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Knod JL, Sathya C, Griggs CL, Henry MC, Froehlich M, Zallen G, Coakley BA, Masiakos PT, Gow KW, Naik-Mathuria B. Promoting Firearm Injury Prevention and Advocacy as Pediatric Surgeons: A Call to Action From the APSA/AAP Advocacy Committee. J Pediatr Surg 2024; 59:1135-1141. [PMID: 38160188 DOI: 10.1016/j.jpedsurg.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Firearm injuries have become the leading cause of death among American children. Here we review the scope of the problem, and the pivotal role pediatric surgeons have in preventing pediatric firearm injury. Specific methods for screening and counseling are reviewed, as well as how to overcome barriers. Community and hospital resources as well as organizational efforts are discussed. Finally, a path for surgeon advocacy is outlined as is a call to action for the pediatric surgeon, as we are uniquely poised to identify pediatric patients and deliver timely interventions to reduce the impact of firearm violence. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- J Leslie Knod
- Division of Pediatric Surgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, United States.
| | - Chethan Sathya
- Center for Gun Violence Prevention, Northwell Health, Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, 1111 Marcus, Suite M15, New Hyde Park, NY 11042, United States
| | - Cornelia L Griggs
- Harvard Medical School, Division of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit Street GRB-11, Boston MA 02114, United States
| | - Marion C Henry
- University of Chicago, 5839 S. Maryland Ave/MC 4062/Suite A-426, Chicago, IL 60637, United States
| | - Mary Froehlich
- Kirk Kerkorian School of Medicine at UNLV, Department of General Surgery, 4505 South Maryland Pkwy, Las Vegas, NV 89154, United States
| | - Garret Zallen
- PeaceHealth Medical Center Springfield Oregon and Shriner's Hospital, Portland, OR, United States
| | - Brian A Coakley
- The Icahn School of Medicine at Mount Sinai, Division of Pediatric Surgery, Department of Surgery, 5 East 98th Street, 15th Floor, New York, NY 10029, United States
| | - Peter T Masiakos
- Harvard Medical School, Division of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit Street GRB-11, Boston MA 02114, United States
| | - Kenneth W Gow
- University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, University of Texas Medical Branch, 301 University Blvd, Research Building 6, Suite 3.220, Galveston, TX 77555, United States
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Nicholson CP, Bodd MH, Sarosi E, Carlough MC, Lysaught MT, Curlin FA. The Power of Proximity: Toward an Ethic of Accompaniment in Surgical Care. Hastings Cent Rep 2024; 54:12-21. [PMID: 38639170 DOI: 10.1002/hast.1575] [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: 04/20/2024]
Abstract
Although the field of surgical ethics focuses primarily on informed consent, surgical decision-making, and research ethics, some surgeons have started to consider ethical questions regarding justice and solidarity with poor and minoritized populations. To date, those calling for social justice in surgical care have emphasized increased diversity within the ranks of the surgical profession. This article, in contrast, foregrounds the agency of those most affected by injustice by bringing to bear an ethic of accompaniment. The ethic of accompaniment is born from a theological tradition that has motivated work to improve health outcomes in those at the margins through its emphasis on listening, solidarity against systemic drivers of disease, and proximity to individuals and communities. Through a review of surgical ethics and exploration of a central patient case, we argue for applying an ethic of accompaniment to the care of surgical patients and their communities.
