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Hale ME, Pinkman K, Quinoy AM, Schoffner KR. Identifying mental health outcomes and evidence-based psychological interventions for supporting pediatric gunshot wound patients: A systematic review and proposed conceptual model. BMC Pediatr 2024; 24:397. [PMID: 38890635 PMCID: PMC11184880 DOI: 10.1186/s12887-024-04878-w] [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: 03/10/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Accidental and assault gunshot wounds (GSWs) are the second leading cause of injury in the United States for youth ages 1- to 17-years-old, resulting in significant negative effects on pediatric patients' mental health functioning. Despite the critical implications of GSWs, there has yet to be a systematic review synthesizing trends in mental health outcomes for pediatric patients; a gap the present review fills. Additionally, this review identifies evidence-based psychological interventions shown to be effective in the treatment of subclinical symptoms of psychological disorders in the general population. METHODS A comprehensive search was conducted using five databases: American Psychological Association (APA) PsycInfo, APA PsycArticles, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resource Information Center (ERIC), and Medical Literature Analysis and Retrieval Systems Online (MEDLINE). Twenty-two articles met inclusion criteria. RESULTS Findings suggest pediatric GSW patients are at a significantly elevated risk for mental health disorders when compared to other- (e.g., motor vehicle collision) and non-injured youth. Disorders include post-traumatic stress, disruptive behavior, anxiety, depression, and substance use. Hospital-based violence intervention programs, cultivating supportive relationships with adults in one's community, and trauma-focused outpatient services were identified as effective interventions for treating subclinical psychological symptoms. CONCLUSIONS Depicted in the proposed conceptual model, the present study delineates a direct association between pediatric GSWs and subsequent onset of mental health disorders. This relation is buffered by evidence-based psychological interventions targeting subclinical symptoms. Results suggest brief psychological interventions can help treat mental health challenges, minimizing risk for significant long-term concerns. Cultural adaptations to enhance the utility and accessibility of interventions for all patients are recommended.
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Affiliation(s)
- Molly E Hale
- Department of Psychology, University of Georgia, Athens, GA, USA.
| | - Kahyah Pinkman
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Alexis M Quinoy
- Department of Neuropsychology and Rehabilitation Services, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Kindell R Schoffner
- Department of Neuropsychology and Rehabilitation Services, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory School of Medicine, Atlanta, GA, USA
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Welbeck A, Torres-Izquierdo B, Mittal MM, Momtaz D, Gonuguntla R, Guisse N, Hu J, Pereira DE, Hosseinzadeh P. Epidemiology of Pediatric Firearm Injuries in the United States: The Progression of Gunshot Injury Rates Through the Coronavirus Disease 2019 Pandemic. J Pediatr Orthop 2024:01241398-990000000-00580. [PMID: 38853750 DOI: 10.1097/bpo.0000000000002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
OBJECTIVES Ballistic injuries among pediatric populations have become a public health crisis in the United States. The surge in firearm injuries among children has outpaced other causes of death. This study aims to assess the trend in pediatric gunshot injuries (GSIs) over the last decade and investigate the impact, if any, of the pandemic on GSIs statistics. METHODS A comprehensive retrospective analysis was conducted using a federated, real-time national database. A total of 15,267,921 children without GSIs and 6261 children with GSIs between 2017 and 2023 were identified. The study evaluated the incidence and annual proportions of GSIs among different demographics. In addition, the incidence proportions per 100,000 for accidental, nonaccidental, fracture-related, and fatal GSIs were analyzed. RESULTS The incidence proportions per 100,000 for GSIs, accidental GSIs, nonaccidental GSIs, fatal GSIs, wheelchair-bound cases, and fracture-related GSIs increased significantly from 2017 to 2023, going from 9.7 to 22.8 (Relative Risk: 2.342, 95% CI: 2.041, 2.687, P < 0.001). The overall increase was mostly a result of accidental GSI when compared with nonaccidental (incidence proportion 25.8 vs 2.1; P < 0.001) in 2021 at the height of the pandemic. In patients with an accidental GSI, the incidence proportion per 100k between 2017 and 2023 increased from 8.81 to 21.11 (Relative Risk: 2.397, 95% CI: 2.076, 2.768, P < 0.001). CONCLUSION The study supports the shift in the leading cause of death among children from motor vehicle accidents to GSIs, with the continued rise in rates despite the coronavirus disease 2019 pandemic. Accidental injuries constituted the majority of GSIs, indicating the need for enhanced gun safety measures, including requirements for gun storage, keeping firearms locked and unloaded, requiring child supervision in homes with guns, and enforcing stricter punishments as penalties. Comprehensive efforts are required to address this public health crisis. Pediatricians play a vital role in counseling and educating families on firearm safety. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Arakua Welbeck
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
| | | | - Mehul M Mittal
- Department of Orthopaedics, UT Southwestern Medical Center, Dallas, TX
| | - David Momtaz
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Rishi Gonuguntla
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Ndéye Guisse
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
| | - Jesse Hu
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
| | - Daniel E Pereira
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
| | - Pooya Hosseinzadeh
- Department of Orthopaedics, School of Medicine, Washington University, St. Louis, MO
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Schauss E, Zettler H, Hawes K, Rashed J, Roberts S, Ahern B, Bartelli D, Li C, Burgess M, Williams R. Call to Action: The Rise of Pediatric Gun Violence During the COVID-19 Pandemic. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:209-215. [PMID: 38938973 PMCID: PMC11199448 DOI: 10.1007/s40653-023-00568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 06/29/2024]
Abstract
This study examines and describes circumstances involving non-fatal firearm injuries in a pediatric population from a Level I Pediatric Trauma Center in the southeastern U.S. Researchers analyzed Firearm Injury Questionnaire (FIQ) data collected from 144 children and adolescents, aged 2-17 years, who were treated in the emergency department and/or admitted to the hospital for non-fatal firearm injuries. Descriptive statistics are presented regarding participant demographics and FIQ responses, such as caregiver information, mental health history, adverse childhood experience (ACE) exposure, firearm access, injury intent, relationship to shooter, type of firearm used, and context of injury. Most patients identified as Black (82%) and male (75%), with most injuries categorized as intentional (72%) versus unintentional (24%) assaults. The average ACEs score was .60, with only 37% of patients' reporting any ACE experience; however, nearly half (47%) of patients reported experiencing a traumatic event beyond an identified ACE. Community violence was the most common context that attributed to patients' assaults (56%). As U.S. pediatric gun injury and fatality trends are increasing, this study provides timely data regarding pediatric firearm injuries and exposure to community violence. These findings highlight the need to provide integrated health services to pediatric patients experiencing non-fatal firearm injuries. Researchers discuss public health implications for integrated mental health care services, hospital- and school-based violence intervention programs, policy recommendations, and directions for future research. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-023-00568-4.
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Affiliation(s)
- Eraina Schauss
- Department of Counseling, Educational Psychology & Research, The BRAIN Center at the University of Memphis, Patterson Hall Room 123, Memphis, TN 38152 USA
| | - Haley Zettler
- Department of Criminal Justice, University of North Texas, Chilton Hall 273G, Denton, TX 76203-1277 USA
| | - Kiersten Hawes
- Department of Counseling, Educational Psychology & Research, The BRAIN Center at the University of Memphis, Patterson Hall Room 123, Memphis, TN 38152 USA
| | - Jihan Rashed
- Department of Counseling, Educational Psychology & Research, The BRAIN Center at the University of Memphis, Patterson Hall Room 123, Memphis, TN 38152 USA
| | - Sydnie Roberts
- Department of Counseling, Educational Psychology & Research, The BRAIN Center at the University of Memphis, Patterson Hall Room 123, Memphis, TN 38152 USA
| | - Brian Ahern
- Department of Counseling, Educational Psychology & Research, The BRAIN Center at the University of Memphis, Patterson Hall Room 123, Memphis, TN 38152 USA
| | - Debra Bartelli
- Department of Counseling, Educational Psychology & Research, The BRAIN Center at the University of Memphis, Patterson Hall Room 123, Memphis, TN 38152 USA
| | - Chi Li
- Department of Counseling, Educational Psychology & Research, The BRAIN Center at the University of Memphis, Patterson Hall Room 123, Memphis, TN 38152 USA
| | - Melanie Burgess
- Department of Counseling, Educational Psychology & Research, The BRAIN Center at the University of Memphis, Patterson Hall Room 123, Memphis, TN 38152 USA
| | - Regan Williams
- Department of Surgery and Pediatrics, University of Tennessee Health Sciences Center, 910 Madison Avenue, Memphis, TN 38163 USA
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Garcia L, de Virgilio C, Nahmias J, Keeley JA, Grigorian A. The Relationship Between the COVID-19 Pandemic and Pediatric Trauma. J Surg Res 2024; 298:169-175. [PMID: 38615550 DOI: 10.1016/j.jss.2024.03.034] [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: 09/19/2023] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The COVID-19 pandemic created difficulties in access to care. There was also increased penetrating trauma in adults, which has been attributed to factors including increased firearm sales and social isolation. However, less is known about the relationship between the pandemic and pediatric trauma patients (PTPs). This study aimed to investigate the national incidence of penetrating trauma in PTPs, hypothesizing a higher rate with onset of the pandemic. We additionally hypothesized increased risk of complications and death in penetrating PTPs after the pandemic versus prepandemic. METHODS We included all PTPs (aged ≤17-years-old) from the 2017-2020 Trauma Quality Improvement Program database, dividing the dataset into two eras: prepandemic (2017-2019) and pandemic (2020). We performed subset analyses of the pandemic and prepandemic penetrating PTPs. Bivariate analyses and a multivariable logistic regression analysis were performed. RESULTS Of the 474,524 PTPs, 123,804 (26.1%) were from the pandemic year. The pandemic era had increased stab wounds (3.3% versus 2.8%, P > 0.001) and gunshot wounds (5.5% versus 4.0%, P < 0.001) compared to the prepandemic era. Among penetrating PTPs, the rates and associated risk of in-hospital complications (2.6% versus 2.8%, P = 0.23) (odds ratio 0.90, confidence interval 0.79-1.02, P = 0.11) and mortality (4.9% versus 5.0%, P = 0.58) (odds ratio 0.90, confidence interval 0.78-1.03, P = 0.12) were similar between time periods. CONCLUSIONS This national analysis confirms increased penetrating trauma, particularly gunshot wounds in pediatric patients following onset of the COVID-19 pandemic. Despite this increase, there was no elevated risk of death or complications, suggesting that trauma systems adapted to the "dual pandemic" of COVID-19 and firearm violence in the pediatric population.
