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Flynn-O'Brien KT, Sathya C, Kotagal M, Banks S, Agoubi LL, Kuhls DA, Nathens A, Hink AB, Rivara FP. Preinjury and Event-Related Characteristics of Pediatric Firearm Injuries: The American College of Surgeons Firearm Study, United States, March 2021‒February 2022. Am J Public Health 2024; 114:1097-1109. [PMID: 39146518 DOI: 10.2105/ajph.2024.307754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Objectives. To assess differences in contextual factors by intent among pediatric firearm injury patients and determine factors associated with data missingness. Methods. We retrospectively queried the American College of Surgeons Firearm Study database (March 1, 2021-February 28, 2022) for patients aged 18 years or younger. We stratified preinjury, firearm-related, and event-related factors by intent and compared them by using Fisher exact, χ2, or 1-way analysis of variance testing. Secondary analysis estimated the adjusted odds of missingness by using generalized linear modeling with binominal logit link. Results. Among 17 395 patients, 2974 (17.1%) were aged 18 years or younger; 1966 (66.1%) were injured by assault, 579 (19.5%) unintentionally, and 76 (2.6%) by self-inflicted means. Most contextual factors differed by intent, including proportion of youths with previous adverse childhood experiences, mental illness, and violent assaults or injury, firearm type and access, perpetrator relationship, and injury location. In adjusted analyses, age, trauma center designation, intent, and admission status were associated with missingness. Conclusions. Contextual factors related to pediatric firearm injury vary by intent. Specific predictors associated with missingness may inform improved future data collection. Public Health Implications. Contextual factors related to pediatric firearm injury can be obtained in a systematic manner nationally to inform targeted interventions. (Am J Public Health. 2024;114(10):1097-1109. https://doi.org/10.2105/AJPH.2024.307754).
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Affiliation(s)
- Katherine T Flynn-O'Brien
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Chethan Sathya
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Meera Kotagal
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Samantha Banks
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Lauren L Agoubi
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Deborah A Kuhls
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Avery Nathens
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Ashley B Hink
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Frederick P Rivara
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
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Cina A, Tarozzi I, Arunkumar P, Gitto L. Firearm Fatalities in the Pediatric Population: A Retrospective Study From the Cook County Medical Examiner's Office. Am J Forensic Med Pathol 2024:00000433-990000000-00212. [PMID: 39133144 DOI: 10.1097/paf.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
ABSTRACT Gunshot injuries are one of the leading causes of death from trauma in the United States. In recent years, the US has experienced an increasing number of fatal pediatric cases related to firearms.A search of the database of the Cook County Medical Examiner's Office over the period January 2016-December 2021 revealed 418 deaths by gunshot wounds (GSWs) among people aged between 0 and 18 years old. Subjects were subcategorized in infants (0 to 1 year), toddlers (≥1 to 3 years), preschool (≥3 to 6 years), preadolescents (≥6 to 12 years), and adolescents (≥12 to 18 years).Most victims were males (n = 374) and adolescents (357 males and 30 females). Homicide (n = 373) was the most common manner of death. Only 2 deaths were accidental. Single GSWs deaths (n = 232) were more common than multiple GSWs (n = 186) and preferentially directed to the head in both homicides and suicides. Gang or robbery related events in areas of readily available firearms explained 4.5% of homicides (17 out of 373 cases). Among deaths by self-inflicted GSWs (n = 36), 7 cases were linked to psychiatric disorders, 3 to family difficulties, 2 to history of playing Russian roulette, and 2 to bullying at school.Pediatric gunshot injuries and deaths are an important public health problem. Understanding and addressing individual and societal risk factors should be the first step toward prevention.
