Browsing by Author "Vetor, Ashley N."

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    Assessing outpatient follow-up care compliance, complications, and sequelae in children hospitalized for isolated traumatic abdominal injuries
    (Elsevier, 2018-10-05) Ogbemudia, Blessing; Raymond, Jodi; Hatcher, LaRanna S.; Vetor, Ashley N.; Rouse, Thomas; Carroll, Aaron E.; Bell, Teresa M.; Medicine, School of Medicine
    Background: Currently there is limited knowledge on compliance with follow-up care in pediatric patients after abdominal trauma. The Indiana Network for Patient Care (INPC) is a large regional health information exchange with both structured clinical data (e.g., diagnosis codes) and unstructured data (e.g., provider notes). The objective of this study is to determine if regional health information exchanges can be used to evaluate whether patients receive all follow-up care recommended by providers. Methods: We identified 61 patients treated at a Pediatric Level I Trauma Center who were admitted for isolated abdominal injuries. We analyzed medical records for two years following initial hospital discharge for injury using the INPC. The encounters were classified by the type of encounter: outpatient, emergency department, unplanned readmission, surgery, imaging studies, and inpatient admission; then further categorized into injury and non-injury related care, based on provider notes. We determined compliance with follow-up care instructions given at discharge and subsequent outpatient visits, as well as the prevalence of complications and sequelae. Results: After reviewing patient records, we found that 78.7% of patients received all recommended follow-up care, 6.6% received partial follow-up care, and 11.5% did not receive follow-up care. We found that 4.9% of patients developed complications after abdominal trauma and 9.8% developed sequelae in the two years following their initial hospitalization. Conclusions: Our findings suggest that health information exchanges such as the INPC are useful in evaluation of follow-up care compliance and prevalence of complications/sequelae after abdominal trauma in pediatric patients. Level of Evidence: Level IV
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    National Instant Criminal Background Check and Youth Gun Carrying
    (American Academy of Pediatrics, 2020-01) Timsina, Lava R.; Qiao, Nan; Mongalo, Alejandro C.; Vetor, Ashley N.; Carroll, Aaron E.; Bell, Teresa M.; Economics, School of Liberal Arts
    Background: Despite being unable to purchase firearms directly, many adolescents have access to guns, leading to increased risk of injury and death. We sought to determine if the National Instant Criminal Background Check System (NICS) changed adolescents' gun-carrying behavior. Methods: We performed a repeated cross-sectional study using National Youth Risk Behavior Survey data from years 1993 to 2017. We used a survey-weighted multivariable logistic regression model to determine if the NICS had an effect on adolescent gun carrying, controlling for state respondent characteristics, state laws, state characteristics, the interaction between the NICS and state gun laws, and time. Results: On average, 5.8% of the cohort reported carrying a gun. Approximately 17% of respondents who carried guns were from states with a universal background check (U/BC) provision at the point of sale, whereas 83% were from states that did not have such laws (P < .001). The model indicated that the NICS together with U/BCs significantly reduced gun carrying by 25% (adjusted relative risk = 0.75 [95% confidence interval: 0.566-0.995]; P = .046), whereas the NICS independently did not (P = .516). Conclusions: Adolescents in states that require U/BCs on all prospective gun buyers are less likely to carry guns compared with those in states that only require background checks on sales through federally licensed firearms dealers. The NICS was only effective in reducing adolescent gun carrying in the presence of state laws requiring U/BCs on all prospective gun buyers. However, state U/BC laws had no effect on adolescent gun carrying until after the NICS was implemented.
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    Prevalence and Treatment of Depression and Posttraumatic Stress Disorder among Trauma Patients with Non-neurological Injuries
    (Wolters Kluwer, 2018-05) Bell, Teresa; Vetor, Ashley N.; Zarzaur, Ben L.; Surgery, School of Medicine
    Background Psychological impairment among injury survivors is well documented. Little is known about the prevalence of treatment of psychological impairment, however. We aimed to determine the proportion of injury survivors treated for depression and post-traumatic stress disorder (PTSD) in the year after injury as well as to determine potential barriers to treatment. Methods Adults (18 and over) admitted to a Level I trauma center with an injury severity score (ISS) greater than 10, but without traumatic brain injury or spinal cord injury were eligible for study inclusion. The Center for Epidemiological Studies-Depression (CES-D) and PTSD CheckList – Civilian Versions (PCL-C) surveys were administered during the initial hospitalization and repeated at 1, 2, 4, and 12 months after injury. Patients were asked if they received treatment specifically for depression or PTSD at each follow-up. Factors associated with treatment were determined using multivariable logistic regression analysis. Results 500 injury survivors were enrolled in this prospective observational study. Of those, 68.4% of patients screened positive for depression at some point in the year after their injury (53.3% 1 month, 49.9% 2 month, 49.0% 4 month, and 50.2% 12 month). Only 22.2% of depressed patients reported receiving treatment for depression. 44.4% of patients screened positive for PTSD (26.6% 1 month, 27.8% 2 month, 29.8% 4 month, and 30.0% 12 month), but only 9.8% received treatment for PTSD. After adjusting for other factors, compared to commercial insurance status, self-pay insurance status was negatively associated with treatment for PTSD or depression (OR 0.44, 95% CI 0.21-0.95). Conclusion Depression and PTSD are common in non-neurotrauma patients in the year following injury. Greater collaboration between those caring for injury survivors and behavioral health experts may help improve psychological outcomes after injury.