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Affiliation(s)
- Lorena Garcia
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
| | | | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine, Orange, California
| | - Jessica A Keeley
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine, Orange, California
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Wolf ER, Rivara FP, Orr CJ, Sen A, Chapman DA, Woolf SH. Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth. JAMA 2024; 331:1732-1740. [PMID: 38703403 PMCID: PMC11070063 DOI: 10.1001/jama.2024.3908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/29/2024] [Indexed: 05/06/2024]
Abstract
Importance Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. Objective To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. Design, Setting, and Participants This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Main Outcomes and Measures Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Results Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. Conclusions and Relevance In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.
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Affiliation(s)
- Elizabeth R. Wolf
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond
| | - Frederick P. Rivara
- Department of Pediatrics, University of Washington, Seattle
- Seattle Children’s Research Institute, Seattle, Washington
- Editor, JAMA Network Open
| | - Colin J. Orr
- Department of Pediatrics, University of North Carolina at Chapel Hill
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Anabeel Sen
- Department of Epidemiology, Virginia Commonwealth University School of Population Health, Richmond
| | - Derek A. Chapman
- Department of Epidemiology, Virginia Commonwealth University School of Population Health, Richmond
| | - Steven H. Woolf
- Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond
- Center on Society and Heath, Virginia Commonwealth University School of Population Health, Richmond
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Stephens CQ, Fallat ME. Setting an agenda for a national pediatric trauma system: Operationalization of the Pediatric Trauma State Assessment Score. J Trauma Acute Care Surg 2024; 96:838-850. [PMID: 37962143 DOI: 10.1097/ta.0000000000004208] [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: 11/15/2023]
Abstract
ABSTRACT Pediatric trauma system development is essential to public health infrastructure and pediatric health systems. Currently, trauma systems are managed at the state level, with significant variation in consideration of pediatric needs. A recently developed Pediatric Trauma System Assessment Score (PTSAS) demonstrated that states with lower PTSAS have increased pediatric mortality from trauma. Critical gaps are identified within six PTSAS domains: Legislation and Funding, Access to Care, Injury Prevention and Recognition, Disaster, Quality Improvement and Trauma Registry, and Pediatric Readiness. For each gap, a recommendation is provided regarding the necessary steps to address these challenges. Existing national organizations, including governmental, professional, and advocacy, highlight the potential partnerships that could be fostered to support efforts to address existing gaps. The organizations created under the US administration are described to highlight the ongoing efforts to support the development of pediatric emergency health systems.It is no longer sufficient to describe the disparities in pediatric trauma outcomes without taking action to ensure that the health system is equipped to manage injured children. By capitalizing on organizations that intersect with trauma and emergency systems to address known gaps, we can reduce the impact of injury on all children across the United States.
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Affiliation(s)
- Caroline Q Stephens
- From the Department of Surgery (C.Q.S.), University of California-San Francisco, San Francisco, CA; and Hiram C. Polk Jr Department of Surgery, University of Louisville School of Medicine (M.E.F.), Louisville, KY
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Fraser Doh K, Bishop Z, Gillings T, Johnson J, Boy A, Waris RS, Bhatia AM, Santore MT, Simon HK. Receptivity of providing firearm safety storage devices to parents along with firearms safety education. Front Public Health 2024; 12:1352400. [PMID: 38577291 PMCID: PMC10991684 DOI: 10.3389/fpubh.2024.1352400] [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: 12/08/2023] [Accepted: 02/23/2024] [Indexed: 04/06/2024] Open
Abstract
Background In the United States, 33% of households with children contain firearms, however only one-third reportedly store firearms securely. It's estimated that 31% of unintentional firearm injury deaths can be prevented with safety devices. Our objective was to distribute safe storage devices, provide safe storage education, evaluate receptivity, and assess impact of intervention at follow-up. Method At five independent, community safety events, parents received a safe storage device after completing a survey that assessed firearms storage methods and parental comfort with discussions regarding firearm safety. Follow-up surveys collected 4 weeks later. Data were evaluated using descriptive analysis. Result 320 participants completed the surveys, and 288 participants were gunowners living with children. Most participants were comfortable discussing safe storage with healthcare providers and were willing to talk with friends about firearm safety. 54% reported inquiring about firearm storage in homes their children visit, 39% stored all their firearms locked-up and unloaded, 32% stored firearms/ammunition separately. 121 (37%0.8) of participants completed the follow-up survey, 84% reported using the distributed safety device and 23% had purchased additional locks for other firearms. Conclusion Participants were receptive to firearm safe storage education by a healthcare provider and distribution of a safe storage device. Our follow up survey results showed that pairing firearm safety education with device distribution increased overall use of safe storage devices which in turn has the potential to reduce the incidence of unintentional and intentional self-inflicted firearm injuries. Providing messaging to promote utilization of safe storage will impact a firearm safety culture change.
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Affiliation(s)
- Kiesha Fraser Doh
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Zhana Bishop
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | | | | | - Angela Boy
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Emory University School of Medicine, Atlanta, GA, United States
| | - Rabbia S Waris
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Amina M Bhatia
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Matthew T Santore
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Harold K Simon
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
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Mulugeta MG, Bailey G, Parsons K, Gillespie S, Johnson LM, Doh KF, Reisner A, Blackwell LS. Trends in pediatric firearm-related injuries and disparities in acute outcomes. Front Public Health 2024; 12:1339394. [PMID: 38566791 PMCID: PMC10985139 DOI: 10.3389/fpubh.2024.1339394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Firearm-related injuries (FRI) are an increasing cause of death and injury in children. The etiology for this rise is multifactorial and includes socioeconomic factors. Despite its prevalence and documented increase over COVID-19, there is a paucity of research on disparities and the influence of social determinants of health (SDH) in pediatric FRI. This study aims to explore the epidemiology of this vulnerable population in Atlanta, trends over time and relevant dates such as COVID-19 and a state firearm law, and disparities in clinical outcomes. Methods Retrospective cohort of patients with FRI (0-20 years-old, x̄=9.8, Median = 11) presenting to our hospital EDs from January 2014 to April 2023 (N = 701) and eligible for the Trauma Registry. This period includes two major events, namely the COVID-19 pandemic (March 2020), and passage of state law Constitutional Carry Act (SB 319) (April 2022), allowing for permit-less concealed firearm carry. Single series interrupted time series (ITS) models were run and clinical outcome differences between race and insurance groups were calculated unadjusted and adjusted for confounders using inverse propensity treatment weights (IPTW). The primary outcome was mortality; secondary are admission and discharge. Results Majority of FRI involved patients who were male (76.7%), Black (74.9%), publicly insured (82.6%), ≤12 years-old (61.8%), and injured by unintentional shootings (45.6%) or assault (43.7%). During COVID-19, there was a sustained increase in FRI rate by 0.42 patients per 1,000 trauma visits per month (95% CI 0.02-0.82, p = 0.042); post-SB 319 it was 2.3 patients per 1,000 trauma visits per month (95% CI 0.23-4.31, p = 0.029). Publicly insured patients had 58% lower odds of mortality than privately insured patients (OR 0.42, 95% CI 0.18-0.99, p = 0.047). When controlled for race and mechanism of injury, among other confounding factors, this association was not significant (p = 0.652). Conclusion Pediatric FRI are increasing over time, with disproportionate burdens on Black patients, at our hospitals. Disparities in mortality based on insurance necessitate further study. As social and economic repercussions of COVID-19 are still present, and state firearm law SB 319 is still in effect, assessment of ongoing trends is warranted to inform preventative strategies.
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Affiliation(s)
| | | | - Kendall Parsons
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura M. Johnson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Kiesha Fraser Doh
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Andrew Reisner
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura S. Blackwell
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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Avila A, Lao OB, Neville HL, Yorkgitis BK, Chang HL, Thatch K, Plumley D, Larson SD, Fitzwater JW, Markley M, Pedroso F, Fischer A, Armstrong LB, Petroze RT, Snyder CW. Social determinants of health in pediatric trauma: Associations with injury mechanisms and outcomes in the context of the COVID-19 pandemic. Am J Surg 2024; 228:107-112. [PMID: 37661530 DOI: 10.1016/j.amjsurg.2023.08.019] [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: 05/13/2023] [Revised: 07/17/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Relationships between social determinants of health and pediatric trauma mechanisms and outcomes are unclear in context of COVID-19. METHODS Children <16 years old injured between 2016 and 2021 from ten pediatric trauma centers in Florida were included. Patients were stratified by high vs. low Social Vulnerability Index (SVI). Injury mechanisms studied were child abuse, ATV/golf carts, and firearms. Mechanism incidence trends and mortality were evaluated by interrupted time series and multivariable logistic regression. RESULTS Of 19,319 children, 68% and 32% had high and low SVI, respectively. Child abuse increased across SVI strata and did not change with COVID. ATV/golf cart injuries increased after COVID among children with low SVI. Firearm injuries increased after COVID among children with high SVI. Mortality was predicted by injury mechanism, but was not independently associated with SVI, race, or COVID. CONCLUSION Social vulnerability influences pediatric trauma mechanisms and COVID effects. Child abuse and firearm injuries should be targeted for prevention.
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Affiliation(s)
- Azalia Avila
- Joe DiMaggio Children's Hospital, Memorial Health, Hollywood, FL, 1005 Joe DiMaggio Dr, Hollywood, FL, 33021, USA.
| | - Oliver B Lao
- Joe DiMaggio Children's Hospital, Memorial Health, Hollywood, FL, 1005 Joe DiMaggio Dr, Hollywood, FL, 33021, USA.
| | - Holly L Neville
- Joe DiMaggio Children's Hospital, Memorial Health, Hollywood, FL, 1005 Joe DiMaggio Dr, Hollywood, FL, 33021, USA.
| | - Brian K Yorkgitis
- University of Florida, College of Medicine-Jacksonville, Department of Surgery, 655 8th St W, Jacksonville, FL, 32209, USA.
| | - Henry L Chang
- Tampa General Hospital - Children's Hospital, Tampa, FL, 1 Tampa General Cir, Tampa, FL, 33606, USA; Johns Hopkins All Children's Hospital, St Petersburg, FL, 501 6th Ave S, St. Petersburg, FL, 33701, USA.
| | - Keith Thatch
- Tampa General Hospital - Children's Hospital, Tampa, FL, 1 Tampa General Cir, Tampa, FL, 33606, USA; Johns Hopkins All Children's Hospital, St Petersburg, FL, 501 6th Ave S, St. Petersburg, FL, 33701, USA.
| | - Donald Plumley
- Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL, 92 W Miller St, Orlando, FL, 32806, USA.
| | - Shawn D Larson
- University of Florida, College of Medicine-Jacksonville, Department of Surgery, 655 8th St W, Jacksonville, FL, 32209, USA.
| | - John W Fitzwater
- Baylor Scott & White McLane Children's Medical Center, Temple, TX, 1901 SW H K Dodgen Loop, Temple, TX, 76502, USA.
| | - Michele Markley
- Salah Foundation Children's Hospital, Broward Health, Ft. Lauderdale, Florida, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA.
| | - Felipe Pedroso
- Nicklaus Children's Hospital, Miami, FL, 3100 SW 62nd Ave, Miami, FL, 33155, USA.
| | - Anne Fischer
- Palm Beach Children's Hospital, West Palm Beach, FL, 901 45th St, West Palm Beach, FL, 33407, USA.
| | - Lindsey B Armstrong
- Johns Hopkins All Children's Hospital, St Petersburg, FL, 501 6th Ave S, St. Petersburg, FL, 33701, USA.
| | - Robin T Petroze
- University of Florida, College of Medicine-Jacksonville, Department of Surgery, 655 8th St W, Jacksonville, FL, 32209, USA.
| | - Christopher W Snyder
- Johns Hopkins All Children's Hospital, St Petersburg, FL, 501 6th Ave S, St. Petersburg, FL, 33701, USA.
