Intentional Hand Fractures Are Associated with Future Psychiatric Conditions in Youth.

BACKGROUND

Hand fractures are common among pediatric patients. The association between pediatric hand fractures and subsequent engagement with mental health and addictions (MHA) services remains unstudied. This study investigated the relationship between hand injury mechanisms and future presentation to MHA services.

METHODS

A retrospective cohort study was conducted off all patients presenting to a pediatric plastic surgery clinic from 2012 through 2017. Data collected included demographics, fracture mechanism and location, and subsequent presentation to MHA services. Stepwise logistic regression models were used to assess risk factors for future presentation to MHA services and diagnosis of psychiatric illness.

RESULTS

A total of 1184 patients presented with pediatric hand fractures. Most injuries were accidental (87.9%), with sports being the most common cause (52.4%). Intentional injuries accounted for 12.2% of cases, primarily due to punching a solid object (53.5%) or another individual (45.1%). Patients with intentional injuries were significantly older (14.1 versus 11.8 years; P < 0.001) and predominantly male (93.1% versus 66.2%; P < 0.001) compared with patients with accidental injuries. Overall, 12.2% of patients were assessed by MHA services, with a relative risk of 5.59 for those with intentional injuries. The most frequently diagnosed psychiatric illness was attention-deficit/hyperactivity disorder (56.7%). Intentional injury mechanism was significantly associated with a future diagnosis of attention-deficit/hyperactivity disorder ( P < 0.001), generalized anxiety disorder ( P = 0.022), major depressive disorder ( P = 0.012), or substance use disorder ( P < 0.001).

CONCLUSIONS

Intentional hand fractures in the pediatric population are strongly associated with future MHA services assessment. These findings support early screening and referral to MHA services when an intentional injury mechanism is identified.