1
|
Harries M. Youth Gun Violence. Pediatr Ann 2024; 53:e197-e199. [PMID: 38852080 DOI: 10.3928/19382359-20240407-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Gun violence is a rapidly growing concern for youth. As rates of death by firearm rise, so does exposure to firearm violence and high levels of accompanying morbidity. Although gun violence cannot be attributed to any one cause, it is important pediatric health care providers understand the prevalence of this issue. Additionally, the long-term health effects are profound with many victims of, and witnesses to, gun violence experiencing new symptoms of general anxiety disorder. There are numerous initiatives taking place at the individual, local, and national levels to address this public health crisis. An overview of such interventions is also presented. With better screening and treatment of upstream and downstream symptoms of youth gun violence, pediatricians can decrease the morbidity and mortality that results from firearm use. [Pediatr Ann. 2024;53(6):e197-e199.].
Collapse
|
2
|
Osborne MC, Reidy DE, Temple JR, DeMello A, Lu Y. Examining the Relation Between Early Violence Exposure and Firearm-Related Experiences in Emerging Adulthood: A Longitudinal Cohort Study. Psychol Rep 2024:332941241254313. [PMID: 38738909 DOI: 10.1177/00332941241254313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Firearms are a leading cause of death among adolescents and young adults in the United States. Early exposure to violence, as a victim or witness, is associated with increased risk of firearm-related experiences, including carrying and threatening others with a gun. These experiences, in turn, increase the risk of both fatal and non-fatal firearm injuries. Using an ethnically diverse sample of emerging adults, we build on prior research by examining the link between early violence exposure at multiple contexts of the social-ecological model and multiple firearm-related experiences (i.e., firearm-threatening victimization, firearm-threatening perpetration, and firearm carriage). We analyzed data from a 10-year longitudinal study of 1042 youth in the Southern United States. Experiencing childhood physical abuse was associated with both firearm-threatening victimization and perpetration in emerging adulthood. Additionally, exposure to neighborhood and interparental violence were linked to threatening others with firearms and carrying firearms, respectively. Counter to expectations, bullying victimization did not emerge as a predictor of any firearm-related experiences. Findings highlight the importance of cross-cutting violence prevention efforts to prevent high-risk firearm-related behaviors among emerging adults. Programs for children and adolescents that address these types of violence exposure should highlight coping skills and sources of positive social support to bolster protective factors against firearm-related outcomes.
Collapse
Affiliation(s)
- Melissa C Osborne
- Wellstar School of Nursing, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Dennis E Reidy
- School of Public Health, Georgia State University, Atlanta, GA, USA;Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Jeff R Temple
- Center for Violence Prevention, UTHealth, Houston, TX, USA; School of Behavioral Health Sciences, UTHealth, Houston, TX, USA
| | - Annalyn DeMello
- School of Nursing, University of Texas Medical Branch, Galveston, TX, USA
| | - Yu Lu
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| |
Collapse
|
3
|
Miller T, Downing J, Wheeler L, Fischer K. The Medical Costs of Firearm Injuries in the United States: A Systematic Review. J Emerg Med 2024; 66:109-132. [PMID: 38262782 DOI: 10.1016/j.jemermed.2023.08.013] [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: 06/22/2023] [Accepted: 08/10/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Firearm injury poses a significant public health burden in the United States. OBJECTIVES The purpose of this systematic review was to provide a comprehensive accounting of the medical costs of firearm injuries in the United States. METHODS A systematic literature review was conducted to identify studies published between January 1, 2000 and July 13, 2022 that reported medical costs of firearm injuries. A search of Embase, PubMed, and the Cochrane Library databases was performed by a medical librarian. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate for risk of bias. Health care-related charges and costs per firearm injury were presented and trends were identified. RESULTS Sixty-four studies were included in the analysis. Study sample sizes ranged from 18 to 868,483 patients. Reported costs per injury ranged from $261 to $529,609. The median cost reported was $27,820 (interquartile range [IQR] $15,133-$40,124) and median charge reported was $53,832 (IQR $38,890-$98,632). Studies that divided initial hospitalization costs and follow-up medical costs identified that initial hospitalization accounts for about 60% of total costs. CONCLUSIONS We found a significant volume of literature about the medical costs of firearm injury, which identified a highly heterogeneous cost burden. A significant amount of cost burden occurs after the index hospitalization, which is the only cost reported in most studies. Limitations of this study include reporting bias that favors hospitalized patients as well as a large focus on hospital charges as measurements of cost identified in the literature.
