Katharina Holtkamp

Bio: Katharina Holtkamp is an academic researcher from University of Duisburg-Essen. The author has contributed to research in topics: Medicine & Pediatrics. The author has co-authored 1 publications.

Pediatric Intensive Care Unit Admissions After Adolescent Suicide Attempts During the Pandemic.

Abstract: BACKGROUND AND OBJECTIVES The worldwide SARS-CoV-2 virus pandemic challenges adolescents' mental health. The aim of this study was to compare the number of pediatric intensive care unit (PICU) admissions after suicide attempts during the first German lockdown and one year later during a second, prolonged lockdown with pre-pandemic years. METHODS A retrospective multicenter study was conducted among 27 German PICUs. Cases <18 years admitted to the PICU due to accidents or injuries between March 16th and May 31st of 2017-2021 were identified based on ICD-10 codes (German modification) and patient data entered into a database. This study is a subset analysis on suicide attempts in adolescents aged 12-17.9 years. The Federal Statistics Office was queried for data on fatal suicides, which were available only for 2020 in adolescents aged 10-17.9 years. RESULTS Total admissions and suicide attempts declined during the first lockdown in 2020 (standardized morbidity ratio (SMR) 0.74 (95% CI 0.58-0.92) and 0.69 (0.43-1.04), respectively) and increased in 2021 (2.14 (SMR 1.86-2.45) and 2.84 (2.29-3.49), respectively). Fatal suicide rates remained stable between 2017-2019 and 2020 (1.57 v. 1.48/100,000 adolescent years) with monthly numbers showing no clear trend during the course of 2020. CONCLUSIONS This study shows a strong increase in serious suicide attempts among adolescents during the course of the pandemic in Germany. More research is needed to understand the relation between pandemic prevention measures and suicidal ideation to help implement mental health support for adolescents.

Trends in accident-related admissions to pediatric intensive care units during the first COVID-19 lockdown in Germany

Abstract: ObjectiveTo compare the number of accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID-19 lockdown with previous years. To investigate if shifts in types of accidents or injuries occurred, especially regarding non-accidental injuries. DesignRetrospective observational multicenter study. Setting37 German PICUs. Patients1444 children and adolescents < 18 years admitted to German PICUs due to trauma or injuries during the first German lockdown period (16.3.-31.5.2020) and during the same periods of the years 2017-2019. InterventionsNone. Measurements and main resultsStandardized morbidity ratios (SMR) and 95% confidence intervals (CI) were calculated for the severity of disease, admission reasons, types of accidents, injury patterns, surgeries and procedures, and outcomes. Disease severity did not differ from previous years. We found an increase in ingestions (SMR 1.41 (CI 0.88 - 2.16)) and a decrease in aspirations (0.77 (0.41 - 1.32)) and burns (0.82 (0.59 - 1.12)). The total number of admissions for trauma remained constant, but traffic accidents (0.76 (0.56 - 1.01) and school/kindergarten accidents (0.25 (0.05 - 0.74) decreased. Household (1.32 (1.05 - 1.64)) and leisure accidents (1.32 (1.05 - 1.65)) increased. Injured structures did not change, but less neurosurgeries (0.69 (0.42 - 1.07)) and more visceral surgeries (2.00 (1.14 - 3.24)) were performed. Non-accidental non-suicidal injuries declined (0.85 (0.50 - 1.37)). Suicide attempts increased in adolescent boys (1.57 (0.58 - 3.42)), while there was a decrease in adolescent girls (0.86 (0.53 - 1.31)). ConclusionsOur study showed shifts in trauma types and associated surgeries during the lockdown period that are generally in line with current literature. The decreased number of non-accidental non-suicidal injuries we observed does not suggest a fundamental increase in severe child abuse during the lockdown period. The decrease in suicide attempts among adolescent girls confirms previous findings, while the increase among boys has not been described yet and deserves further investigation.