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Nofi CP, Roberts BK, Cornell E, Tijerina M, Tussing O, Henry MC, Sathya C. Hospital-Based Violence Intervention Programs to Reduce Firearm Injuries in Children: A Scoping Review. J Pediatr Surg 2023; 58:2212-2221. [PMID: 37217364 DOI: 10.1016/j.jpedsurg.2023.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Hospital-based violence intervention programs (HVIPs) have shown promise in preventing reinjury and enhancing recovery from violent injuries, including those related to firearms. Historically, HVIPs have primarily focused on at-risk adolescents and young adults. The aim of this study is to perform a scoping review of HVIPs targeting children under the age of 18, describe the evidence supporting these programs, and deduce the potential impact of expanding HVIPs to younger children. METHODS A scoping review was performed utilizing PubMed database with search terms "violence intervention program" and pediatric, or children, or youth. Articles were screened for youth-inclusive violence programs, and the literature was analyzed for program descriptions, evidence supporting interventions, and barriers to evaluation. RESULTS 36 studies (covering 23 programs) were identified that met criteria (including patients ≤18 years old), with only 4 programs including children under 10. Many HVIPs utilize brief hospital interventions with longitudinal wraparound outpatient services. Despite heterogeneity in programs and studied outcomes, many HVIPs demonstrated positive outcomes, such as reduction of risk factors, decreased reinjury, decreased violent behaviors, decreased criminal justice involvement, and positive attitude or behavioral changes. Only a few studies reported increased odds of enrollment and positive impact in younger patients specifically. CONCLUSIONS Children are an impressionable population in which HVIPs may have significant impact; however, there remains a gap in targeted programs. Given that firearm injuries are the leading cause of death in children and adolescents, priority should be given to piloting, implementing, and evaluating HVIPs among younger age groups. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Colleen P Nofi
- Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY, USA; Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA.
| | - Bailey K Roberts
- Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY, USA; Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA
| | - Emma Cornell
- Center for Gun Violence Prevention, Northwell Health, New Hyde Park, NY, USA
| | | | | | - Marion C Henry
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Chethan Sathya
- Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY, USA; Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA; Center for Gun Violence Prevention, Northwell Health, New Hyde Park, NY, USA
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Heimke IM, Connelly M, Clarke A, De Mario B, Breslin MA, Furdock R, Moore TA, Vallier HA. Recidivism after orthopaedic trauma has diminished over time. Eur J Trauma Emerg Surg 2023; 49:1891-1896. [PMID: 37162555 PMCID: PMC10170426 DOI: 10.1007/s00068-023-02274-0] [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] [Received: 01/24/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE The purpose was to analyze our trauma population during two periods to assess for predictors of recidivism. METHODS Prior (2007-2011, n = 879) and recent (2014-2019, n = 954) orthopaedic trauma patients were reviewed. Recidivists were those returning with an unrelated injury. Recidivism rates were compared, and factors associated with recidivism were identified. RESULTS Recidivism decreased: 18.7% to 14.3% (p = 0.01). Mean age and sex of the two cohorts were not different. Recent recidivists were more likely to sustain gunshot wound (GSW) injuries (22.1% vs 18.9%, p = 0.09), and mental illness was more common (56.6% vs 28.1%, p < 0.0001). The recent recidivist population was less often married (12.9% vs 23.8%, p = 0.03), and both recidivist groups were often underinsured (Medicaid or uninsured: (60.6% vs 67.0%)). CONCLUSION Recidivism diminished, although more GSW and mental illness were seen. Recidivists are likely to be underinsured. The changing profile of recidivists may be attributed to socioeconomic trends and new programs to improve outcomes after trauma.
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Affiliation(s)
- Isabella M Heimke
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Madison Connelly
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Amelia Clarke
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Belinda De Mario
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Mary A Breslin
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Ryan Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Timothy A Moore
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA.
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Li BH, Haukoos JS, Gangidine MM, Hopkins E, McDaniel M, Williams JE, Morgan JL, Green E, Mireles AR, Palacios J, Ramirez JH, Bakes KM. Development of a clinical prediction instrument to estimate risk of initial violent injury. Injury 2022; 53:3263-3268. [PMID: 35970636 DOI: 10.1016/j.injury.2022.08.012] [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: 03/10/2022] [Revised: 07/13/2022] [Accepted: 08/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Interpersonal violent injury is a public health crisis, disproportionately affecting young people of color. We aimed to evaluate associations between sociobehavioral predictors and first-time violent injury, and to develop a predictive risk score for violent injury. METHODS We performed a retrospective case-cohort study of adolescents aged 12-18 years. Multivariable logistic regression was used to estimate associations between 35 candidate variables and interpersonal first-time violent injury resulting in an emergency department (ED) visit. Multiple imputation was used to account for missing values and a risk score was developed by multiplying regression coefficients by 10 to generate a composite tool to predict initial violent injury (IVI). Discrimination and calibration were assessed using 10-fold cross validation. RESULTS 19,210 adolescents were included, 276 (1.4%) as victims of IVI. The final model, the Initial Violent Injury Risk Prediction Tool (IVI-RPT), included: age, fight within the prior year, trouble with the law, and alcohol use. IVI-RPT scores were categorized as: 0-7 (low risk), 8-16 (moderate), and 17-26 (high), and IVI prevalence was 0.8% (95% confidence interval [CI]: 0.6%, 0.9%), 2.5% (95% CI: 1.9%, 3.1%), and 5.3% (95% CI: 4.1%, 6.6%), respectively. The area under the receiver operating characteristic curve was 0.70 (95% CI: 0.66, 0.73), while the slope of the calibration curve was 1.1 (95% CI: 0.9, 1.2). CONCLUSIONS We developed a promising clinical prediction instrument, the IVI-RPT, that categorizes individuals into risk groups with increasing probabilities of violent injury. External validation of this tool is required prior to clinical practice implementation.