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Affiliation(s)
- Alexandra Cina
- From the Albert Einstein Medical Center, Philadelphia, PA
| | - Ilaria Tarozzi
- Modena Local Health Agency, Legal Medicine and Risk Management Department, Modena, Italy
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Hatfield SA, Medina S, Gorman E, Barie PS, Winchell RJ, Villegas CV. A decade of firearm injuries: Have we improved? J Trauma Acute Care Surg 2024; 97:213-219. [PMID: 38227677 DOI: 10.1097/ta.0000000000004249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Firearm injuries are a growing public health issue, with marked increases coinciding with the coronavirus disease 2019 (COVID-19) pandemic. This study evaluates temporal trends over the past decade, hypothesizing that despite a growing number of injuries, mortality would be unaffected. In addition, the study characterizes the types of centers affected disproportionately by the reported firearm injury surge in 2020. METHODS Patients 18 years and older with firearm injuries from 2011 to 2020 were identified retrospectively using the National Trauma Data Bank (NTDB®). Trauma centers not operating for the entirety of the study period were excluded to allow for temporal comparisons. Joinpoint regression and risk-standardized mortality ratios (SMR) were used to evaluate injury counts and adjusted mortality over time. Subgroup analysis was performed to describe centers with the largest increases in firearm injuries in 2020. RESULTS A total of 238,674 patients, treated at 420 unique trauma centers, met inclusion criteria. Firearm injuries increased by 31.1% in 2020, compared to an annual percent change of 2.4% from 2011 to 2019 ( p = 0.01). Subset analysis of centers with the largest changes in firearm injuries in 2020 found that they were more often Level I centers, with higher historic trauma volumes and percentages of firearm injuries ( p < 0.001). Unadjusted mortality decreased by 0.9% from 2011 to 2020, but after controlling for demographics, injury characteristics and physiology, there was no difference in adjusted mortality over the same time period. However, among patients with injury severity scores ≥25, adjusted mortality improved compared with 2011 (SMR of 0.950 in 2020; 95% confidence interval, 0.916-0.986). CONCLUSION Firearm injuries pose an increasing burden to trauma systems, with Level I and high-volume centers seeing the largest growth in 2020. Despite increasing numbers of firearm injuries, mortality has remained unchanged over the past decade. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Sarah A Hatfield
- From the Department of Surgery (S.A.H., E.G., P.S.B., R.J.W., C.V.V.), NewYork-Presbyterian/Weill Cornell Medicine; and Undergraduate Medical Education (S.M.), Weill Cornell Medical College, New York, New York
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Collins CE, Lao O, Chang HL, Yorkgitis BK, Plumley DA, Larson SD, Fitzwater JW, Markley M, Fischer A, Pedroso F, Neville HL, Snyder CW. Firearm Injuries in Young Children: Surgical Resource Utilization and Implications for Prevention. J Surg Res 2024; 302:64-70. [PMID: 39094258 DOI: 10.1016/j.jss.2024.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/19/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Pediatric firearm injury prevention research in younger age groups is limited. This study evaluated a large multicenter cohort of younger children with firearm injuries, focusing on injury patterns and surgical resource utilization. METHODS Children ≤15 y old sustaining firearm injuries between 2016 and 2021 and treated at 10 pediatric trauma centers in Florida were included. Individual cases were reviewed for demographics, shooting details, injury patterns, resource utilization, and outcomes. Patients were grouped by age into preschool (0-5 y), elementary school (6-10 y), middle school (11-13 y), and early high school (14-15 y). Multivariable logistic regression was used to identify predictors of death and critical resource utilization. RESULTS A total of 489 children (80 preschool, 76 elementary school, 92 middle school, and 241 early high school) met inclusion criteria. Demographics, injury patterns, and resource utilization were similar across age groups. Assault and self-harm increased with age. Self-harm was implicated in 5% of cases but accounted for 18% of deaths. Hand surgery (i.e., below-elbow) procedures were common at 8%. Overall mortality was 10%, but markedly higher for self-harm injuries (47%). On multivariable regression, age and demographics were not predictive of death or critical resource utilization, but self-harm intent was a strong independent risk factor for both. CONCLUSIONS This study suggests that given the age distribution and disproportionately high impact of self-harm injuries, behavioral health resources should be available to children at the middle school level or earlier. Hand surgery may represent an overlooked but frequently utilized resource to mitigate injury impact and optimize long-term function.