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Reddy AR. Child opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania. Front Public Health 2024; 12:1339334. [PMID: 38327580 PMCID: PMC10847309 DOI: 10.3389/fpubh.2024.1339334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Firearm injury is the leading cause of death in children. This study uses geospatial mapping to illustrate the burden of pediatric firearm injury in Philadelphia and assesses the relationship between Child Opportunity Index (COI) and injury, hypothesizing that lower COI zip codes would have higher injury and mortality rates. Methods Pediatric firearm injury data for children aged 0-19 years in Philadelphia, from 2015 to February 2023, was visualized by race/ethnicity, fatal versus non-fatal status, and COI for zip code. COI was then dichotomized as "High" or "Low" based on nationally normed scores and used to compare incidence and odds of mortality. Injury incidence rates by COI were calculated using weighted Poisson regression, to adjust for the total number of children in each COI category. Odds of mortality by COI, adjusted for age, sex and race/ethnicity, were calculated using multivariable logistic regression. Results Of 2,339 total pediatric firearm injuries, 366 (16%) were fatal. Males (89%), adolescents (95%) and Black children (88%) were predominately affected. Geospatial mapping showed highest burden in North and West Philadelphia, which corresponded with areas of low COI. The incidence rate ratio (IRR) of injury in low COI zip codes was 2.5 times greater than high COI (IRR 2.5 [1.93-3.22]; p < 0.01). After adjusting for age, sex, and race/ethnicity, odds of mortality in low COI zip codes was nearly twice that of high COI zip codes (aOR 1.95 [0.77-4.92]), though did not demonstrate statistical significance (p = 0.16). Conclusion Child opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania.
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Affiliation(s)
- Anireddy R. Reddy
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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11
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Hoffmann JA, Carter CP, Olsen CS, Chaudhari PP, Chaudhary S, Duffy S, Glomb N, Goyal MK, Grupp-Phelan J, Haasz M, Ketabchi B, Kravitz-Wirtz N, Lerner EB, Shihabuddin B, Wendt W, Cook LJ, Alpern ER. Pediatric Firearm Injury Emergency Department Visits From 2017 to 2022: A Multicenter Study. Pediatrics 2023; 152:e2023063129. [PMID: 37927086 PMCID: PMC10842699 DOI: 10.1542/peds.2023-063129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Pediatric firearm injuries increased during the coronavirus disease 2019 pandemic, but recent trends in firearm injury emergency department (ED) visits are not well described. We aimed to assess how pediatric firearm injury ED visits during the pandemic differed from expected prepandemic trends. METHODS We retrospectively studied firearm injury ED visits by children <18 years old at 9 US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry before (January 2017 to February 2020) and during (March 2020 to November 2022) the pandemic. Multivariable Poisson regression models estimated expected visit rates from prepandemic data. We calculated rate ratios (RRs) of observed to expected visits per 30 days, overall, and by sociodemographic characteristics. RESULTS We identified 1904 firearm injury ED visits (52.3% 15-17 years old, 80.0% male, 63.5% non-Hispanic Black), with 694 prepandemic visits and 1210 visits during the pandemic. Death in the ED/hospital increased from 3.1% prepandemic to 6.1% during the pandemic (P = .007). Firearm injury visits per 30 days increased from 18.0 prepandemic to 36.1 during the pandemic (RR 2.09, 95% CI 1.63-2.91). Increases beyond expected rates were seen for 10- to 14-year-olds (RR 2.61, 95% CI 1.69-5.71), females (RR 2.46, 95% CI 1.55-6.00), males (RR 2.00, 95% CI 1.53-2.86), Hispanic children (RR 2.30, 95% CI 1.30-9.91), and Black non-Hispanic children (RR 1.88, 95% CI 1.34-3.10). CONCLUSIONS Firearm injury ED visits for children increased beyond expected prepandemic trends, with greater increases among certain population subgroups. These findings may inform firearm injury prevention efforts.
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Affiliation(s)
- Jennifer A Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Camille P Carter
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Cody S Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Sofia Chaudhary
- Division of Emergency Medicine, Department of Pediatrics and Department of Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Susan Duffy
- Departments of Emergency Medicine and Pediatrics, Brown University, Hasbro Children's Hospital, Providence, Rhode Island
| | - Nicolaus Glomb
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California
| | - Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Bijan Ketabchi
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Nicole Kravitz-Wirtz
- Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | - E Brooke Lerner
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Bashar Shihabuddin
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Wendi Wendt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
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12
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Donnelly KA, Goyal MK. The Epidemiology of Violence Exposure in Children. Pediatr Clin North Am 2023; 70:1057-1068. [PMID: 37865430 DOI: 10.1016/j.pcl.2023.06.005] [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
Exposure to violence remains a significant issue for children in the United States. The COVID-19 pandemic exacerbated many of these exposures. Violence unequally impacts children of color and lesbian, gay, bisexual, transgender, and questioning youth. Pediatricians can and must continue to advocate and intervene to decrease pediatric violence exposure and its effects.
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Affiliation(s)
- Katie A Donnelly
- Children's National Hospital, The George Washington University, 111 Michigan Avenue NW, Washington, DC 20010, USA.
| | - Monika K Goyal
- Children's National Hospital, The George Washington University, 111 Michigan Avenue NW, Washington, DC 20010, USA
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13
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Bleyer A, Siegel SE, Thomas CR. Retrospective evidence for pediatric benefit of U.S. assault weapons ban as rationale for implementing an even more effective ban. J Natl Med Assoc 2023; 115:528-538. [PMID: 37880064 DOI: 10.1016/j.jnma.2023.09.003] [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: 06/15/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND With data available since 1981, firearm death rates in American children and adolescents can be evaluated for trends during the 13 years before, the decade of, and during 16 years since the United States (U.S.) 1994-2004 Federal Assault Weapons Ban (FAWB). METHODS National and regional firearm mortality trends in the U.S. during 1981-2020 were assessed with joinpoint regression applied to Centers for Disease Control and Prevention data. RESULTS After increasing exponentially before the FAWB, the national firearm death rate in 0-14 year-olds promptly reversed course and declined throughout the FAWB and then reversed again after the FAWB and resumed an exponential increase (all phases p<0.001). The reduction in firearm death rate occurred within 1-3 years of the start of the FAWB, in both sexes, in all four census regions of the U.S., and in all four major race/ethnicity subgroups, especially non-Hispanic blacks. No other form of violence in 0-14 year-olds had this temporal relationship with the FAWB. The firearm mortality reduction during the FAWB is strongly-highly correlated with the concomitant reduction in handgun manufacturing in 91 % of 24 sex, race/ethnicity and region subsets analyzed, These FAWB-related trends were also apparent in older adolescents and young adults and less so in older persons. CONCLUSIONS Firearm death rates in 0-14 year-olds before, during, and after the FAWB, and no other type of injury, implicate the FAWB as having had a beneficial effect. Legislation to mitigate firearm mortality and injury inclusive of a FAWB should be especially beneficial to children and young adolescents, and regardless of sex, race/ethnicity or region in the U.S.
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Affiliation(s)
- Archie Bleyer
- Oregon Health and Science University, Portland, OR, USA; University of Texas McGovern Medical School, Houston, TX, USA.
| | | | - Charles R Thomas
- Radiation Oncology, Geisel School of Medicine @ Dartmouth, Hanover, NH, USA
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14
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Sullivan TM, Scheese D, Jain E, Milestone ZP, Haynes J, Boomer LA. Injury Patterns and Outcomes at a Single Pediatric Trauma Center During the Coronavirus Disease 19 Pandemic. J Surg Res 2023; 292:123-129. [PMID: 37619496 PMCID: PMC10285201 DOI: 10.1016/j.jss.2023.06.003] [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: 12/13/2022] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The coronavirus disease 19 (COVID-19) pandemic is reported to have changed injury patterns, prevalence, and outcomes across multiple institutions in the United States. Interpretation of aggregate data is difficult because injury patterns vary between urban and rural hospitals and the implementation of locoregional public health policies and guidelines in response to COVID-19 differed. To prepare our trauma system for future societal shutdowns, we compared injury patterns and outcomes of injured children and adolescents at a single pediatric trauma center before and during the first 2 y of the COVID-19 pandemic. METHODS We abstracted demographic, injury, and outcome data for injured children and adolescents (age <15 y) who required admission using our hospital trauma registry and the electronic medical record. We compared differences prior to and during the COVID-19 pandemic using univariate analysis. To address confounding variables, we also analyzed in-hospital mortality using a multivariable regression. RESULTS We observed an increase in the number of injured children requiring admission during the first year of the COVID-19 pandemic compared to the prepandemic era. Among injury types sustained, we observed an increase in firearm and nonfirearm related penetrating injuries (P < 0.001) during the first year, but not the second year, of the COVID-19 pandemic. Controlling for several confounding variables, we also observed an increase in in-hospital mortality (P = 0.04) during the first year of the COVID-19 pandemic. CONCLUSIONS The psychosocial and socioeconomic burden of the COVID-19 pandemic may have contributed to the rise in penetrating injuries and the odds of in-hospital mortality among a cohort of children and adolescents who were admitted to our hospital following injury. This data may be used to prepare our trauma system for future societal shutdowns through data informed resource utilization.