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Affiliation(s)
- Benjamin H Li
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America; Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America.
| | - Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America; Department of Epidemiology, Colorado School of Public Health, 13001 East 17th Place, 3rd Floor, Mail Stop B119, Aurora, CO, 80045, United States of America
| | - Matthew M Gangidine
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America
| | - Emily Hopkins
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America
| | - Michelle McDaniel
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Johnnie E Williams
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Jerry L Morgan
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Erica Green
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Alma R Mireles
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Jose Palacios
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Jesus H Ramirez
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Katherine M Bakes
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America; Department of Emergency Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, United States Department of Veterans Affairs, 1700 North Wheeling Street, Aurora, CO, 80045, United States of America
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Violent Trauma Reinjury and Preventive Interventions in Youth: a Literature Review. CURRENT TRAUMA REPORTS 2022. [DOI: 10.1007/s40719-022-00242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Pino EC, Fontin F, James TL, Dugan E. Mechanism of penetrating injury mediates the risk of long-term adverse outcomes for survivors of violent trauma. J Trauma Acute Care Surg 2022; 92:511-519. [PMID: 34284465 DOI: 10.1097/ta.0000000000003364] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND While hospital-based violence intervention programs are primarily designed to aid youth victims of gun violence at high risk for reinjury, the root causes and complex outcomes of community violence are varied. In this study, we examined the risk factors for violent penetrating injury and how the risk of adverse outcomes for survivors differs by injury type (stabbing vs. gunshot wound). METHODS This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a penetrating injury due to community violence between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of all-cause mortality and violent reinjury within 3 years after surviving a penetrating injury. RESULTS Of the 4,280 survivors of the initial violent penetrating injury, there were 88 deaths (2.1%) and 568 violent reinjuries (13.3%) within 3 years. Compared with gunshot wound victims, stab wound victims were 31% less likely to be reinjured with a gunshot wound (HR, 0.69; 95% CI, 0.51-0.93), 72% more likely to be reinjured with a stab wound (HR, 1.72; 95% CI, 1.21-2.43), and 49% more likely to be reinjured by assault (HR, 1.49; 95% CI, 1.14-1.94). While survivors of stabbing and firearm injuries were equally at risk for 3-year all-cause mortality, stab wound victims were 3.75 times more likely to die by a drug/alcohol overdose (HR, 3.75; 95% CI, 1.11-20.65). CONCLUSION Patients surviving a stab wound have a significantly higher risk of violent reinjury by stabbing or assault, and risk of death by drug/alcohol overdose. Hospital-based violence intervention programs with similar patient populations should explore options to expand partnerships with drug treatment programs. These results illustrate two distinct populations of victims of violence-gunshot victims and stabbing/assault victims-with separate risk factors and outcomes, mediated by substance use disorder. LEVEL OF EVIDENCE Prognostic and Epidemiologic; level III.