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Affiliation(s)
- Camden E Collins
- Wake Forest University, Winston-Salem, North Carolina; Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Oliver Lao
- Department of Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Henry L Chang
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; Department of Surgery, Tampa General Hospital, Tampa, Florida
| | - Brian K Yorkgitis
- Department of Surgery, University of Florida Health - Jacksonville, Jacksonville, Florida
| | - Donald A Plumley
- Department of Surgery, Arnold Palmer Hospital for Children, Orlando, Florida
| | - Shawn D Larson
- Department of Surgery, University of Florida Health Shands Hospital, Gainesville, Florida
| | - John W Fitzwater
- Department of Surgery, St. Joseph's Children's Hospital - Baycare, Tampa, Florida
| | - Michele Markley
- Department of Surgery, Salah Foundation Children's Hospital, Broward Health, Fort Lauderdale, Florida
| | - Anne Fischer
- Department of Surgery, St. Mary's Medical Center, West Palm Beach, Florida
| | - Felipe Pedroso
- Department of Surgery, Nicklaus Children's Hospital, Miami, Florida
| | - Holly L Neville
- Department of Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Christopher W Snyder
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
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Kandeepan A, Lee J, Bagdure D, Garber N, Day J, Holloway A, Lichenstein R, Slattery J, Wolfe A, Wadsworth J, Moss J, Davie N, Foster C. Firearm screening in pediatric patients. Front Pediatr 2024; 12:1415612. [PMID: 38978836 PMCID: PMC11228932 DOI: 10.3389/fped.2024.1415612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/05/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction In the United States, firearm-related injuries are the leading cause of death among children and adolescents 1-19 years of age. Although many pediatricians believe addressing firearm safety is important and have guidance from organizations like the American Academy of Pediatrics, few routinely screen and counsel on firearm safety. The goal of this project was to screen all patients presenting to the pediatric emergency department, pediatric floor, and pediatric intensive care unit for the presence of firearms in the home, firearm storage practices, and whether they had previously received any firearm counseling by medical professionals. Methods A 13-item survey was administered to each participant. Items included demographic information, willingness to answer questions about firearms, practice of asking questions about firearms, previous counseling from medical professionals about the presence of firearms in the home and the presence of firearm in their personal home as well as storage practices. Results A total of 200 parents responded to the survey. Of those that responded to the survey, 171 (85.5%) did not have a firearm in the home and 28 (14%) did have a firearm in the home. 75% (n = 21) had never had a medical provider discuss firearm safety with them. 100% had never been asked by another parent about the presence of a firearm in their home when a child came over for a playdate. 39% (n = 11) of parents with a firearm in the home had asked other parents whether they have a firearm in the home where their child goes to play. Discussion Findings from our study highlight a significant lack of screening of our pediatric patients both in the inpatient and outpatient settings, with the majority reporting that they had never been asked by a medical provider about firearm safety. In addition, three quarters of parents with a firearm in the home reported that they did not mind answering questions about firearms yet none had been asked by other parents about firearms. Thus, although firearm possession and safety is considered to be a sensitive topic, many parents are willing to discuss it with their health care providers and other parents.