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Affiliation(s)
- Travis M Sullivan
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Daniel Scheese
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Eisha Jain
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Jeffrey Haynes
- Division of Pediatric Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Laura A Boomer
- Division of Pediatric Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
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15
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Wurster LA, Herndon M, Seastrom D, Fritzeen J, Mitchell K, Schmid M, Rumsey K. Quality Improvement Practices and Resources Targeting Firearm Injuries: A Survey of U.S. Pediatric Trauma Centers. J Trauma Nurs 2023; 30:328-333. [PMID: 37937873 DOI: 10.1097/jtn.0000000000000751] [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: 11/09/2023]
Abstract
BACKGROUND The increase in firearm injuries at U.S. pediatric trauma centers is a national public health crisis. This spike in penetrating trauma has challenged even the most mature pediatric trauma centers. OBJECTIVE This project aims to identify U.S. pediatric trauma center best practices for the evaluation and resources dedicated to pediatric firearm injuries. METHODS This study used an exploratory cross-sectional survey design using a study-specific questionnaire. An electronic survey was distributed to 159 verified U.S. pediatric trauma centers targeting patients younger than 15 years with firearm injuries from 2017 to 2021. Trauma approaches to injury prevention, advocacy, and common performance improvement events were surveyed. A follow-up survey provided a drill-down on the top three performance improvement events. RESULTS A total 159 surveys were distributed, of which 63 (40%) submitted partial responses and 32 (20%) completed the initial survey in full. A 49% increase in pediatric firearm injuries occurred between 2019 and 2020. Eighty-six percent of the trauma centers identified at least one to two opportunities for improvement events related to firearm injuries, with most of these events requiring a tertiary level of review. The top three performance improvement events included the massive transfusion protocol/fluid resuscitation, emergency department procedures, and operating room resource availability. CONCLUSIONS This study provides the first known examination of U.S. pediatric trauma center quality improvement efforts to address the crisis of pediatric firearm injuries. Our results indicate that most pediatric trauma centers are engaged in quality improvement and resource enhancement to combat firearm injuries.
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Affiliation(s)
- Lee Ann Wurster
- Nationwide Children's Hospital, Columbus, Ohio (Ms Wurster); St. Louis Children's Hospital, St. Louis, Missouri (Ms Herndon); Children's Mercy Kansas City, Kansas City, Missouri (Mr Seastrom); Children's National Hospital, Washington, District of Columbia (Ms Fritzeen); Emergency Department, Phoenix Children's Hospital, Phoenix, Arizona (Ms Mitchell); Operations Network at Medically Home, Atlanta, Georgia (Ms Schmid); and Bon Secours Mercy Health, St. Francis Medical Center, Midlothian, Virginia (Dr Rumsey)
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16
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Cannon AD, Reese K, Tetens P, Fingar KR. Preventable tragedies: findings from the #NotAnAccident index of unintentional shootings by children. Inj Epidemiol 2023; 10:52. [PMID: 37872595 PMCID: PMC10594669 DOI: 10.1186/s40621-023-00464-3] [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: 12/20/2022] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Between 2015 and 2021, 3,498 Americans died from unintentional gun injuries, including 713 children 17 years and younger. Roughly 30 million American children live in homes with firearms, many of which are loaded and unlocked. This study assesses the scope of unintentional shootings by children 17 and younger in the US and the relationship between these shootings and state-level secure storage laws. METHODS Demographic and injury data of both perpetrators and victims of unintentional shootings by children 17 and younger in the US from 1/1/2015-12/31/2021 were extracted from the #NotAnAccident Index. The #NotAnAccident Index contains media-report data, which is systematically flagged through Google Alerts. We describe characteristics of incidents and examine incident rates over time. The association between state-level secure storage laws and rates of unintentional shootings by children is assessed in multivariate negative binomial regression models. RESULTS 2,448 unintentional shootings by children resulted in 926 deaths and 1,603 nonfatal gun injuries over a period of seven years. Most perpetrators (81%) and victims (76%) were male. The mean age was 10.0 (SD 5.5) for shooters and 10.9 (SD 8.1) for victims. Children were as likely to shoot themselves (49%) as they were to shoot others (47%). The majority of victims were under 18 years old (91%). Shootings most often occurred in or around homes (71%) and with handguns (53%). From March to December 2020, coinciding with the COVID-19 pandemic, incidents increased 24% over the same period in 2019, which was driven largely by an increase among shooters ages 0-5. Depending on the type of law, rates of unintentional shootings by children were 24% to 72% lower in states with secure storage laws, compared to states without such laws. CONCLUSIONS Unintentional shootings by children are on the rise, particularly among children 0-5 years old, but are preventable tragedies. Our results show that secure firearm storage policies are strongly correlated with lower rates of unintentional shootings by children. Firearm storage policies, practices, and education efforts are needed to ensure guns are kept secured and inaccessible to children.
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Affiliation(s)
- Ashley D. Cannon
- Everytown for Gun Safety Support Fund, PO Box 4184, New York, NY 10163 USA
| | - Kate Reese
- Everytown for Gun Safety Support Fund, PO Box 4184, New York, NY 10163 USA
| | - Paige Tetens
- Everytown for Gun Safety Support Fund, PO Box 4184, New York, NY 10163 USA
| | - Kathryn R. Fingar
- Everytown for Gun Safety Support Fund, PO Box 4184, New York, NY 10163 USA
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17
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Kannikeswaran N, Ehrman RR, Vitale L, Oag K, Sundaralingam S, Spencer P, Donoghue L, Sethuraman U. Comparison of Trauma and Burn Evaluations in a Pediatric Emergency Department During Pre, Early and Late COVID-19 Pandemic. J Pediatr Surg 2023; 58:1803-1808. [PMID: 37032192 PMCID: PMC10019029 DOI: 10.1016/j.jpedsurg.2023.03.008] [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: 10/17/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Pediatric trauma epidemiology altered during early COVID-19 pandemic period but the impact of the ongoing pandemic is unknown. OBJECTIVES To compare pediatric trauma epidemiology between the pre, early and late pandemic periods and to evaluate the association of race and ethnicity on injury severity during the pandemic. METHODS We performed a retrospective study of trauma consults for an injury/burn in children ≤16 years between January 1, 2019 and December 31, 2021. Study period was categorized into pre (January 1, 2019-February 28, 2020), early (March 1, 2020-December 31, 2020), and late (January 1, 2021-December 31, 2021) pandemic. Demographics, etiology, injury/burn severity, interventions and outcomes were noted. RESULTS A total of 4940 patients underwent trauma evaluation. Compared to pre-pandemic, trauma evaluations for injuries and burns increased during both the early (RR: 2.13, 95% CI: 1.6-2.82 and RR: 2.24, 95% CI: 1.39-3.63, respectively) and late pandemic periods (RR: 1.42, 95% CI: 1.09-1.86 and RR: 2.44, 95% CI: 1.55-3.83, respectively). Severe injuries, hospital admissions, operations and death were higher in the early pandemic but reverted to pre-pandemic levels during late pandemic. Non-Hispanic Blacks had an approximately 40% increase in mean ISS during both pandemic periods though they had lower odds of severe injury during both pandemic periods. CONCLUSIONS Trauma evaluations for injuries and burns increased during the pandemic periods. There was a significant association of race and ethnicity with injury severity which varied with pandemic periods. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Nirupama Kannikeswaran
- Central Michigan University, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA.
| | - Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, 540 E. Canfield Ave Detroit, MI 48201, USA
| | - Lisa Vitale
- Department of Surgery, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
| | - Katherine Oag
- Department of Surgery, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
| | | | - Priya Spencer
- Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
| | - Lydia Donoghue
- Department of Surgery, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
| | - Usha Sethuraman
- Central Michigan University, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
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18
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Roberts BK, Nofi CP, Cornell E, Kapoor S, Harrison L, Sathya C. Trends and Disparities in Firearm Deaths Among Children. Pediatrics 2023; 152:e2023061296. [PMID: 37599647 PMCID: PMC10471507 DOI: 10.1542/peds.2023-061296] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In 2020, firearm injuries became the leading cause of death among US children and adolescents. This study aimed to evaluate new 2021 data on US pediatric firearm deaths and disparities to understand trends compared with previous years. METHODS Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research was queried for firearm mortalities in children/adolescents from 2018 to 2021. Absolute mortality, death rates, and characteristics were reported. Death rates were defined per 100 000 persons in that population per year. Death rates across states were illustrated via geographic heat maps, and correlations with state poverty levels were calculated. RESULTS In 2021, firearms continued to be the leading cause of death among US children. From 2018 to 2021, there was a 41.6% increase in the firearm death rate. In 2021, among children who died by firearms, 84.8% were male, 49.9% were Black, 82.6% were aged 15 to 19 years, and 64.3% died by homicide. Black children accounted for 67.3% of firearm homicides, with a death rate increase of 1.8 from 2020 to 2021. White children accounted for 78.4% of firearm suicides. From 2020 to 2021, the suicide rate increased among Black and white children, yet decreased among American Indian or Alaskan Native children. Geographically, there were worsening clusters of firearm death rates in Southern states and increasing rates in Midwestern states from 2018 to 2021. Across the United States, higher poverty levels correlated with higher firearm death rates (R = 0.76, P < .001). CONCLUSIONS US pediatric firearm deaths increased in 2021, above the spike in 2020, with worsening disparities. Implementation of prevention strategies and policies among communities at highest risk is critical.
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Affiliation(s)
- Bailey K. Roberts
- Division of Pediatric Surgery, Cohen Children’s Medical Center, Queens, New York
- Institute for Health System Science, Feinstein Institutes
| | - Colleen P. Nofi
- Division of Pediatric Surgery, Cohen Children’s Medical Center, Queens, New York
- Institute for Health System Science, Feinstein Institutes
| | - Emma Cornell
- Center for Gun Violence Prevention, Northwell Health
| | - Sandeep Kapoor
- Institute for Health System Science, Feinstein Institutes
- Center for Gun Violence Prevention, Northwell Health
- Addiction Services, Emergency Medicine Service Line, Northwell Health, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Laura Harrison
- Center for Gun Violence Prevention, Northwell Health
- Addiction Services, Emergency Medicine Service Line, Northwell Health, New Hyde Park, New York
| | - Chethan Sathya
- Division of Pediatric Surgery, Cohen Children’s Medical Center, Queens, New York
- Institute for Health System Science, Feinstein Institutes
- Center for Gun Violence Prevention, Northwell Health
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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19
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Hicks BM, Vitro C, Johnson E, Sherman C, Heitzeg MM, Durbin CE, Verona E. Who bought a gun during the COVID-19 pandemic in the United States?: Associations with QAnon beliefs, right-wing political attitudes, intimate partner violence, antisocial behavior, suicidality, and mental health and substance use problems. PLoS One 2023; 18:e0290770. [PMID: 37643192 PMCID: PMC10464976 DOI: 10.1371/journal.pone.0290770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
There was a large spike in gun purchases and gun violence during the first year of the COVID-19 pandemic in the United States. We used an online U.S. national survey (N = 1036) to examine the characteristics of people who purchased a gun between March 2020 and October 2021 (n = 103) and compared them to non-gun owners (n = 763) and people who own a gun but did not purchase a gun during the COVID-19 pandemic (n = 170). Compared to non-gun owners, pandemic gun buyers were younger and more likely to be male, White race, and to affiliate with the Republican party. Compared to non-gun owners and pre-pandemic gun owners, pandemic gun buyers exhibited extreme elevations on a constellation of political (QAnon beliefs, pro-gun attitudes, Christian Nationalism, approval of former President Donald Trump, anti-vax beliefs, COVID-19 skepticism; mean Cohen's d = 1.15), behavioral (intimate partner violence, antisocial behavior; mean d = 1.38), mental health (suicidality, depression, anxiety, substance use; mean d = 1.21), and personality (desire for power, belief in a dangerous world, low agreeableness, low conscientiousness; mean d = 0.95) characteristics. In contrast, pre-pandemic gun owners only endorsed more pro-gun attitudes (d = 0.67), lower approval of President Joe Biden (d = -0.41) and were more likely to be male and affiliate with the Republican party relative to non-gun owners. Pandemic gun buyers represent an extreme group in terms of political and psychological characteristics including several risk-factors for violence and self-harm.