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Affiliation(s)
- Elizabeth C Pino
- From the Boston Violence Intervention Advocacy Program, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
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Abraham PJ, Abraham MN, Griffin RL, Tanner L, Jansen JO. Evaluation of Injury Recidivism Using the Electronic Medical Record. J Surg Res 2021; 267:217-223. [PMID: 34153565 DOI: 10.1016/j.jss.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Traumatic injuries remain one of the leading causes of death in the United States. Patients who survive traumatic injuries but return to the emergency department with repeat injuries are said to suffer from injury recidivism. Numerous studies have described trends in injury recidivism using trauma registry and survey data. To our knowledge, no prior study has leveraged electronic medical record (EMR) data to characterize injury recidivism. The EMR is potentially more comprehensive as it contains details of patients who visited the emergency department after injury but did not meet the criteria for inclusion in the trauma registry. Such injuries could be predictive of future recidivism. We therefore aimed to describe patterns of injury recidivism seen at a Level 1 trauma center using the EMR. METHODS A retrospective review was conducted of all injury-related encounters between January 2016 and December 2019. Manual review was conducted of all recidivistic encounters with < 11 months between encounters to ensure the recidivistic encounter was not a sequela of the index visit. A general estimating equation logistic regression adjusted for age, race, sex, and insurance payor, estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between injury mechanism and odds of recidivistic encounter. RESULTS A total of 20,566 index encounters was included during the study period. Of the 20,566 encounters, 7.6% (n = 1570) had a recidivistic encounter during the study period, half of which (n = 781) occurred within the first year of the index encounter. An over two-fold increased odds of recidivism was observed for blunt assault encounters (OR 2.53, 95% CI 2.03-3.15) and unintentional falls (OR 2.10, 95% CI 1.76-2.52). For both mechanisms, this increase was observed across the three years following the index encounter. CONCLUSIONS Our study found that patients with assault injuries have the highest odds of injury recidivism and assault-related recidivistic encounters. These results demonstrate the feasibility and utility of incorporating EMR data, and suggest that the development of targeted interventions focused on mitigating assault injuries, such as hospital-based violence intervention programs, should be considered in our region.
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Affiliation(s)
- Peter J Abraham
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | - Russell L Griffin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Lauren Tanner
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jan O Jansen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
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Mattson CM, Kaylor R, Koehler TJ, Ydenberg M, Grill J, Stork BR. Gun Violence and Firearm Injuries in West Michigan: Targeting Prevention. West J Emerg Med 2021; 22:488-497. [PMID: 34125018 PMCID: PMC8203015 DOI: 10.5811/westjem.2021.3.49255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/25/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Firearm-related deaths and injuries are ongoing public health issues in the United States. We reviewed a series of gun violence- and firearm-related injuries treated at a multi-campus community healthcare system in West Michigan to better understand the demographic and clinical characteristics of these injuries. We also studied hospital charges, and payers responsible, in an effort to identify stakeholders and opportunities for community- and hospital-based prevention. METHODS We performed a retrospective review of firearm injuries treated at Mercy Health Muskegon (MHM) between May 1, 2015 and June 30, 2019. Demographic data, injury type, Injury Severity Score (ISS), anatomic location and organ systems involved, length of stay (LOS), mortality, time of year, and ZIP code in which the injury occurred were reviewed, as were hospital charges and payers responsible. RESULTS Of those reviewed, 307 firearm-related injuries met inclusion criteria for the study. In 69.4% of cases the injury type was attempted murder or intent to do bodily harm. Accidental and self-inflicted injuries accounted for 25% of cases. There was a statistically significant difference in the mechanism of injury between Black and White patients with a higher proportion of Black men injured due to gun violence (P < 0.001). Median ISS was 8 and the most commonly injured organ system was musculoskeletal. Median LOS was one day. Self-inflicted firearm injuries had the highest rate of mortality (50%) followed by attempted murder (7%) and accidental discharge (3.1%; P < 0.001). Median hospital charge was $8,008. In 68% of cases, Medicaid was the payer. MHM received $4.98 million dollars in reimbursement from Medicaid; however, when direct and indirect costs were taken into account, a loss of $12,648 was observed. CONCLUSION Findings from this study reveal that young, Black men are the primary victims of gun violence-related injuries in our West Michigan service area. Hospital care of firearm-related injuries at MHM was predominantly paid for by Medicaid. Multiple stakeholders stand to benefit from funding and supporting community- and hospital-based prevention programs designed to reduce gun violence and firearm-related injuries in our service area.