Collapse
Affiliation(s)
- Taylor Miller
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jessica Downing
- The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lauren Wheeler
- Health Sciences & Human Services Library, University of Maryland, Baltimore, Maryland
| | - Kyle Fischer
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
4
|
Pulcini CD, Hoffmann JA, Alpern ER, Chaudhary S, Ehrlich PF, Fein JA, Fleegler EW, Goyal MK, Hall M, Jeffries KN, Myers R, Sheehan KM, Zamani M, Zima BT, Hargarten S. A Holistic Approach to Childhood Firearm Injuries. Pediatrics 2024; 153:e2023063322. [PMID: 38087959 PMCID: PMC10752822 DOI: 10.1542/peds.2023-063322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 12/30/2023] Open
Affiliation(s)
- Christian D. Pulcini
- Department of Emergency Medicine & Pediatrics, University of Vermont Medical Center and Children’s Hospital, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, CS Mott Children’s Hospital, University of Michigan Ann Arbor, Ann Arbor, Michigan
| | - Joel A. Fein
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric W. Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School; Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Kristyn N. Jeffries
- Department of Pediatrics, Section of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rachel Myers
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen M. Sheehan
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark Zamani
- Children’s Hospital Association, Lenexa, Kansas
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Stephen Hargarten
- Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | |
Collapse
|
5
|
Henry MC, Ehrlich PF, Flynn O'Brien KT, Griggs C, Hartman HA, Kotagal M, Masiakos P, Naik-Mathuri B, Sathya C, Stevens J, Thomas A, Trinidad S, Williams R, Campbell BT. Pediatric Surgery Firearm Injury Collaborative Symposium. J Pediatr Surg 2024; 59:68-73. [PMID: 37875380 DOI: 10.1016/j.jpedsurg.2023.09.031] [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: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023]
Abstract
Injury from a firearm is now the leading cause of death of children and youth under age 19 in the United States (U.S.) [1] and the incidence of these deaths continues to increase each year [2]. For every death from firearm violence, there are several young people who have been injured by a bullet but not killed. As pediatric surgeons, we are on the front lines of treating these young patients. We have the unforgettable memories of delivering the horrible news to parents in "quiet rooms." [3]. As these injuries fall within our scope of practice, it is incumbent on us as professionals to work to prevent these injuries, apply best practices and work for the best pathways to recovery for our patients who do survive. There is a diverse community of pediatric surgeons tackling this public health problem in a variety of ways [4]. In a pre-meeting symposium at the APSA 2023 Annual meeting, we brought together a community of pediatric surgeons working on this critical area. The following summarizes the presentations of the symposium, with topics including Risk Factors, Injury Prevention, Treatment, Public Initiatives, and National Collaborative Efforts. TYPE OF STUDY: Review Article, Proceedings of a Symposium. LEVEL OF EVIDENCE: 1 through 4 all presented.
Collapse
Affiliation(s)
- Marion C Henry
- Section of Pediatric Surgery, The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL, USA.