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Affiliation(s)
- Brian M. Hicks
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Catherine Vitro
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Elizabeth Johnson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Carter Sherman
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - C. Emily Durbin
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Edelyn Verona
- Department of Psychology, University of South Florida, Tampa, Florida, United States of America
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20
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Orantes C, Chan HK, Walter D, Chavez S, Ugalde IT. Pediatric firearm injury epidemiology at a level 1 trauma center from 2019 to 2021: including time of the COVID-19 pandemic. Inj Epidemiol 2023; 10:41. [PMID: 37550792 PMCID: PMC10405374 DOI: 10.1186/s40621-023-00448-3] [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: 12/13/2022] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Firearms are a leading cause of death in children. The demand for firearms increased following COVID-19 "stay-at home orders" in March 2020, resulting in record-breaking firearm sales and background checks. We aim to describe the changes in pediatric firearm-related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic. RESULTS The total number of pediatric firearm-related injury cases increased during March 15th to December 31st, 2020 and 2021 compared to the same time period in 2019 (104 verses 89 verses 78). The demographic group most affected across years were males (87% in 2019 vs 82% in 2020 and 87% in 2021) between 14 and 17 years old (83% in 2019 vs 81% in 2020 and 76% in 2021). There was an increase in firearm injuries among black youth across all years (28% in 2019 vs 41% in 2020 vs 49% in 2021). Injuries in those with mental illness (10% in 2019 vs 24% in 2020 vs 17% in 2021), and injuries where the shooter was a known family member or friend (14% in 2019 vs 18% in 2020 vs. 15% in 2021), increased from 2019 to 2020. CONCLUSION The total number of pediatric firearm-related injuries increased during the COVID-19 pandemic compared to the previous year despite a decline in overall pediatric emergency department visits. Increases in pediatric firearm-related injuries in already vulnerable populations should prompt further hospital initiatives including counseling on safe firearm storage, implementation of processes to identify children at risk for firearm injuries, and continued research to mitigate the risk of injury and death associated with firearms in our community.
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Affiliation(s)
- Cynthia Orantes
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin Street, JJL 475, Houston, Texas 77030 USA
| | - Hei Kit Chan
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin Street, JJL 475, Houston, Texas 77030 USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, USA
| | - Daniel Walter
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin Street, JJL 475, Houston, Texas 77030 USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, USA
| | - Summer Chavez
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, 5055 Medical Circle Rm 1316, Houston, TX 77204 USA
| | - Irma T. Ugalde
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin Street, JJL 475, Houston, Texas 77030 USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, USA
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21
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Martin GC, Boulanger E, Maalej R, Partouche S, Dentel A, Grosselin M, Ettayeb R, Chapron T, Caputo G, Vignal-Clermont C. Specificities of pediatric ocular emergencies before and during the COVID-19 era: A retrospective comparative study in an eye-related emergency department in Paris. Arch Pediatr 2023:S0929-693X(23)00095-7. [PMID: 37394362 DOI: 10.1016/j.arcped.2023.06.002] [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: 06/27/2022] [Revised: 02/05/2023] [Accepted: 06/04/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Epidemiological data on the use of eye-related emergency services by children are limited. The objective of this study was to determine how COVID-19 affected the epidemiological trends of pediatric ocular emergencies. METHODS We performed a retrospective chart review of children under the age of 18 years who visited our eye-related emergency department between March 17 and June 7, 2020 and between March 18 and June 9, 2019. This was a descriptive and comparative analysis of the two study periods based on the demographic characteristics of patients and the diagnosis reported by the ophthalmologist in the digital medical charts. One of the investigators performed a second reading of the files to homogenize the diagnosis classification based on the most frequently found items. RESULTS In total, 754 children were seen in our eye-related emergency department during the 2020 study period versus 1399 in 2019, representing a 46% decrease. In 2019, the four main diagnoses were traumatic injury (30%), allergic conjunctivitis (15%), infectious conjunctivitis (12%), and chalazion/blepharitis (12%). In the 2020 study period there was a significant decrease in the proportion of patients presenting with traumatic injuries (p < 0.001), infectious conjunctivitis (p = 0.03), and chalazion/blepharitis (p < 0.001). Consultations for chalazion/blepharitis were the most affected by the pandemic, followed by traumatic injuries (-72% and -64%, respectively). The proportion of patients who required surgery after trauma was higher in 2020 than in 2019 (p < 0.01), but the absolute number of severe trauma cases remained stable. CONCLUSIONS The COVID-19 pandemic was accompanied by a decrease in the overall use of a pediatric eye-related emergency services in Paris. Visits due to benign causes and ocular trauma also decreased, but visits for more severe pathologies were not affected. Longer-term epidemiological studies may confirm or refute a change in eye emergency department use habits.
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Affiliation(s)
- Gilles C Martin
- Rothschild Foundation Hospital, Ophthalmology Department, Paris, France.
| | - Etienne Boulanger
- Rothschild Foundation Hospital, Ophthalmology Department, Paris, France
| | - Rim Maalej
- Rothschild Foundation Hospital, Ophthalmology Department, Paris, France
| | - Sarah Partouche
- Rothschild Foundation Hospital, Ophthalmology Department, Paris, France
| | - Alexandre Dentel
- Rothschild Foundation Hospital, Ophthalmology Department, Paris, France
| | | | - Rizlene Ettayeb
- Rothschild Foundation Hospital, Ophthalmology Department, Paris, France
| | - Thibaut Chapron
- Rothschild Foundation Hospital, Ophthalmology Department, Paris, France
| | - Georges Caputo
- Rothschild Foundation Hospital, Ophthalmology Department, Paris, France
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22
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Donnelly M, Kuza C, Sargent B, Swentek L, de Virgilio C, Grigorian A, Schubl S, Nahmias J. Firearm Violence Surrounding the COVID-19 Pandemic: A Reopening Phenomenon. J Surg Res 2023; 285:168-175. [PMID: 36680877 PMCID: PMC9808419 DOI: 10.1016/j.jss.2022.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/15/2022] [Accepted: 12/24/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Past research has demonstrated a "reopening phenomenon" of increased firearm violence associated with the initial lifting of coronavirus disease 2019 (COVID-19) pandemic-related restrictions after the first wave. Now, with widespread societal reemergence from stay-at-home measures, we hypothesize another spike in firearm violence in the United States (US). Thus, the purpose of this study was to evaluate the trends in firearm violence before and after extensive community reopenings during the COVID-19 pandemic. METHODS The Gun Violence Archive was utilized to collect data on daily firearm violence incidents, injuries, and deaths as well as on types of firearm violence. Mann-Whitney U-tests were performed for trends and types of firearm violence "before" (12/14/20-4/9/21) versus "after" (4/10/21-7/31/21) widespread societal reopening in the US. Additional analyses also sought to compare the after reopening time-period to historical data (2017-2020) of similar calendar dates, to better control for possible annual/seasonal variation. RESULTS Median daily firearm violence incidents (153 versus 176, P < 0.001), injuries (89 versus 121, P < 0.001) and deaths (54 versus 58, P < 0.001) increased from before versus after reopening. Compared to all historical years, in the after reopening time-period there were consistent increases in total as well as mass shooting incidents/injuries/deaths (all P < 0.05). CONCLUSIONS Firearm violence incidents, injuries, and deaths increased after societal reemergence from the COVID-19 pandemic. In addition, there has been an increase in mass shootings despite a relative lull initially brought on by the pandemic. This suggests the "reopening phenomenon" has worsened an already substantial national firearm epidemic.
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Affiliation(s)
- Megan Donnelly
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California
| | - Catherine Kuza
- Department of Anesthesiology, University of Southern California, Los Angeles, California
| | - Brynn Sargent
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California
| | - Lourdes Swentek
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California
| | | | - Areg Grigorian
- Department of Surgery, University of Southern California, Los Angeles, California
| | - Sebastian Schubl
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California
| | - Jeffry Nahmias
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California.
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23
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The effects of the COVID-19 pandemic on violent injuries in children: a literature review. Adv Pediatr 2023. [PMCID: PMC10070782 DOI: 10.1016/j.yapd.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Tatebe LC, Cone JT, Slidell MB, Chang G, Jonikas M, Stewart A, Doherty J, Arunkumar P, Schlanser V, Dennis AJ. When public health crises collide: 5 years of pediatric firearm injury prevention opportunities. Trauma Surg Acute Care Open 2023; 8:e001026. [PMID: 37303982 PMCID: PMC10254944 DOI: 10.1136/tsaco-2022-001026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/08/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Prior publications on pediatric firearm-related injuries have emphasized significant social disparities. The pandemic has heightened a variety of these societal stresses. We sought to evaluate how we must now adapt our injury prevention strategies. Patients and methods Firearm-related injuries in children 15 years old and under at five urban level 1 trauma centers between January 2016 and December 2020 were retrospectively reviewed. Age, gender, race/ethnicity, Injury Severity Score, situation, timing of injury around school/curfew, and mortality were evaluated. Medical examiner data identified additional deaths. Results There were 615 injuries identified including 67 from the medical examiner. Overall, 80.2% were male with median age of 14 years (range 0-15; IQR 12-15). Black children comprised 77.2% of injured children while only representing 36% of local schools. Community violence (intentional interpersonal or bystander) injuries were 67.2% of the cohort; 7.8% were negligent discharges; and 2.6% suicide. Median age for intentional interpersonal injuries was 14 years (IQR 14-15) compared with 12 years (IQR 6-14, p<0.001) for negligent discharges. Far more injuries were seen in the summer after the stay-at-home order (p<0.001). Community violence and negligent discharges increased in 2020 (p=0.004 and p=0.04, respectively). Annual suicides also increased linearly (p=0.006). 5.5% of injuries were during school; 56.7% after school or during non-school days; and 34.3% were after legal curfew. Mortality rate was 21.3%. Conclusions Pediatric firearm-related injuries have increased during the past 5 years. Prevention strategies have not been effective during this time interval. Prevention opportunities were identified specifically in the preteenage years to address interpersonal de-escalation training, safe handling/storage, and suicide mitigation. Efforts directed at those most vulnerable need to be reconsidered and examined for their utility and effectiveness. Level of evidence Level III; epidemiological study type.