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Affiliation(s)
| | - Ryan Kaylor
- Naval Medical Center, Department of Emergency Medicine, San Diego, California
| | - Tracy J Koehler
- Mercy Health, Department of Scholarly Activity Support, Muskegon, Michigan
| | - Marc Ydenberg
- Mercy Health, Department of Emergency Medicine, Muskegon, Michigan
| | - Justin Grill
- Mercy Health, Department of Emergency Medicine, Muskegon, Michigan
| | - Brian R Stork
- University of Michigan, Department of Urology, Ann Arbor, Michigan
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Abstract
BACKGROUND Blood-borne pathogen infections (BPIs), caused by the human immunodeficiency virus, hepatitis C and hepatitis B viruses pose an occupational hazard to healthcare workers. Facial trauma reconstruction surgeons may be at elevated risk because of routine use of sharps, and a higher than average incidence of BPIs in the trauma patient population. METHODS The authors retrospectively reviewed health records of patients admitted to a level 1 trauma center with a facial fracture between January 2010 and December 2015. Patient demographics, medical history, mechanism of injury, type of fracture, and procedures performed were documented. The authors detemined the frequency of human immunodeficiency virus, hepatitis B, and hepatitis C diagnosis and utilized univariable/multivariable analyses to identify risk factors associated with infection in this population. RESULTS In total, 4608 consecutive patients were included. Infections were found in 4.8% (n = 219) of patients (human immunodeficiency virus 1.6%, hepatitis C 3.3%, hepatitis B 0.8%). 76.3% of BPI patients in this cohort were identified by medical history, while 23.7% were diagnosed by serology following initiation of care. 39.0% of all patients received surgical treatment during initial hospitalization, of whom 4.3% had a diagnosed BPI. History of intravenous drug use (odds ratio [OR] 6.79, P < 0.001), assault-related injury (OR 1.61, P = 0.003), positive toxicology screen (OR 1.56, P = 0.004), and male gender (OR 1.53, P = 0.037) were significantly associated with a BPI diagnosis. CONCLUSION Patients presenting with facial fractures commonly harbor a BPI. The benefit of early diagnosis and risk to surgical staff may justify routine screening for BPI in high risk facial trauma patients (male, assault-related injury, and history of intravenous drug use).
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Ma J, Chen X, Zheng Q, Zhang Y, Ming Z, Wang D, Wu H, Ye H, Zhou X, Xu Y, Li R, Sheng X, Fan F, Yang Z, Luo T, Lu Y, Deng Y, Yang F, Liu C, Liu C, Li X. Serious Workplace Violence Against Healthcare Providers in China Between 2004 and 2018. Front Public Health 2021; 8:574765. [PMID: 33520908 PMCID: PMC7841458 DOI: 10.3389/fpubh.2020.574765] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: Workplace violence (WPV) against healthcare providers has severe consequences and is underreported worldwide. The aim of this study was to present the features, causes, and outcomes of serious WPV against healthcare providers in China. Method: We searched for serious WPV events reported online and analyzed information about time, location, people, methods, motivations, and outcomes related to the incident. Result: Serious WPV reported online in China (n = 379) were mainly physical (97%) and often involved the use of weapons (34.5%). Doctors were victims in most instances (81.1%). Serious WPV mostly happened in cities (90.2%), teaching hospitals (87.4%), and tertiary hospitals (67.9%) and frequently in Emergency Department (ED), Obstetrics and Gynecology Department (OB-GYN), and pediatric departments; it was most prevalent in the months of June, May, and February. Rates of serious WPV increased dramatically in 2014 and decreased after 2015, with death (12.8%), severe injury (6%), and hospitalization (24.2%) being the major outcomes. A law protecting healthcare providers implemented in 2015 may have helped curb the violence. Conclusion: Serious WPV in China may stem from poor patient-doctor relationships, overly stressed health providers in highly demanding hospitals, poorly educated/informed patients, insufficient legal protection, and poor communication. Furthering knowledge about WPV and working toward curtailing its presence in healthcare settings are crucial to increasing the safety and well-being of healthcare workers.