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Affiliation(s)
- Aarani Kandeepan
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Jessica Lee
- Department of Pediatrics, The Children's Hospital of Montefiore, New York, NY, United States
| | - Dayanand Bagdure
- Department of Pediatrics, Ochsner LSU Health, Shreveport, LA, United States
| | - Nan Garber
- Department of Pediatrics, West Virginia University, Morgantown, WV, United States
| | - Jenni Day
- Department of Nursing, University of Maryland, Baltimore, MD, United States
| | - Adrian Holloway
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Richard Lichenstein
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Joseph Slattery
- Department of Pediatrics, St. Josephs Hospital, Baltimore, MD, United States
| | - Alexa Wolfe
- Department of Pediatrics, University of Wisconsin, Madison, WI, United States
| | - Jenna Wadsworth
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Julianne Moss
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Nicole Davie
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Cortney Foster
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
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Trinidad S, Goldshore M, Kotagal M. Addressing health equity in pediatric surgical care in the United States- Progress and challenges. Semin Pediatr Surg 2023; 32:151354. [PMID: 37967486 DOI: 10.1016/j.sempedsurg.2023.151354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
There are notable inequities in health outcomes for children based on their social determinants of health (SDOH), including where they are born and live, their primary language, their race and ethnicity, socioeconomic status, and more. These health inequities are not restricted to resource limited settings; here we highlight three broad topics that are relevant to pediatric surgeons in the United States (US): access to care and disparities, and examples of inequities in firearm-related injuries and appendicitis. Most of our patients will at some point require operative interventions, yet there can be significant challenges in accessing this care and navigating our health systems, particularly around complex perioperative care. There are significant opportunities to improve equitable care by helping patients navigate our health systems and connecting them with additional resources, including screening for primary care services. Firearm-related injuries are now the leading cause of death in children in the US, with significant associated morbidity for non-fatal injuries. There are notable inequities in the risk of injury and types of injuries experienced by children based on their SDOH. Appendicitis is one of the most common pathologies managed by pediatric surgeons, with similar inequities in the rates of perforated appendicitis based on a child's SDOH. For both issues, addressing the inequities our patients experience requires moving upstream and working towards prevention. Key opportunities include better research and data to understand the drivers for observed inequities, multidisciplinary collaboration, community engagement, and public health advocacy among others. As a profession, we have a responsibility to work to address the health inequities our patients experience.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Matthew Goldshore
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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Sidell M, Negriff S, Koebnick C, Grant DL, Nau C, Zhou H, Hechter R. Trends in firearm injury in a southern California health care system from 2010 to 2020. BMC Public Health 2023; 23:2220. [PMID: 37950238 PMCID: PMC10636882 DOI: 10.1186/s12889-023-17116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Firearm injury is a significant public health concern in the United States. METHODS Data on fatal and nonfatal firearm injuries were obtained from a cohort of N = 7,473,650 members of Kaiser Permanente Southern California, a large integrated healthcare system between 2010 and 2020. Age-adjusted rates of combined fatal and nonfatal firearm injury per 100,000 members were calculated by year, with the 2010 US census as the reference population. Trends were evaluated using Poisson or negative binomial regression. RESULTS There was an increasing trend in overall firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system (p < .0001), primarily driven by non-self-inflicted firearm injuries (p < .0001). Self-inflicted injuries decreased during this time (p = .01). Injuries among youth showed no significant change. CONCLUSION There was an increasing trend in firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system, primarily driven by non-self-inflicted firearm injuries; however, self-inflicted injuries decreased during this time. Injuries among youth showed no significant change.
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Affiliation(s)
- Margo Sidell
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA.
| | - Sonya Negriff
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Corinna Koebnick
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Deborah Ling Grant
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Claudia Nau
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Hui Zhou
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Rulin Hechter