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Affiliation(s)
- Leah C Tatebe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer T Cone
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Mark B Slidell
- Department of Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois, USA
| | - Grace Chang
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Meghan Jonikas
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Amy Stewart
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - James Doherty
- Department of Surgery, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Ponni Arunkumar
- Department of Pathology, Northwestern University, Chicago, Illinois, USA
| | | | - Andrew J Dennis
- Department of Trauma, Cook County Health, Chicago, Illinois, USA
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25
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Evaluating the regional differences in pediatric injury patterns during the COVID-19 pandemic. J Surg Res 2023; 289:61-68. [PMID: 37086597 PMCID: PMC10033255 DOI: 10.1016/j.jss.2023.03.003] [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: 08/23/2022] [Revised: 02/18/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
Background Reports of pediatric injury patterns during the COVID-19 pandemic are conflicting and lack the granularity to explore differences across regions. We hypothesized there would be considerable variation in injury patterns across Pediatric Trauma Centers (PTCs) in the United States. Materials and Methods A multicenter, retrospective study evaluating patients <18-years-old with traumatic injuries meeting National Trauma Data Bank criteria was performed. Patients injured after Stay-at-Home Orders through September 2020 (“COVID” cohort) were compared to “Historical” controls from an averaged period of equivalent dates in 2016–2019. Differences in injury type, intent, and mechanism were explored at the site level. Results 47,385 pediatric trauma patients were included. Overall trauma volume increased during the COVID cohort compared to the Historical (COVID 7,068 patients vs. Historical 5,891 patients); however, some sites demonstrated a decrease in overall trauma of 25% while others had an increase over 33%. Bicycle injuries increased at every site, with a range in percent change from 24% to 135% increase. Although the greatest net increase was due to blunt injuries, there was a greater relative increase in penetrating injuries at 7/9 sites, with a range in percent change from 110% increase to a 69% decrease. Conclusions There was considerable discrepancy in pediatric injury patterns at the individual site level, perhaps suggesting a variable impact of the specific sociopolitical climate and pandemic policies of each catchment area. Investigation of the unique response of the community during times of stress at PTCs is warranted to be better prepared for future environmental stressors.
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26
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El Tawil C, Bergeron A, Khalil E. A Scoping Review of Pediatric Mass-Casualty Incident Triage Algorithms. Disaster Med Public Health Prep 2023; 17:e317. [PMID: 36789661 DOI: 10.1017/dmp.2022.287] [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: 02/16/2023]
Abstract
OBJECTIVE For the pediatric population, there is no consensus on which triage system to use for mass-casualty incidents (MCI). A scoping review was conducted to identify the most accurate triage system for pediatric patients in MCIs. METHODS MEDLINE (NLM, Bethesda, MA, USA), Embase (Elsevier Inc., Amsterdam, Netherlands), CINAHL (EBSCO Information Services, Ipswitch, MA, USA), and The Cochrane CENTRAL Register of Controlled Trials (John Wiley & Sons, Hoboken, NJ, USA), as well as Scopus (Elsevier Inc., Amsterdam, Netherlands), Global Health (Centre for Agriculture and Bioscience International, Wallingford, UK), Global Health Archive (Centre for Agriculture and Bioscience International, Wallingford, UK), and Global Index Medicus (World Health Organization, Geneva, Switzerland) were searched for relevant studies that were divided into 3 categories: accuracy of a single system, comparison of 2 or more primary triage system and comparison of secondary triage systems. Grey literature was also searched. RESULTS 996 studies were identified from which 18 studies were included. Systems studied were found to have poor inter-rater reliability, had a low level of agreement between providers, had missed critically ill patients or were not externally validated. 11 studies compared pediatric MCI triage algorithms using different strategies and the most accurate algorithm was not identified. A recently developed secondary triage system, specifically for pediatric patients, was found to perform better than the comparison triage system. CONCLUSION Although some algorithms performed better than others, no primary triage algorithm was accurate enough for the pediatric population. However, only 1 secondary triage algorithm was found to be superior to the others.
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Affiliation(s)
- Chady El Tawil
- Division of Pediatric Emergency Medicine, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Amy Bergeron
- McGill University Health Centre Medical Libraries, Montreal, Quebec, Canada
| | - Elene Khalil
- Division of Pediatric Emergency Medicine, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
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27
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Health Inequities in Pediatric Trauma. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020343. [PMID: 36832472 PMCID: PMC9955182 DOI: 10.3390/children10020343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
This review article highlights the disparities evident in pediatric trauma care in the United States. Social determinants of health play a significant role in key aspects of trauma care including access to care, gun violence, child abuse, head trauma, burn injuries, and orthopedic trauma. We review the recent literature as it relates to these topics. The findings from these recent studies emphasize the important principle that trauma care for children should be designed with a focus on equity for all children.
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Toxic Exposures Among Young Children One Year into the COVID-19 Pandemic: A Retrospective Review of Three San Francisco Bay Area Emergency Departments. J Emerg Med 2023; 64:263-268. [PMID: 36828751 PMCID: PMC9482847 DOI: 10.1016/j.jemermed.2022.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Daycare and school closures prompted by shelter-in-place orders may have increased opportunities for unintentional ingestions among young children. OBJECTIVES We examined emergency department (ED) presentations for toxic exposures among young children during the COVID-19 pandemic in the San Francisco Bay Area, which had some of the strictest and most prolonged shelter-in-place policies in the United States. METHODS We performed a retrospective cross-sectional study of children 0 to 5 years of age who presented with an ED International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis code of toxic exposure within a tertiary care hospital system between March 16, 2016 and March 15, 2021. We considered the period after March 16, 2020 to represent the pandemic. RESULTS During the pandemic, the absolute number of poisonings among young children remained stable. Overall, ED encounters within this cohort decreased by 55%, which doubled the relative toxic exposure rate per 1000 ED encounters from 4.99 (95% confidence interval [CI] 3.19-5.90) to 9.79 (95% CI 8.09-11.49). Rates of admission, severe medical complications, operating room case requests, and length of stay were not significantly different. Shelter-in-place was associated with significantly higher odds of cannabis ingestion (odds ratio = 2.70, 95% CI 1.60-4.49). CONCLUSION Despite dramatic decreases in overall ED patient volumes, the absolute number and severity of toxic exposures were similar during the pandemic compared with previous years. © 2022 Elsevier Inc.
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29
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Romo ND, Castillo C, Green J, Lin J, Mendelsohn E, Dawkins-Hamilton C, Reddy SH, Blumberg SM. Improving Adolescent Violent Trauma Outcomes With a Hospital-Based Violence Prevention Initiative. Hosp Pediatr 2023; 13:153-158. [PMID: 36597702 DOI: 10.1542/hpeds.2021-006428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Violent trauma results in significant morbidity/mortality in Black/Hispanic males aged 15 to 24 years. Hospital- and community-level interventions may improve patient and community outcomes. OBJECTIVE To determine if a hospital-based violence prevention intervention using community outreach workers was associated with improved violent trauma patient postdischarge follow-up and reinjury rates. METHODS This is a retrospective, single-center, cohort study of admitted violent trauma patients to a public hospital in the Bronx, NY. Data were collected from a convenience sample of patients aged 15 to 24 years admitted with International Classification of Diseases, 10th Revision, codes for gunshot wound, stab wound, or physical assault from August 2014 to April 2018. The exposure variable was documentation of intervention team evaluation during admission. The outcome variables included attending >50% scheduled postdischarge follow-up visits, and subsequent violent reinjury (gunshot wound, stab wound, blunt assault) during the study time period. Multivariable regression models were used to determine the association between the exposure and outcome variables. RESULTS A total of 535 patients were evaluated and were primarily male (92.5%), Black (54%)/Latino (36.4%), with mean age of 19.1 years. Patients in the exposure group had increased odds of attending >50% of scheduled clinic postdischarge follow-up visits (odds ratio, 2.29; 95% confidence interval 1.59-3.29) and decreased odds of subsequent violent reinjury presentation (odds ratio, 0.41; 95% confidence interval 0.22-0.75) 3 months after hospital discharge. CONCLUSION A hospital-based violence prevention intervention may be associated with decreased odds of violent reinjury and increased odds of postdischarge scheduled appointment adherence in admitted pediatric violent trauma patients.
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Affiliation(s)
- Noé D Romo
- Departments of Pediatrics.,Departments of Pediatrics
| | | | - Jaylen Green
- Departments of Pediatrics.,Departments of Pediatrics
| | - Juan Lin
- Biostatistics, The Albert Einstein College of Medicine, Bronx, New York
| | - Erika Mendelsohn
- Social Work, NYC Health + Hospitals/Jacobi, Bronx, New York.,New York State Department of Criminal Justice Services, SNUG Anti-Violence Initiative, Albany, New York
| | - Carjah Dawkins-Hamilton
- Social Work, NYC Health + Hospitals/Jacobi, Bronx, New York.,New York State Department of Criminal Justice Services, SNUG Anti-Violence Initiative, Albany, New York
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30
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The impact of the COVID-19 pandemic on pediatric firearm injuries in Colorado. J Pediatr Surg 2023; 58:344-349. [PMID: 36411111 PMCID: PMC9595415 DOI: 10.1016/j.jpedsurg.2022.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2019 firearm injuries surpassed automobile-related injuries as the leading cause of pediatric death in Colorado. In the spring of 2020, the COVID-19 pandemic led to community-level social, economic, and health impacts as well as changes to injury epidemiology. Thus, we sought to determine the impact of the COVID-19 pandemic on pediatric firearm injuries in Colorado. METHODS We conducted a retrospective review of pediatric firearm injured patients (≤ 18-years-old) evaluated at three trauma centers in Colorado from 2018-2021. Patients were stratified into two groups based on the time of their firearm injury: pre- COVID injuries and post- COVID injuries. Group differences were examined using t-tests for continuous variables and Chi Squared or Fisher's exact tests for categorical variables. RESULTS Overall, 343 firearm injuries occurred during the study period. There was a significant increase in firearm injuries as a proportion of overall pediatric ED trauma evaluations following the onset of the COVID-19 pandemic (pre COVID: 5.18/100 trauma evaluations; post COVID: 8.61/100 trauma evaluations, p<0.0001). Assaults were the most common injury intent seen both pre and post COVID (70.3% vs. 56.7%, respectively); however, unintentional injuries increased significantly from 10.3% to 22.5% (p = 0.004) following the onset of the pandemic. Additionally, the COVID-19 pandemic was associated with a 177% increase in unintentional injuries in adolescents. CONCLUSION Pediatric firearm injuries, particularly unintentional injuries, increased significantly in Colorado following the onset of the COVID-19 pandemic. The substantial increase in unintentional injuries among adolescents highlights the necessity of multi-disciplinary approaches to limit or regulate their access to firearms. LEVEL OF EVIDENCE Level III. STUDY TYPE Retrospective.