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Affiliation(s)
- Jing Ma
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Xi Chen
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Qiongjuan Zheng
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Yun Zhang
- Medical College of Northwest University for Nationalities, Lanzhou, China
| | - Zhi Ming
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Dongxin Wang
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Hua Wu
- Furong Forensic Center of The Second People's Hospital of Hunan Province, Yuhua, China
| | - Haisen Ye
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoxuan Zhou
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Yunxuan Xu
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Renjiao Li
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Xia Sheng
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Fangxiu Fan
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Zuiwen Yang
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Ting Luo
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Yajun Lu
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Ye Deng
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Fen Yang
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Chuntao Liu
- Department of Child and Adolescent Psychiatry, School of Clinical Medicine, The Second People's Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Chunyu Liu
- Department of Psychiatry, Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Xiaosong Li
- Hunan Provincial People's Hospital, Changsha, China
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12
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Walker GN, Dekker AM, Hampton DA, Akhetuamhen A, Moore PQ. A Case for Risk Stratification in Survivors of Firearm and Interpersonal Violence in the Urban Environment. West J Emerg Med 2020; 21:132-140. [PMID: 33207158 PMCID: PMC7673864 DOI: 10.5811/westjem.2020.8.45041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 08/06/2020] [Indexed: 11/11/2022] Open
Abstract
The emergency department (ED) serves as the main source of care for patients who are victims of interpersonal violence. As a result, emergency physicians across the nation are at the forefront of delivering care and determining dispositions for many at-risk patients in a dynamic healthcare environment. In the majority of cases, survivors of interpersonal violence are treated and discharged based on the physical implications of the injury without consideration for risk of reinjury and the structural drivers that may be at play. Some exceptions may exist at institutions with hospital-based violence intervention programs (HVIPs). At these institutions, disposition decisions often include consideration of a patient’s risk for repeat exposure to violence. Ideally, HVIP services would be available to all survivors of interpersonal violence, but a variety of current constraints limit availability. Here we offer a scoping review of HVIPs and our perspective on how risk-stratification could help emergency physicians determine which patients will benefit most from HVIP services and potentially reduce re-injury secondary to interpersonal violence.
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Affiliation(s)
- Garth N Walker
- Northwestern Buehler Center Health Economics and Policy and Northwestern Department of Emergency Medicine, Chicago, Illinois
| | - Annette M Dekker
- University of California, Los Angeles, Department of Emergency Medicine, Los Angeles, California
| | - David A Hampton
- University of Chicago, Department of Surgery, Section of Trauma and Acute Care Surgery, Chicago, Illinois
| | - Adesuwa Akhetuamhen
- Northwestern Buehler Center Health Economics and Policy and Northwestern Department of Emergency Medicine, Chicago, Illinois
| | - P Quincy Moore
- University of Chicago, Department of Medicine, Section of Emergency Medicine, Chicago, Illinois
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13
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Decker HC, Hubner G, Nwabuo A, Johnson L, Texada M, Marquez R, Orellana J, Henderson T, Dicker R, Plevin RE, Juillard C. "You don't want anyone who hasn't been through anything telling you what to do, because how do they know?": Qualitative analysis of case managers in a hospital-based violence intervention program. PLoS One 2020; 15:e0234608. [PMID: 32579607 PMCID: PMC7313749 DOI: 10.1371/journal.pone.0234608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 05/31/2020] [Indexed: 11/18/2022] Open
Abstract
STATEMENT OF PURPOSE Intentional violent injury is a leading cause of disability and death among young adults in the United States. Hospital-based violence intervention programs (HVIPs), which strive to prevent re-injury through intensive case management, have emerged as a successful and cost-effective strategy to address this issue. Despite the importance of strong therapeutic relationships between clients and their case managers, specific case manager behaviors and attributes that drive the formation of these relationships have not been elucidated. METHODS A qualitative analysis with a modified grounded theory approach was conducted to gain insight into what clients perceive to be crucial to the formation of a strong client-case manager relationship. Twenty-four semi-structured interviews were conducted with prior clients of our hospital's HVIP. The interviews were analyzed using constant comparison method for recurrent themes. RESULTS Several key themes emerged from the interviews. Clients emphasized that their case managers must: 1) understand and relate to their sociocultural contexts, 2) navigate the initial in-hospital meeting to successfully create connection, 3) exhibit true compassion and care, 4) serve as role models, 5) act as portals of opportunity, and 6) engender mutual respect and pride. CONCLUSIONS This study identifies key behaviors of case managers that facilitate the formation of strong therapeutic relationships at the different stages of client recovery. This study's findings emphasize the importance of case managers being culturally aligned with and embedded in their clients' communities. This work can provide a roadmap for case managers to form optimally effective relationships with clients.
