ABSTRACT
Objectives: Substance use (SU) in minors has become an increasing public concern over the past decade. We hypothesized that SU would increase over time, particularly affecting minors with a history of trauma, suicide attempt, or violence. Method(s): Variables (such as sociodemographics, psychiatric treatment, urine toxicology report, and self-report of substance use) were extracted from the charts of all unique child and adolescent patients admitted to a 17-bed metropolitan inpatient psychiatry unit between June 2018 and November 2021. Statistical analyses included descriptive statistics, chi2 tests, independent t tests, Pearson correlations, and logistic regression. Result(s): Of the 1101 patients admitted, 30% (n = 330) were found to have SU by positive urine toxicology (n = 147) or self-report. Patients with SU were older than those without use (mean age 15.4 vs 13.4 years;p <.001). Significant racial differences were found, with White participants making up 21.8% of the SU population but only 14.1% of the non-SU group (p <.01), and Asian participants making up only 1.2% of the SU group (vs 4.2% without;p <.01). SU patients were more likely to have a history of self-harm (nonsuicidal self-injurious behavior [NSSIB]) or suicide attempt (NSSIB: 64.8% vs 52.%, p <.001;suicide attempt: 41.5% vs 25.7%, p <.001). Patients with SU were less likely to be admitted for aggression (14.5% vs 22.8%;p <.01) and more likely to be admitted for mania (2.4% vs 0.8%;p =.03). Positive predictors of SU were older age (OR = 1.41;95% CI, 1.15-1.72;p <.001), White race (OR = 1.98;95% CI, 1.19-3.29;p <.01), history of an impulsive/behavioral disorder (OR = 1.69;95% CI, 1.03-2.79;p <.04), history of suicide attempt (OR = 1.44;95% CI, 1.04-2.00;p =.03), history of violence (OR = 1.86;95% CI, 1.26-2.75;p <.01), and history of Administration of Children's Services (ACS)/Child Protective Services (CPS) involvement (OR = 1.45;95% CI, 1.03-2.03;p =.03). Gender, other races, history of other diagnoses, trauma history, or history of NSSIB were not found to be significant predictors. Conclusion(s): Our findings are consistent with emerging literature that SU in minors has had a slow increase in the COVID-19 era, particularly seen among White patients, patients of older age, and patients with a history of NSSIB or suicide attempt. While some of our analyses did control for potential confounding factors (logistic regression), further analyses are required to formulate a preventative plan for SU in youth. SUD, ICP, ALC Copyright © 2022
ABSTRACT
SESSION TITLE: Variety in Chest Infections Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Viruses are thought to trigger acute exacerbation of interstitial lung disease (AE-ILD) [1]. AE-ILD results in significant morbidity and mortality [1]. We report a case of AE-ILD due to non-SARS CoV2 viral infection in the era of the COVID-19 pandemic. CASE PRESENTATION: A 61 year-old African-American male with a history of hypertension, diabetes mellitus, and smoking crack cocaine presented with acute onset of dyspnea, fever, and worsening of his chronic cough. He was diagnosed with ILD suspected to be idiopathic pulmonary fibrosis (IPF) 9 months prior to hospitalization and needed 3 L supplemental oxygen at baseline. He had received 3 doses of COVID-19 vaccination. He was tachycardic, tachypneic, hypoxemic and arrived on a non-rebreather mask to the ED. Physical examination revealed bilateral coarse inspiratory crackles. Laboratory workup revealed leukocytosis, neutrophilia, and lymphopenia. Procalcitonin, lactic acid, BNP, and troponin were normal. CXR showed significantly increased bilateral interstitial markings compared to prior imaging. The patient was not stable for a chest CT. Respiratory pathogen panel was negative for SARS-CoV2, but positive for Coronavirus OC43. Sputum culture grew normal respiratory flora. He continued to have increased work of breathing and was placed on NIV support. He received methylprednisolone, bronchodilators, and ceftriaxone with azithromycin. Antibiotics were discontinued after negative sputum cultures. The patient continued to worsen despite supportive care, he wished to transition the goals of care to comfort only. He was transitioned to hospice care and died within 24 hours. DISCUSSION: Viruses are identified in 10-20% of cases of AE-ILD, in which the virus may be acting as an extrinsic trigger [2]. Efficacious antiviral agents are lacking. Currently, there are no strong evidence based guidelines for the treatment of AE-ILD. Corticosteroids are empirically used to manage exacerbation, however response is variable and particularly worse in the IPF variant of ILD [3]. An effort should be made to identify a treatable infectious etiology in all cases of AE-ILD with any worsening symptoms. Our case highlights that the "common cold” may have fatal consequences for at-risk patients. Care for patients with AE-ILD often goes beyond medications and should encompass emotional and family support. CONCLUSIONS: Hand hygiene and mask wearing are beneficial for ILD patients, in addition to pneumococcal, COVID-19, and influenza vaccinations. In patients with IPF, antifibrotics may help prevent exacerbations [2]. There remains a need for clinical trials to aid in establishing efficacious treatment in AE-ILD. Reference #1: Charokopos A, Moua T, Ryu JH, Smischney NJ. Acute exacerbation of interstitial lung disease in the intensive care unit. World J Crit Care Med 2022;11(1): 22-32 [DOI: 10.5492/wjccm.v11.i1.22] Reference #2: Kreuter M, Polke M, Walsh SLF, et al. Acute exacerbation of idiopathic pulmonary fibrosis: international survey and call for harmonisation. Eur Respir J 2020;55: 1901760 [https://doi.org/ 10.1183/13993003.01760-2019 Reference #3: Jang HJ, Yong SH, Leem AY, et al. Corticosteroid responsiveness in patients with acute exacerbation of interstitial lung disease admitted to the emergency department. Sci Rep. 2021;11(1):5762. Published 2021 Mar 11. doi:10.1038/s41598-021-85539-1 DISCLOSURES: No relevant relationships by Ibukun Fakunle No relevant relationships by Prajwal Shanker No relevant relationships by Aashish Valvani