elementary school children; however, the majority of research
, RISK FACTORS FOR SLEEP-RELATED INFANT DEATHS IN IN-HOME AND OUT-OFHOME SETTINGS. Kassa H, Moon RY, Colvin JD. Pediatrics. 2016;138(5):e20161124 125