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Affiliation(s)
- Hannah C. Decker
- Department of Surgery, University of California at San Francisco, San Francisco, California, United States of America
| | - Gwendolyn Hubner
- Department of Surgery, University of California at San Francisco, San Francisco, California, United States of America
| | - Adaobi Nwabuo
- Department of Surgery, University of California at San Francisco, San Francisco, California, United States of America
| | - Leslie Johnson
- Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Michael Texada
- Department of Surgery, University of California at San Francisco, San Francisco, California, United States of America
| | - Ruben Marquez
- Department of Surgery, University of California at San Francisco, San Francisco, California, United States of America
| | - Julia Orellana
- Department of Surgery, University of California at San Francisco, San Francisco, California, United States of America
| | - Terrell Henderson
- Department of Surgery, University of California at San Francisco, San Francisco, California, United States of America
| | - Rochelle Dicker
- Department of Surgery, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Rebecca E. Plevin
- Department of Surgery, University of California at San Francisco, San Francisco, California, United States of America
| | - Catherine Juillard
- Department of Surgery, University of California at Los Angeles, Los Angeles, California, United States of America
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14
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Simske NM, Rivera T, Breslin MA, Hendrickson SB, Simpson M, Kalina M, Ho VP, Vallier HA. Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period. Trauma Surg Acute Care Open 2020; 5:e000363. [PMID: 32072016 PMCID: PMC6996789 DOI: 10.1136/tsaco-2019-000363] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The primary goal of the present study is to describe the psychosocial support services provided at our institution and the evolution of such programming through time. This study will also report the demographics and injury patterns of patients using available resources. METHODS Trauma Recovery Services (TRS) is a social and psychological support program that provides services and resources to patients and families admitted to our hospital. It includes a number of different services such as emotional coaching from licensed counselors, educational materials, peer mentorship from trauma survivors, monthly support groups, post-traumatic stress disorder (PTSD) screening and programming for victims of crime. Patients using services were prospectively recorded by hired staff, volunteers and students who engaged in distributing programming. Demographics and injury characteristics were retrospectively gathered from patient's medical records. RESULTS From May of 2013 through December 2018, a total of 4977 discrete patients used TRS at an urban level 1 trauma center. During the study period, 31.4% of the 15 640 admitted adult trauma patients were exposed to TRS and this increased from 7.2% in 2013 to 60.1% in 2018. During the period of 5.5 years, 3317 patients had 'direct contact' (coaching and/or educational materials) and 1827 patients had at least one peer visit. The average number of peer visits was 2.7 per patient (range: 2-15). Of the 114 patients who attended support groups over 4 years, 55 (48%) attended more than one session, with an average of 3.9 visits (range: 2-10) per patient. After the establishment of PTSD screening and Victims of Crime Advocacy and Recovery Program (VOCARP) services in 2017, a total of 482 patients were screened for PTSD and 974 patients used VOCARP resources during the period of 2 years, with substantial growth from 2017 to 2018. CONCLUSIONS Hospital-provided resources aimed at educating patients, expanding support networks and bolstering resiliency were popular at our institution, with nearly 5000 discrete patients accessing services during a period of 5.5 years. Moving forward, greater investigation of program usage, development, and efficacy is necessary. LEVEL OF EVIDENCE Level II therapeutic.
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Affiliation(s)
| | - Trenton Rivera
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mary A Breslin
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | | | - Megen Simpson
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mark Kalina
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Vanessa P Ho
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
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15
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Kao AM, Schlosser KA, Arnold MR, Kasten KR, Colavita PD, Davis BR, Sing RF, Heniford BT. Trauma Recidivism and Mortality Following Violent Injuries in Young Adults. J Surg Res 2019; 237:140-147. [DOI: 10.1016/j.jss.2018.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/16/2018] [Accepted: 09/04/2018] [Indexed: 11/15/2022]
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