Ten-year research review of physical injuries

Objective: To review the past 10 years of research relevant to psychiatry o n injuries in children and adolescents. Method: A literature search of data bases for "wounds and injuries, excluding head injuries," was done with Med line and PsycINFO, yielding 589 and 299 citations, respectively. Further se arching identified additional studies. Results: Progress is occurring in pr evention, pain management, acute care, psychiatric treatment, and outcomes, The emotional and behavioral effects of injuries contribute to morbidity a nd mortality. Psychiatric assessment, crisis intervention, psychotherapy, p sychopharmacological treatment, and interventions for families are now prio rities. Research offers new interventions for pain, delirium, posttraumatic stress disorder, depression, prior maltreatment, substance abuse, disrupti ve behavior, and end-of-life care. High-risk subgroups are infants, adolesc ents, maltreated children, suicide attempters, and substance abusers. Staff training improves quality of care and reduces staff stress. Conclusions: D espite the high priority that injuries receive in pediatric research and tr eatment, psychiatric aspects are neglected. There is a need for assessment and for planning of psychotherapeutic, psychopharmacological, and multimoda l treatments, based on severity of injury, comorbid psychopathology, bodily location(s), and prognosis. Psychiatric collaboration with emergency, trau ma, and rehabilitation teams enhances medical care. Research should focus o n alleviating pain, early psychiatric case identification, and treatment of children, adolescents, and their families, to prevent further injuries and reduce disability.