The extent to which medically attended injuries complicate the clinical course of HIVinfected (HIV+) children is unknown. In a cohort of HIV+ children delivered from 1985 to 1990 and aged less than 60 months, we determined medically attended injuries per 100 child-years, Injury Severity Scores (ISS), and predictors of medically attended injuries by using New York State Medicaid claims from 1986 to 1992 linked to birth certificates. Injury rates and ISS were compared to those of a population of black, inner city children aged less than 60 months from emergency room records. HIV+ children had slightly more injuries (19.3 vs. 16.8/100 child-years) but similar ISS (2.4 vs. 2.3). Predictors of injuries in HIV+ children included younger maternal age (24/100 child-years, p=0.008) and delivery outside of New York City (29/100 child-years, p=0.02). Illicit drug use and alcohol use were associated with greater ISS while cocaine use was associated with a higher rate of possibly intentional injuries. Medically attended injuries affected one in five HIV+ children in our cohort annually, slightly more than the comparison population. Specific maternal and birth characteristics such as substance abuse and younger age at delivery may help target at-risk children.
Get full access to this article
View all access options for this article.
References
1.
1. Stefansdottir A, Mogensen B.Epidemiology of childhood injuries in Reykjavik 1974-1991. ScandJPrim Health Care. 1997;15:30-34.
2.
2. Bienefeld M, Pickett W, Carr PA. A descriptive study of childhood injuries in Kingston, Ontario, using data from a computerized injury surveillance system. ChronicDis Can. 1996;17:21-27.
3.
3. Addor V, Santos-Eggimann B.Population-based incidence of injuries among preschoolers. Eur J Pediatr. 1996;155:130-135.
4.
4. Kogan M, Overpeck M, Fingerhut L.Medically attended nonfatal injuries among preschool-age children: national estimates. AmJPrev Med. 1995; 11:99-104.
5.
5. Leland N, Garrard J, Smith D.Comparison of injuries to children with and without disabilities in a day-care center. J Dev Behav Pediatr. 1994; 15:402-408.
6.
6. Thomas PA, WeedonJ, Krasinski K, et al. Maternal predictors of perinatal human immunodeficiency virus transmission. Pediatr Infect Dis J. 1994; 13:489-495.
7.
7. Gofin R, Lison M, Morag C.Injuries in primary care practices. Arch Dis Child. 1993;68:223-226.
8.
8. Turner BJ, Markson LE, Hauck WW, et al. Prenatal care of HIV-infected women: analysis of a large New York State cohort. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;4:371-378.
9.
9. Green J, Arno PS. The 'Medicaidization' of AIDS: trends in the financing of HIV-related medical care. JAMA. 1990;264:1261-1266.
10.
10. Ray WA, Griffin MR. Use of Medicaid data for pharmacoepidemiology. AmJ EPidemiol. 1989;129:837-849.
11.
11. Fanning TR, Turner BJ, Cosler LE, et al. Quality of Medicaid data for HIV/AIDS research: examination of a statewide database. AIDS Pub PolJ. 1995;10:39-47.
12.
12. Fisher ES, Whaley FS, Krushat WM, et al. The accuracy of Medicare's hospital claims data: progress has been made but problems remain. AmJPublic Health. 1992;82:243-248.
13.
13. Hauck W, McKee L, Turner BJ. Twopart survival models applied to administrative data for determining rate of and predictors for maternal-child transmission of HIV. Stat Med. 1997;16:1683-1694.
14.
14. Centers for Disease Control and Prevention. 1994 Revised classification system for human immunodeficiency virus (HIV) infection in children less than 13 years of age. MMWR1994;43: 1-19.
15.
15. Centers for Disease Control and Prevention. Classification system for human immunodeficiency virus (HIV) infection in children under 13 years of age. MMWR1987;36:25-35.
16.
16. Turner BJ, Denison M, Eppes SC, et al. Survival experience of 789 children with the acquired immunodeficiency syndrome. Pediatr Infect Dis J. 1993;12:310-320.
17.
17. Turner BJ, Markson LE, Taroni F.Estimation of survival after AIDS diagnosis: CD4 T-lymphocyte count versus clinical severity. J Clin Epidemiol. 1996;49:59-65.
18.
18. Kessner DM. Infant Death: An Analysis by Maternal Risk and Health Care. Washington, DC: National Academy Press; 1973.
19.
19. Miller TR, Lestina DC. Patterns in U.S. medical expenditures and utilization for injury, 1987. Am JPublic Health. 1996;86:89-93.
20.
20. Smith G, Langlois JA, Buechner JS. Methodological issues in using hospital discharge data to determine the incidence of hospitalized injuries. AmJ Epidemiol. 1991;134:1146-1158.
21.
21. Baker SP, O'Neill B, Haddon WJr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187-198.
22.
22. MacKenzie EJ, Steinwachs DM, Shankar BS. Classifying trauma severity based on hospital discharge diagnoses: validation of an ICD-9-CM to AIS-85 conversion table. Med Care. 1989;27:412-422.