| | - Peter F Ehrlich
- Section of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | | | - Cornelia Griggs
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Center for Gun Violence Prevention, Boston, MA, USA
| | - Heather A Hartman
- Section of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Peter Masiakos
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Center for Gun Violence Prevention, Boston, MA, USA
| | - Bindi Naik-Mathuri
- Department of Surgery, Division of Pediatric Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Chethan Sathya
- Cohen Children's Medical Center at Northwell Health, Zucker-Hofstra School of Medicine, Queens, NY, USA
| | - Jenny Stevens
- Department of Surgery, Louisiana State University, New Orleans, LA, USA
| | - Arielle Thomas
- Department of Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Regan Williams
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brendan T Campbell
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
| |
Collapse
|
6
|
Lennon T, Kemal S, Heffernan ME, Bendelow A, Sheehan K, Davis MM, Macy ML. Childhood Exposure to Firearm Violence in Chicago and Its Impact on Mental Health. Acad Pediatr 2023:S1876-2859(23)00467-9. [PMID: 38101617 DOI: 10.1016/j.acap.2023.12.001] [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: 09/24/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To describe how often Chicago children are exposed to firearm violence, the types of exposure, and the parent-reported impact of these exposures on child mental health symptoms. METHODS Data were collected in May-July 2022 using the Voices of Child Health in Chicago Parent Panel Survey, administered to parents with children aged 2-17 years from all 77 Chicago neighborhoods. Firearm violence exposure was characterized as indirect (hearing gunshots or knowing someone who was shot) or direct (witnessing a shooting, being threatened with a firearm, being shot at but not injured, or being shot and injured). Parents indicated if children in their household had any of the following mental health symptoms associated with firearm violence exposure: fear, anxiety, sadness, isolation, difficulty concentrating, difficulty in school, or aggression. Chi-squared tests and multivariable logistic regression models were used for statistical analysis. RESULTS Responses were received from 989 Chicago parents. More than one third (37%) of children were exposed to firearm violence with an indirect exposure prevalence of 32% and a direct exposure prevalence of 10%. Mental health symptoms associated with firearm violence exposure were reported for 20% of children. Mental health symptoms were reported for 7% of children without firearm violence exposure compared to 31% with indirect exposure (aOR 6.2, 95% CI: 3.7, 10.6) and 68% with direct exposure (aOR 36.1, 95% CI: 16.6, 78.6) CONCLUSIONS: Chicago children with indirect and direct exposure to firearm violence had more parent-reported mental health symptoms than unexposed children. Trauma informed care approaches to mitigate the negative mental health effects of both direct and indirect firearm violence exposure are critical.
Collapse
Affiliation(s)
- Tyler Lennon
- Division of Emergency Medicine (T Lennon, S Kemal, K Sheehan, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill.
| | - Samaa Kemal
- Division of Emergency Medicine (T Lennon, S Kemal, K Sheehan, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| | - Marie E Heffernan
- Smith Child Health Outcomes, Research, and Evaluation Center (ME Heffernan and ML Macy), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| | - Anne Bendelow
- Data Analytics and Reporting (A Bendelow), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| | - Karen Sheehan
- Division of Emergency Medicine (T Lennon, S Kemal, K Sheehan, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care (MM Davis), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Ill
| | - Michelle L Macy
- Division of Emergency Medicine (T Lennon, S Kemal, K Sheehan, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill; Smith Child Health Outcomes, Research, and Evaluation Center (ME Heffernan and ML Macy), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Kemal S, Nwabuo A, Hoffmann J. Mental Health and Violence in Children and Adolescents. Pediatr Clin North Am 2023; 70:1201-1215. [PMID: 37865440 DOI: 10.1016/j.pcl.2023.06.011] [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] [Indexed: 10/23/2023]
Abstract
This article examines the complex interplay between mental health and violence among children. Although children with mental illness are more likely to be victims of violence than perpetrators, this article describes the few mental health conditions associated with increased violent behavior among children. Next, the authors examine the spectrum of mental health sequelae among children following exposure to various forms of violence. Lastly, the authors discuss the underutilization of mental health services in this population and highlight screening and intervention tools available to pediatric clinicians caring for children exposed to violence.
Collapse
Affiliation(s)
- Samaa Kemal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611, USA.