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31
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Burnout in Trauma Surgeons During the COVID-19 Pandemic: a Long-standing Problem Worsens. CURRENT TRAUMA REPORTS 2023; 9:1-9. [PMID: 36591542 PMCID: PMC9793372 DOI: 10.1007/s40719-022-00247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/29/2022]
Abstract
Purpose of Review Physician burnout is well-described in the literature. We analyze the effects of the COVID-19 pandemic on burnout in trauma and acute care surgeons (TACS). Recent Findings Along with other healthcare workers and trainees, TACS faced unprecedented clinical, personal, and professional challenges in treating a novel pathogen and were uniquely affected due to their skillset as surgeons, intensivists, and leaders. The pandemic and its consequences have increased burnout and are suspected to have worsened PTSD and moral injury among TACS. The healthcare system is just beginning to grapple with these problems. Summary COVID-19 significantly added to the pre-existing burden of burnout among TACS. We offer prevention and mitigation strategies. Furthermore, to build upon the work done by individuals and organizations, we urge that national institutions address burnout from a regulatory standpoint.
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Pediatric injury trends and relationships with social vulnerability during the COVID-19 pandemic: A multi-institutional analysis. J Trauma Acute Care Surg 2023; 94:133-140. [PMID: 35995783 PMCID: PMC9812296 DOI: 10.1097/ta.0000000000003687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on pediatric injury, particularly relative to a community's vulnerability, is unknown. The objective of this study was to describe the change in pediatric injury during the first 6 months of the COVID-19 pandemic compared with prior years, focusing on intentional injury relative to the social vulnerability index (SVI). METHODS All patients younger than 18 years meeting inclusion criteria for the National Trauma Data Bank between January 1, 2016, and September 30, 2020, at nine Level I pediatric trauma centers were included. The COVID cohort (children injured in the first 6 months of the pandemic) was compared with an averaged historical cohort (corresponding dates, 2016-2019). Demographic and injury characteristics and hospital-based outcomes were compared. Multivariable logistic regression was used to estimate the adjusted odds of intentional injury associated with SVI, moderated by exposure to the pandemic. Interrupted time series analysis with autoregressive integrated moving average modeling was used to predict expected injury patterns. Volume trends and observed versus expected rates of injury were analyzed. RESULTS There were 47,385 patients that met inclusion criteria, with 8,991 treated in 2020 and 38,394 treated in 2016 to 2019. The COVID cohort included 7,068 patients and the averaged historical cohort included 5,891 patients (SD, 472), indicating a 20% increase in pediatric injury ( p = 0.031). Penetrating injuries increased (722 [10.2%] COVID vs. 421 [8.0%] historical; p < 0.001), specifically firearm injuries (163 [2.3%] COVID vs. 105 [1.8%] historical; p = 0.043). Bicycle collisions (505 [26.3%] COVID vs. 261 [18.2%] historical; p < 0.001) and collisions on other land transportation (e.g., all-terrain vehicles) (525 [27.3%] COVID vs. 280 [19.5%] historical; p < 0.001) also increased. Overall, SVI was associated with intentional injury (odds ratio, 7.9; 95% confidence interval, 6.5-9.8), a relationship which increased during the pandemic. CONCLUSION Pediatric injury increased during the pandemic across multiple sites and states. The relationship between increased vulnerability and intentional injury increased during the pandemic. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Iantorno SE, Swendiman RA, Bucher BT, Russell KW. Surge in Pediatric Firearm Injuries Presenting to US Children's Hospitals During the COVID-19 Pandemic. JAMA Pediatr 2022; 177:204-206. [PMID: 36534391 PMCID: PMC9856622 DOI: 10.1001/jamapediatrics.2022.4881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This cohort study uses administrative health data to evaluate trends in pediatric firearm injuries before and during the COVID-19 pandemic.
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Affiliation(s)
- Stephanie E. Iantorno
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Robert A. Swendiman
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Brian T. Bucher
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Katie W. Russell
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
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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.
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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
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Bernardin ME, Clukies L, Gu H, Fairfax C, Keller MS. COVID-19 Pandemic effects on the epidemiology and mortality of pediatric firearm injuries; A single center study. J Pediatr Surg 2022:S0022-3468(22)00678-9. [PMID: 36402591 PMCID: PMC9596183 DOI: 10.1016/j.jpedsurg.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with increased firearm injuries amongst adults, though the pandemic's effect on children is less clearly understood. METHODS This cross-sectional study was performed at a Level 1 Pediatric Trauma Center and included youths 0-19 years. The trauma registry was retrospectively queried for firearm injuries occurring pre-COVID-19 pandemic (March 2015-February 2020). Baseline data was compared to prospectively collected data occurring during the COVID-19 pandemic (March 2020-March 2022). Fischer's exact, Pearson's Chi-square and/or correlation analysis was used to compare pre and post-COVID-19 firearm injury rates and intent, victim demographics and disposition. Temporal relationships between firearm injury rates and local COVID-19 death rates were also described. RESULTS 413 pre-COVID-19 firearm injuries were compared to 259 pandemic firearm injuries. Victims were mostly Black males with a mean age of 13.4 years. Compared to the 5 years pre-pandemic, monthly firearm injury rates increased 51.5% (6.8 vs 10.3 shootings/month), including a significant increase (p = 0.04) in firearm assaults/homicides and a relative decrease in unintentional shootings. Deaths increased 29%, and there were significantly fewer ED discharges and more admissions to OR and/or PICU (p = 0.005). There was a significant increase in Black victims (p = 0.01) and those having Medicaid or self-pay (p<0.001). Firearm injury spikes were noted during or within the 3 months following surges in local COVID-19 death rates. CONCLUSIONS The COVID-19 pandemic was associated with an increase in the frequency and mortality of pediatric firearm injuries, particularly assaults amongst Black children following surges in COVID death rates. Increased violence-intervention services are needed, particularly amongst marginalized communities. LEVEL OF EVIDENCE This is a prognostic study, evaluating the effects of the COVID-19 pandemic on pediatric firearm injuries, including victim demographics, injury intent and mortality. This study is retrospective and observational, making it Oxford Level III evidence.
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Affiliation(s)
- Mary Elizabeth Bernardin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO, USA; Division of Pediatric Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Lindsay Clukies
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongjie Gu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Connor Fairfax
- Trauma Services, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Martin S Keller
- Division of Pediatric Surgery, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Wells JM, Rodean J, Cook L, Sills MR, Neuman MI, Kornblith AE, Jain S, Hirsch AW, Goyal MK, Fleegler EW, DeLaroche AM, Aronson PL, Leonard JC. Injury-Related Pediatric Emergency Department Visits in the First Year of COVID-19. Pediatrics 2022; 150:188520. [PMID: 35836331 DOI: 10.1542/peds.2021-054545] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the epidemiology of pediatric injury-related visits to children's hospital emergency departments (EDs) in the United States during early and later periods of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS We conducted a cross-sectional study using the Pediatric Health Information System, an administrative database to identify injury-related ED visits at 41 United States children's hospitals during the SARS-CoV-2 pandemic period (March 15, 2020 to March 14, 2021) and a 3 year comparator period (March 15-March 14, 2017-2020). For these 2 periods, we compared patient characteristics, injury type and severity, primary discharge diagnoses, and disposition, stratified by early (March 15, 2020 to June 30, 2020), middle (July 1, 2020 to October 31, 2020), and late (November 1, 2020 to March 14, 2021) pandemic periods. RESULTS Overall, ED injury-related visits decreased by 26.6% during the first year of the SARS-CoV-2 pandemic, with the largest decline observed in minor injuries. ED injury-related visits resulting in serious-critical injuries increased across the pandemic (15.9% early, 4.9% middle, 20.6% late). Injury patterns with the sharpest relative declines included superficial injuries (41.7% early) and sprains/strains (62.4% early). Mechanisms of injury with the greatest relative increases included (1) firearms (22.9% early; 42.8% middle; 37% late), (2) pedal cyclists (60.4%; 24.9%; 32.2%), (3) other transportation (20.8%; 25.3%; 17.9%), and (4) suffocation/asphyxiation (21.4%; 20.2%; 28.4%) and injuries because of suicide intent (-16.2%, 19.9%, 21.8%). CONCLUSIONS Pediatric injury-related ED visits declined in general. However, there was a relative increase in injuries with the highest severity, which warrants further investigation.
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Affiliation(s)
- Jordee M Wells
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Lawrence Cook
- Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah
| | - Marion R Sills
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aaron E Kornblith
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco, San Francisco, California
| | - Shobhit Jain
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Alexander W Hirsch
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monika K Goyal
- Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, District of Columbia
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy M DeLaroche
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Paul L Aronson
- Departments of Pediatrics and of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Julie C Leonard
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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Jewett PI, Gangnon RE, Borowsky IW, Peterson J, Areba EM, Kiragu A, Densley J. US Mass public shootings since Columbine: victims per incident by race and ethnicity of the perpetrator. Prev Med 2022; 162:107176. [PMID: 35878710 DOI: 10.1016/j.ypmed.2022.107176] [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: 03/13/2022] [Revised: 06/06/2022] [Accepted: 07/17/2022] [Indexed: 11/25/2022]
Abstract
White individuals in the United States (US) have historically had disproportionate access to firearms. The real-life availability of firearms, including those most lethal, may still be greater among White populations, manifesting in the number of victims in shootings. We compared the severity of US mass public shootings since Columbine by race and/or ethnicity of the perpetrator using The Violence Project Database of Mass Shooters, assessing fatalities (minimum four), total victims, type, and legal status of guns used. We used data visualization and Quasi-Poisson regression of victims minus four - accounting for truncation at 4 fatalities - to assess fatality and total victim rates comparing Non-Hispanic (NH) White with NH Black shooters, using winsorization to account for outlier bias from the 2017 Las Vegas shooting. In 104 total mass public shootings until summer 2021, NH White shooters had higher median fatalities (6 [IQR 5-9] versus 5 [IQR 4-6]) and total victims (9 [IQR 6-19] versus 7 [IQR 5-12]) per incident. Confidence intervals of NH Black versus NH White fatalities rate ratios (RR) ranged from 0.17-1.15, and of total victim RRs from 0.15-1.04. White shooters were overrepresented in mass public shootings with the most victims, typically involving legally owned assault rifles. To better understand the consequences when firearms are readily available, including assault rifles, we need a database of all US gun violence. Our assessment of total victims beyond fatalities emphasizes the large number of US gun violence survivors and the need to understand their experiences to capture the full impact of gun violence.