23.
23. Copes WS, Champion HR, Sacco WIJ, et al. Progress in characterizing injury. J Trauma. 1990;30:1200-1207.
24.
24. Schwarz DF, Grisso JA, Miles CG, et al. A longitudinal study of injury morbidity in an African-American population.JAMA. 1994;271:755-760.
25.
25. Efron B.Better bootstrap confidence intervals (with discussion). J Am Stat Assoc. 1987;82:171-200.
26.
26. Turner BJ, Eppes S, McKee L, et al. A population-based comparison of the clinical course of children and adults with AIDS. AIDS. 1995;9:65-72.
27.
27. Blanche S, Newell ML, Mayaux MJ, et al. Morbidity and mortality in European children vertically infected by HIV-1. The French Pediatric HIV Infection Study Group and European Collaborative Study. J Acquir Immune Defic Syndr Hum Retrovirol. 1997; 14:442-450.
28.
28. Diaz C, Hanson C, Cooper ER, et al. Disease progression in a cohort of infants with vertically acquired HIV infection observed from birth: the Women and Infants Transmission Study (WITS). J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18:221-228.
29.
29. Bussing R, Menvielle E, Zima B.Relationship between behavioral problems and unintentional injuries in US children. Findings of the 1988 National Health Interview Survey. Arch Pediatr Adolesc Med. 1996;150:50-56.
30.
30. Aagran PF, Winn DG, Anderson CL, Del Valle CP. Pediatric injury hospitalization in Hispanic children and nonHispanic white children in southern California. Arch Pediatr Adolesc Med. 1996;150:400-406.
31.
31. Turner BJ, Eppes SC, Markson LE, et al. Health care of children and adults with acquired immunodeficiency syndrome. Arch PediatrAdolesc Med. 1996; 150:615-622.
32.
32. Rogers ME, Caldwell MB, Gwinn ML, Simonds RJ. Epidemiology of pediatric human immunodeficiency virus infection in the United States. Acta Paediatrica. 1994;7(Suppl 5):400-400.
33.
33. Moran K.The abused child: recognizing common patterns of nonaccidental injury. Aust Fam Physician. 1994;23: 1894-1895, 1897-1898, 1901-1901.
34.
34. Cooper A, Barlow B, Davidson L, et al. Epidemiology of pediatric trauma: importance of population-based statistics. J Pediatr Surg. 1992;27:149-153.
35.
35. Turner BJ, McKee L, Silverman NS, et al. Prenatal care and birth outcomes of a cohort of HIVinfected women. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;12:259-267.
36.
36. Wilson LM, Reid AJ, Midmer DK, et al. Antenatal psychosocial risk factors associated with adverse postpartum family outcomes. Can Med AssocJ. 1996;154:785-799.
37.
37. Wasserman DR, Leventhal JM. Maltreatment of children born to cocaine-dependent mothers. Am J Dis Child. 1993;147:1324-1328.
38.
38. Jaudes PK, Ekwo E, Van VoorhisJ. Association of drug abuse and child abuse. Child Abuse Negl. 1995;19:1065-1075.
39.
39. Boyce MC, Melhorn KJ, Vargo G.Pediatric trauma documentation. Adequacy for assessment of child abuse. Arch PediatrAdolesc Med. 1996;150:730-732.
40.
40. Turner BJ, Hauck WW, Fanning TR, Markson LE. Cigarette smoking and maternal-child HIV transmission. JAcquirImmune Defic Syndr Hum Retrovirol. 1997;14:327-337.
41.
41. Matheson PB, Abrams EJ, Thomas PA, et al. Efficacy of antenatal zidovudine in reducing perinatal transmission of human immunodeficiency virus type 1.JInfectDis. 1995;172:353-358.
42.
42. Rosenblum L, Buehler JW, Morgan MW, et al. HIV infection in hospitalized patients and Medicaid enrollees: the accuracy of medical record coding. Am J Public Health. 1993;83:1457-1459.
43.
43. Galli L, DeMartino M, Tovo P-A, et al. Onset of clinical signs in children with HIV-1 perinatal infection. AIDS. 1995;9:455-461.
44.
44. Benedict M, Zuravin S, Brandt D, Abbey H.Types and frequency of child maltreatment by family foster care providers in an urban population. Child Abuse Neglect. 1994;18:577-585.
45.
45. Benedict M, Zuravin S, Somerfield M, Brandt D.The reported health and functioning of children maltreated while in family foster care. Child Abuse Neglect. 1996;20:561-571.
46.
46. Clamp M, Kendrick D.A randomized controlled trial of general practitioner safety advice for families with children under 5 years. Br MedJ. 1998;316:1576-1579.
47.
47. Davidson LL, Durkin MS, Kuhn L, et al. The impact of the Safe Kids/ Health Neighborhoods Injury Prevention Program in Harlem, 1988 through 1991. Am J Public Health. 1994:84:580-586.