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Goel R, Zhu X, Makhani S, Josephson CD, White JL, Karam O, Nellis ME, Gehrie EA, Sherpa M, Crowe EP, Bloch EM, Tobian AA. Pediatric firearm injury related emergency department visits and hospitalizations: a population-based study in the United States. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100503. [PMID: 37214769 PMCID: PMC10192937 DOI: 10.1016/j.lana.2023.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Background Firearm injury (FI) is the leading cause of death in children and adolescents in the United States (US). We describe the epidemiology of pediatric FI-associated emergency department (ED) visits and hospitalizations in the US stratified by race and ethnicity. Methods Data on pediatric (0-17-year-olds) FI were analyzed using the 2019 Nationwide Emergency Department Sample (NEDS) and Kids' Inpatient Database (KID), the largest all-payer databases in the US for ED visits and pediatric hospitalizations, respectively. FI encounters were stratified by race and ethnicity. Poisson regression was used to identify factors associated with in-hospital mortality. Sampling weights were applied to generate nationally representative estimates. Findings There were 7017 pediatric ED visits with FI (NEDS); 85.0% (5961/7017) were male and 73.0% (5125/7017) were adolescents (15-17 years). Overall, 5.5% (384/7017) died in the ED; 53.1% (3727/7017) of ED encounters did not result in hospitalization. There were 2817 pediatric FI hospitalizations (KID); 84.1% (2369/2817) were male and 71.6% (2018/2817) were adolescents; 51.4% (1447/2817) of FI were unintentional, 42.8% (1207/2817) were assault-related, and 5.8% (163/2817) were self-inflicted. Black children had the highest proportion (52.6%; 1481/2817) of hospitalizations among all race and ethnicities (p < 0.0001 vs. White). White children had the highest proportion of hospitalizations for self-inflicted injuries (16.6% [91/551] vs. 4.9% [25/504; p < 0.0001] in Hispanics and 1.7% [24/1481] in Blacks; p < 0.0001). The majority (56.5%; 1591/2817) of hospitalizations were patients from low-income zip codes (median annual-household-income <$44,000); 70% (1971/2817) had Medicaid as the primary insurance payer. Overall, 8.0% (225/2817) died during FI-associated hospitalizations. Self-inflicted injuries had the highest in-hospital mortality (prevalence ratio = 8.20, 95% CI = 6.06-11.10 vs. unintentional). Interpretation Black children and children with lower household incomes were disproportionately impacted by FI resulting from assaults and accidents, while White children had the highest proportion of self-inflicted FI injuries. Public health and legal policy interventions are needed to prevent pediatric FI. Funding US National Institutes of Health.
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Affiliation(s)
- Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Simmons Cancer Institute at SIU School of Medicine, Springfield, IL, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Makhani
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Cassandra D. Josephson
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Jodie L. White
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Karam
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Eric A. Gehrie
- American Red Cross, Biomedical Services Division, National Headquarters, Washington, DC, USA
| | | | - Elizabeth P. Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bernardin ME, Spectorsky K, Gu H, Fairfax C, Cutler K. Child Firearm Injury Circumstances and Associations With Violence Intervention Program Enrollment. J Surg Res 2023; 285:67-75. [PMID: 36652770 DOI: 10.1016/j.jss.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/07/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Pediatric firearm injuries are the leading cause of death among American children. While assault is the most commonly cited cause, few studies have investigated circumstances surrounding such injuries. Violence intervention programs (VIPs) have been utilized to combat firearm violence, though a similar lack of knowledge exists regarding possible associations between firearm injury circumstances and youth VIP enrollment. METHODS This cross-sectional study included children aged 6-17 y who presented to an urban level 1 pediatric trauma center with firearm injuries from 2014 to 2017. Victim demographics and enrollment in a VIP were obtained from medical records, as well as circumstances surrounding the injuries based on account of the victim, victim's family/friends, and/or police present at the hospital. Circumstances included location of the shooting, if the shooter was known to the victim, and if the shooting was confirmed by the victim or their contacts to have been accidental or an intentional assault. Medical record numbers were used to locate victims in our trauma registry in order to obtain their assigned international classification of disease codes. Wilcox-rank sum, Pearson's chi-squared and Fisher's exact tests were used to detect associations between demographics, VIP enrollment, and shooting circumstances. RESULTS 156 victims of firearm injury were described, including primarily Black adolescent males. 72% of victims were shot outdoors by an unknown shooter, the motivation of which was unknown in 93% of cases. 36% of these shootings were "drive-by". The majority of victims received international classification of disease codes for assault, though shootings that were confirmed by the victim to have been intentional assaults were relatively uncommon (13.4%). Most children lived in the same zip code in which they were shot (71%), and three particular zip codes accounted for 40% of shootings. 26% of victims chose to enroll in the VIP, and those that were victims of confirmed assaults (odds ratio 3.5) as well as those admitted to the hospital (odds ratio 2.4) were significantly more likely to enroll. CONCLUSIONS Based on victim account, children living in an urban setting are more frequently victims of unclearly motivated, outdoor neighborhood shootings rather than intentional assaults. More accurate understanding of the causes of pediatric firearm injuries should inform both recruitment into VIPs, as well as a balancing of VIPs with community-level interventions to address firearm violence.