Impact of the First COVID Lockdown on Accident- and Injury-Related Pediatric Intensive Care Admissions in Germany—A Multicenter Study

Abstract: Children’s and adolescents’ lives drastically changed during COVID lockdowns worldwide. To compare accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID lockdown with previous years, we conducted a retrospective multicenter study among 37 PICUs (21.5% of German PICU capacities). A total of 1444 admissions after accidents or injuries during the first lockdown period and matched periods of 2017–2019 were reported and standardized morbidity ratios (SMR) were calculated. Total PICU admissions due to accidents/injuries declined from an average of 366 to 346 (SMR 0.95 (CI 0.85–1.05)). Admissions with trauma increased from 196 to 212 (1.07 (0.93–1.23). Traffic accidents and school/kindergarten accidents decreased (0.77 (0.57–1.02 and 0.26 (0.05–0.75)), whereas household and leisure accidents increased (1.33 (1.06–1.66) and 1.34 (1.06–1.67)). Less neurosurgeries and more visceral surgeries were performed (0.69 (0.38–1.16) and 2.09 (1.19–3.39)). Non-accidental non-suicidal injuries declined (0.73 (0.42–1.17)). Suicide attempts increased in adolescent boys (1.38 (0.51–3.02)), but decreased in adolescent girls (0.56 (0.32–0.79)). In summary, changed trauma mechanisms entailed different surgeries compared to previous years. We found no evidence for an increase in child abuse cases requiring intensive care. The increase in suicide attempts among boys demands investigation.

A comparison of pediatric inflammatory multisystem syndrome temporarily-associated with SARS-CoV-2 and Kawasaki disease

Abstract: The connection between Pediatric Inflammatory Multisystem Syndrome (PIMS) and Kawasaki Disease (KD) is not yet fully understood. Using the same national registry, clinical features and outcome of children hospitalized in Germany, and Innsbruck (Austria) were compared. Reported to the registry were 395 PIMS and 69 KD hospitalized patients. Patient age in PIMS cases was higher than in KD cases (median 7 [IQR 4-11] vs. 3 [IQR 1-4] years). A majority of both PIMS and KD patients were male and without comorbidities. PIMS patients more frequently presented with organ dysfunction, with the gastrointestinal (80%), cardiovascular (74%), and respiratory (52%) systems being most commonly affected. By contrast, KD patients more often displayed dermatological (99% vs. 68%) and mucosal changes (94% vs. 64%), plus cervical lymph node swelling (51% vs. 34%). Intensive care admission (48% vs. 19%), pulmonary support (32% vs. 10%), and use of inotropes/vasodilators (28% vs. 3%) were higher among PIMS cases. No patients died. Upon patient discharge, potentially irreversible sequelae-mainly cardiovascular-were reported (7% PIMS vs. 12% KD). Despite differences in age distribution and disease severity, PIMS and KD cases shared many common clinical and prognostic characteristics. This supports the hypothesis that the two entities represent a syndrome continuum.

The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review

Abstract: Background Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. Aims To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic. Method A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool. Results Fifty-one studies were included: 57% (29/51) were rated as ‘low’ quality, 31% (16/51) as ‘moderate’ and 12% (6/51) as ‘high-moderate’. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17–56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls. Conclusions Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.

Pediatric Suspected Suicides and Nonfatal Suicide Attempts Reported to United States Poison Control Centers Before and During the COVID-19 Pandemic

Abstract: This study investigated the characteristics and compared the trends of pediatric suspected suicide and nonfatal suicide attempts reported to United States (US) poison control centers (PCCs) before and during the first year of the COVID-19 pandemic. An interrupted time series analysis using an ARIMA model was conducted to evaluate the trends of suspected suicides and nonfatal suicide attempts among children 6–19 years old reported to the National Poison Data System during March 2020 through February 2021 (pandemic period) compared with March 2017 through February 2020 (pre-pandemic period). The annual number of cases of suspected suicides and nonfatal suicide attempts increased by 4.5% (6095/136,194) among children 6–19 years old during March 2020 through February 2021 compared with the average annual number during the previous three pre-pandemic years. There were 11,876 fewer cases than expected from March 2020 to February 2021, attributable to a decrease in cases during the initial three pandemic months. The average monthly and average daily number of suspected suicides and nonfatal suicide attempts among children 6–12 years old and 13–19 years old was higher during school months than non-school months and weekdays than weekends during both the pre-pandemic and pandemic periods. There was a greater than expected decrease in the number of suspected suicides and nonfatal suicide attempts among children 6–19 years old reported to US PCCs during the early pandemic months, followed by an increase in cases. Recognizing these patterns can help guide an appropriate public health response to similar future crises.