| | - Adaobi Nwabuo
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, 2230 Stockton Boulevard, Sacramento, CA 95817, USA
| | - Jennifer Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611, USA
| |
Collapse
|
9
|
Hoffmann JA, Pulcini CD, Hall M, De Souza HG, Alpern ER, Chaudhary S, Ehrlich PF, Fein JA, Fleegler EW, Goyal MK, Hargarten S, Jeffries KN, Zima BT. Timing of Mental Health Service Use After a Pediatric Firearm Injury. Pediatrics 2023; 152:e2023061241. [PMID: 37271760 PMCID: PMC10694862 DOI: 10.1542/peds.2023-061241] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES To examine how timing of the first outpatient mental health (MH) visit after a pediatric firearm injury varies by sociodemographic and clinical characteristics. METHODS We retrospectively studied children aged 5 to 17 years with a nonfatal firearm injury from 2010 to 2018 using the IBM Watson MarketScan Medicaid database. Logistic regression estimated the odds of MH service use in the 6 months after injury, adjusted for sociodemographic and clinical characteristics. Cox proportional hazard models, stratified by previous MH service use, evaluated variation in timing of the first outpatient MH visit by sociodemographic and clinical characteristics. RESULTS After a firearm injury, 958 of 2613 (36.7%) children used MH services within 6 months; of these, 378 of 958 (39.5%) had no previous MH service use. The adjusted odds of MH service use after injury were higher among children with previous MH service use (adjusted odds ratio, 10.41; 95% confidence interval [CI], 8.45-12.82) and among non-Hispanic white compared with non-Hispanic Black children (adjusted odds ratio, 1.29; 95% CI, 1.02-1.63). The first outpatient MH visit after injury occurred sooner among children with previous MH service use (adjusted hazard ratio, 6.32; 95% CI, 5.45-7.32). For children without previous MH service use, the first MH outpatient visit occurred sooner among children with an MH diagnosis made during the injury encounter (adjusted hazard ratio, 2.72; 95% CI, 2.04-3.65). CONCLUSIONS More than 3 in 5 children do not receive MH services after firearm injury. Previous engagement with MH services and new detection of MH diagnoses during firearm injury encounters may facilitate timelier connection to MH services after injury.
Collapse
Affiliation(s)
- Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christian D. Pulcini
- Department of Emergency Medicine & Pediatrics, University of Vermont Medical Center and Children’s Hospital, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS, USA
| | | | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, CS Mott Children’s Hospital University of Michigan Ann Arbor, Michigan, USA
| | - Joel A. Fein
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Eric W. Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School; Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington, DC, USA
| | - Stephen Hargarten
- Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristyn N. Jeffries
- Department of Pediatrics, Section of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
10
|
Pulcini CD, Goyal MK, Hall M, De Souza HG, Chaudhary S, Alpern ER, Fein JA, Fleegler EW. Two-Year Utilization and Expenditures for Children After a Firearm Injury. Am J Prev Med 2022; 63:875-882. [PMID: 36075816 DOI: 10.1016/j.amepre.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Firearm injuries are a leading cause of morbidity among children, but data on healthcare utilization and expenditures after injury are limited. This study sought to analyze healthcare encounters and expenditures for 2 years after a nonfatal firearm injury. METHODS A retrospective cohort study was conducted between 2020 and 2022 of children aged 0-18 years with International Classification of Diseases, Ninth Revision/ICD-10 diagnosis codes for firearm injury from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included the difference in healthcare encounters and expenditures, including mental health. Descriptive statistics characterized patient demographics and healthcare utilization. Changes in health expenditures were evaluated with Wilcoxon sign rank tests. RESULTS Among 911 children, there were 12,757 total healthcare encounters in the year before the index firearm injury, 15,548 1 encounters in the year after (p<0.001), and 10,228 total encounters in the second year (p<0.001). Concomitantly, there was an overall increase of $14.4 million in health expenditures ($11,415 per patient) 1 year after (p<0.001) and a $0.8 million decrease 2 years after the firearm injury (p=0.001). The children with low previous expenditures (majority of sample) had sustained increases throughout the second year after injury. There was a 31% and 37% absolute decrease in mental health utilization and expenditures, respectively, among children 2 years after the firearm injury. CONCLUSIONS Children who experience nonfatal firearm injury have an increased number of healthcare encounters and healthcare expenditures in the year after firearm injury, which is not sustained for a second year. Mental health utilization and expenditures remain decreased up to 2 years after a firearm injury. More longitudinal research on the morbidity associated with nonfatal firearm injuries is needed.
Collapse
Affiliation(s)
- Christian D Pulcini
- Department of Emergency Medicine and Pediatrics, University of Vermont Medical Center and Children's Hospital, Larner College of Medicine, The University of Vermont, Burlington, Vermont.
| | - Monika K Goyal
- Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, District of Columbia
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | | | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth R Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joel A Fein
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric W Fleegler
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|