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Affiliation(s)
- Mary Elizabeth Bernardin
- Department of Emergency Medicine, University of Missouri School of Medicine, Division of Pediatric Emergency Medicine, Columbia, Missouri; Department of Pediatrics, Washington University School of Medicine, Division of Pediatric Emergency Medicine, St. Louis, Missouri.
| | - Kathryn Spectorsky
- Department of Pediatrics, Washington University School of Medicine, Division of Pediatric Emergency Medicine, St. Louis, Missouri
| | - Hongjie Gu
- Washington University School of Medicine, Division of Biostatistics, St. Louis, Missouri
| | - Connor Fairfax
- Trauma Services, St. Louis Children's Hospital, St. Louis, Missouri
| | - Keven Cutler
- Department of Emergency Medicine, University of Missouri School of Medicine, Division of Pediatric Emergency Medicine, Columbia, Missouri
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Hoefer L, Camarena A, Twohig K, Polcari A, Keskey R, LaVigne D, Slidell MB, Wilson K, Hampton D. Rising Mortality in Pediatric Self-Inflicted Firearm Trauma Associated With Distinct Anatomic Injury. J Surg Res 2023; 283:259-265. [PMID: 36423474 DOI: 10.1016/j.jss.2022.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/25/2022] [Accepted: 10/15/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Self-inflicted injuries are the second leading cause of pediatric (10-18 y old) mortality. Self-inflicted firearm trauma (SIFT) was responsible for up to half of these deaths in certain age groups. We hypothesized that SIFT prevalence has increased and is associated with specific demographics, injury patterns, and outcomes. MATERIALS AND METHODS Data were abstracted from the 2007-2018 American College of Surgeons (ACS) Trauma Quality Programs Participant Use Files (TQP-PUF). Pediatric (1-17 yold) victims of firearm violence were eligible. Age, race, gender, anatomic region, and intent were abstracted. Variables were analyzed using chi-squared tests, t-tests, and single-variate linear regression models. Temporal trends were analyzed using ANCOVA tests. Multivariate logistic regressions were conducted to identify factors influencing mortality. Significance was P < 0.05. RESULTS There were 41,239 pediatric firearm trauma patients (SIFT: 5.5% [n = 2272]). SIFT incidence increased over the 12-y period (2007 (n = 67) versus 2018 (n = 232), P < 0.05). SIFT was significantly associated with Caucasian race, 67% (n = 1537), teenagers, 90% (n = 2056), male gender, 87% (n = 1978), and a higher median injury severity score (ISS) than other intents of injury (SIFT: 20.0 (IQR: 9.0, 25.0) versus other: 9.0 (IQR: 1.0-13.0), P < 0.001). The SIFT mortality rate was 44% (n = 1005). On multivariate regression head gunshot wounds (OR: 21.1, 95% C.I.: 9.9-45.2, P = 0.001), and ISS (OR:1.1, 95% C.I.: 1.1-1.1, P = 0.001) were significantly associated with mortality. Compared to other intents, SIFT mortality rates increased at a higher annual rate (P < 0.001). CONCLUSIONS Comprehensive local and federal policy changes to reduce firearms access and increase pediatric mental health support may mitigate these injuries.
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Affiliation(s)
- Lea Hoefer
- University of Chicago, Department of Surgery, Chicago, Illinois
| | - Adrian Camarena
- Duke University, Department of Surgery, Durham, North Carolina
| | - Kelly Twohig
- University of Chicago, Department of Surgery, Chicago, Illinois
| | - Ann Polcari
- University of Chicago, Department of Surgery, Chicago, Illinois
| | - Robert Keskey
- University of Chicago, Department of Surgery, Chicago, Illinois
| | - Danielle LaVigne
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Mark B Slidell
- University of Chicago, Department of Surgery, Chicago, Illinois
| | - Kenneth Wilson
- University of Chicago, Department of Surgery, Chicago, Illinois
| | - David Hampton
- University of Chicago, Department of Surgery, Chicago, Illinois.
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11
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Price JH, Khubchandani J. Firearm Mortality Among Pre-school Age Children, 2010–2020. J Community Health 2022; 48:414-419. [DOI: 10.1007/s10900-022-01180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
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Trinidad S, Kotagal M. Social determinants of health as drivers of inequities in pediatric injury. Semin Pediatr Surg 2022; 31:151221. [PMID: 36347129 DOI: 10.1016/j.sempedsurg.2022.151221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A child's social determinants of health (SDH), including their neighborhood environment, insurance status, race and ethnicity, English language proficiency and geographic location, all significantly impact their risk of injury and outcomes after injury. Children from socioeconomically disadvantaged neighborhoods experience overall higher rates of injury and different types of injuries, including higher rates of motor vehicle-, firearm-, and violence-related injuries. Similarly, children with public insurance or no insurance, as a proxy for lower socioeconomic status, experience higher rates of injuries including firearm-related injuries and non-accidental trauma, with overall worse outcomes. Race and associated racism also impact a child's risk of injury and care received after injury. Black children, Hispanic children, and those from other minority groups disproportionately experience socioeconomic disadvantage with sequelae of injury risk as described above. Even after controlling for socioeconomic status, there are still notable disparities with further evidence of racial inequities and bias in pediatric trauma care after injury. Finally, where a child lives geographically also significantly impacts their risk of injury and available care after injury, with differences based on whether a child lives in a rural or urban area and the degree of state laws regarding injury prevention. There are clear inequities based on a child's SDH, most predominantly in a child's risk of injury and the types of injuries they experience. These injuries are preventable and the SDH provide potential upstream targets in injury prevention efforts.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children...s Hospital Medical Center, Cincinnati, Ohio.
| | - Meera Kotagal
- Assistant Professor, Division of General and Thoracic Surgery, Director, Trauma Services, Director, Pediatric Surgery Global Health Program, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States.
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Woodruff G, Palmer L, Fontane E, Kalynych C, Hendry P, Thomas A, Crandall M. Nine years of pediatric gunshot wounds: a descriptive analysis. Prev Med Rep 2022; 28:101890. [PMID: 35832637 PMCID: PMC9272024 DOI: 10.1016/j.pmedr.2022.101890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/26/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Firearm injury increases with age with previous studies examining ages 0–14 vs. 15–18. There is poor documentation in the literature of key demographic details surrounding the injury. There are important demographic differences that exist between older adolescent (13–14 years) and younger children (0–12 years). Adolescents aged 13 years and older have similar profile to older adolescents/teens and may benefit from interventions such as violence intervention programs.
Pediatric firearm violence carries significant morbidity and mortality. Studies targeting children ≤14 years are limited. Our goal was to study the distribution and determinants of GSWs in the pediatric population. We performed a retrospective review of children ≤14 years presenting with GSWs at this level 1 trauma center. This cohort was split into younger children, 0–12 years, and older children, 13–14 years. Summary and bivariate statistics were calculated using Stata v10. 142 patients (68.3% black, 76.7% male) were identified. Injuries more often occurred at home (39.6%) by family or friends (60.7%). Older children often suffered handgun injuries (85.5%) and more often were sent immediately to the OR on presentation (29.2%). Younger children more often suffered from air-gun (50%) and pistols (40%). Younger children more commonly had blood transfusions (9.4%) compared to exploratory laparotomy in older children (13.5%). The most common disposition from the ED was home (36.2%). Descriptive data entailing incident specifics such as time of injury and CPS involvement were frequently missing in the healthcare record. Older children were more likely to be injured by strangers, have longer lengths of stay especially associated with surgical operations, and have a disposition of immediate arrest compared to their younger cohort. Consequently, this group may benefit from interventions typically aimed at older patients such as violence intervention programs. When available, differences in demographics and outcomes were identified which could shape novel prevention strategies for firearm injury.
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