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Affiliation(s)
- Patricia I Jewett
- Department of Medicine, University of Minnesota, Minneapolis, United States of America.
| | - Ronald E Gangnon
- Department of Population Health Sciences, University of Wisconsin, Madison, United States of America; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, United States of America
| | - Iris W Borowsky
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, United States of America
| | - Jillian Peterson
- Department of Criminology and Criminal Justice, Hamline University, Saint Paul, United States of America
| | - Eunice M Areba
- School of Nursing, University of Minnesota, Minneapolis, United States of America
| | - Andrew Kiragu
- Department of Pediatrics, University of Minnesota; Hennepin Healthcare; Children's Minnesota, United States of America
| | - James Densley
- School of Law Enforcement and Criminal Justice, Metropolitan State University, Saint Paul, United States of America
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Geibel E, Pasman E, Nylund C, Rudolph B, Reeves P. The Impact of the COVID-19 Pandemic on Foreign Body Ingestion Trends in Children: A Comparison of the Pre-Pandemic Period to 2020. J Pediatr Gastroenterol Nutr 2022; 75:299-303. [PMID: 35984456 PMCID: PMC9365073 DOI: 10.1097/mpg.0000000000003472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/30/2022] [Indexed: 12/10/2022]
Abstract
Foreign body ingestion (FBI) among children is associated with morbidity and mortality. We used the National Electronic Injury Surveillance System to compare FBI trends from 2017-2019 to 2020 during the spread of SARS-CoV-2. The pandemic and associated stay-at-home orders were associated with uptrends in button battery and magnet ingestions but unchanged total FBI trends.
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Affiliation(s)
- Elyse Geibel
- From the Department of Pediatrics, Naval Medical Center San Diego, San Diego, CA, USA
| | - Eric Pasman
- From the Department of Pediatrics, Naval Medical Center San Diego, San Diego, CA, USA
- the Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cade Nylund
- the Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Bryan Rudolph
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA, and the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Brooke Army Medical Center, San Antonio, TX, USA
| | - Patrick Reeves
- the Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Martin R, Rajan S, Shareef F, Xie KC, Allen KA, Zimmerman M, Jay J. Racial Disparities in Child Exposure to Firearm Violence Before and During COVID-19. Am J Prev Med 2022; 63:204-212. [PMID: 35418336 PMCID: PMC8921002 DOI: 10.1016/j.amepre.2022.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Childhood exposure to neighborhood firearm violence adversely affects mental and physical health across the life course. Study objectives were to (1) quantify racial disparities in these exposures across the U.S. and (2) assess changes during the COVID-19 pandemic, when firearm violence increased. METHODS The study used counts of children aged 5-17 years, disaggregated by U.S. Census racial category, for every census tract (N=73,056). Neighborhood firearm violence was the number of fatal shootings per census tract, based on 2015-2021 Gun Violence Archive data. Quasi-Poisson regressions were used to estimate baseline disparities and COVID-19‒related changes and examined differences across geographic regions. RESULTS Prepandemic exposure was lowest among White children and highest among Black children, who experienced 4.44 times more neighborhood firearm violence exposure (95% CI=4.33, 4.56, p<0.001) than White children. The pandemic increased exposure by 27% in the lowest risk group (i.e., White children; 95% CI=20%, 34%, p<0.001), but pandemic effects were even greater for children in nearly all non-White categories. Baseline violence levels and racial disparities varied considerably by region, with the highest levels in the South and the largest magnitude disparities observed in the Northeast and Midwest. CONCLUSIONS Large-scale racial disparities exist in child exposure to neighborhood firearm violence, and these disparities grew during the pandemic. Equitable access to trauma-informed programs, community-based prevention, and structural reforms are urgently needed.
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Affiliation(s)
- Rachel Martin
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York
| | - Faizah Shareef
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Kristal C Xie
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Kalice A Allen
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Marc Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
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Monroe K, Smola C, Schmit E, Jeffries K, Burks AR, Nichols M. Important Advances in Pediatric Injury Prevention. South Med J 2022; 115:630-634. [PMID: 35922051 DOI: 10.14423/smj.0000000000001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In children, injuries are the leading cause of death, a major source of disability, and the number one cause of death for children after the first year of life. The principles of injury prevention include surveillance, coalitions, communication, interventions, and evaluation. This article discusses a number of common pediatric injuries and their prevention strategies. This review article addresses key components of injury prevention and specifically addresses the following injuries: motor vehicle crashes (with a section on teen driver crashes, sleep-related injury, and death), poisoning, all-terrain vehicle crashes, drowning, and firearm injuries. Injuries are preventable occurrences that can result in devastating sequelae or death. We present an overview of the more common pediatric injuries along with injury-prevention strategies.
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Affiliation(s)
- Kathy Monroe
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; Division of Hospital Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; and Division of Hospital Medicine, Children's Mercy Hospital, Kansas City Missouri
| | - Cassi Smola
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; Division of Hospital Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; and Division of Hospital Medicine, Children's Mercy Hospital, Kansas City Missouri
| | - Erinn Schmit
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; Division of Hospital Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; and Division of Hospital Medicine, Children's Mercy Hospital, Kansas City Missouri
| | - Kristyn Jeffries
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; Division of Hospital Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; and Division of Hospital Medicine, Children's Mercy Hospital, Kansas City Missouri
| | - Allison Reid Burks
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; Division of Hospital Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; and Division of Hospital Medicine, Children's Mercy Hospital, Kansas City Missouri
| | - Michele Nichols
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; Division of Hospital Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; and Division of Hospital Medicine, Children's Mercy Hospital, Kansas City Missouri
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Abstract
This cross-sectional study examines gun-related deaths during the early stages of the US COVID-19 pandemic among children aged 0 to 17 years.
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Affiliation(s)
- Pablo A Peña
- Kenneth C. Griffin Department of Economics, University of Chicago, Chicago, Illinois
| | - Anupam Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- National Bureau of Economic Research, Cambridge, Massachusetts
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Collings AT, Farazi M, Van Arendonk KJ, Fallat ME, Minneci PC, Sato TT, Speck KE, Deans KJ, Falcone Jr RA, Foley DS, Fraser JD, Gadepalli SK, Keller MS, Kotagal M, Landman MP, Leys CM, Markel TA, Rubalcava N, St. Peter SD, Flynn-O'Brien KT. The COVID-19 pandemic and associated rise in pediatric firearm injuries: A multi-institutional study. J Pediatr Surg 2022; 57:1370-1376. [PMID: 35501165 PMCID: PMC9001175 DOI: 10.1016/j.jpedsurg.2022.03.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Firearm sales in the United States (U.S.) markedly increased during the COVID-19 pandemic. Our objective was to determine if firearm injuries in children were associated with stay-at-home orders (SHO) during the COVID-19 pandemic. We hypothesized there would be an increase in pediatric firearm injuries during SHO. METHODS This was a multi institutional, retrospective study of institutional trauma registries. Patients <18 years with traumatic injuries meeting National Trauma Data Bank (NTDB) criteria were included. A "COVID" cohort, defined as time from initiation of state SHO through September 30, 2020 was compared to "Historical" controls from an averaged period of corresponding dates in 2016-2019. An interrupted time series analysis (ITSA) was utilized to evaluate the association of the U.S. declaration of a national state of emergency with pediatric firearm injuries. RESULTS Nine Level I pediatric trauma centers were included, contributing 48,111 pediatric trauma patients, of which 1,090 patients (2.3%) suffered firearm injuries. There was a significant increase in the proportion of firearm injuries in the COVID cohort (COVID 3.04% vs. Historical 1.83%; p < 0.001). There was an increased cumulative burden of firearm injuries in 2020 compared to a historical average. ITSA showed an 87% increase in the observed rate of firearm injuries above expected after the declaration of a nationwide emergency (p < 0.001). CONCLUSION The proportion of firearm injuries affecting children increased during the COVID-19 pandemic. The pandemic was associated with an increase in pediatric firearm injuries above expected rates based on historical patterns.
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Affiliation(s)
- Amelia T. Collings
- Department of Surgery, Indiana University, 545 Barnhill Dr., Emerson 125, Indianapolis, IN, United States,Corresponding author
| | | | | | - Mary E. Fallat
- Norton Children's Hospital, Louisville, KY, United States,Hiram C. Polk, Jr Department of Surgery, University of Louisville, KY, United States
| | - Peter C. Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | | | - K. Elizabeth Speck
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI, United States
| | - Katherine J. Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Richard A. Falcone Jr
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - David S. Foley
- Norton Children's Hospital, Louisville, KY, United States,Hiram C. Polk, Jr Department of Surgery, University of Louisville, KY, United States
| | - Jason D. Fraser
- Children's Mercy Kansas City, Kansas City, MO, United States
| | - Samir K. Gadepalli
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI, United States
| | - Martin S. Keller
- Division of Pediatric Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Matthew P. Landman
- Department of Surgery, Indiana University, 545 Barnhill Dr., Emerson 125, Indianapolis, IN, United States
| | - Charles M. Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States
| | - Troy A. Markel
- Department of Surgery, Indiana University, 545 Barnhill Dr., Emerson 125, Indianapolis, IN, United States
| | - Nathan Rubalcava
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI, United States
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Wieck MM, Silva T, Kohler JE. Changing Patterns of Pediatric Trauma During the COVID-19 Pandemic. Pediatr Ann 2022; 51:e286-e290. [PMID: 35858219 DOI: 10.3928/19382359-20220504-07] [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: 11/20/2022]
Abstract
The implementation of lockdown and social distancing policies at the beginning of the coronavirus disease 2019 (COVID-19) pandemic changed both the nature of pediatric traumatic injuries and how those injuries were managed by pediatric trauma centers. At the start of the pandemic, the number of injured children evaluated at trauma centers decreased. Trauma volumes have since rebounded, and a concerning increase in abuse-related injuries has been seen. Pediatric trauma systems responded to the pandemic with new approaches to protect health care providers, conserve critical resources, and assist adult trauma systems overburdened by patients with COVID-19. The widespread effect of COVID-19 continues to have significant repercussions on children's health, but the lessons learned and gaps exposed by the pandemic may be an opportunity to positively transform injury prevention and health care delivery. [Pediatr Ann. 2022;51(7):e286-e290.].
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Golomb MR, Tejada JG, Ducis KA, Martinez ML. Acute and Delayed Cerebrovascular Injury From Gunshot to the Head in a 12-Year-Old Child During the COVID-19 Pandemic. Pediatr Neurol 2022; 130:1-3. [PMID: 35245820 PMCID: PMC8830928 DOI: 10.1016/j.pediatrneurol.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/16/2022] [Accepted: 02/05/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Meredith R Golomb
- Division of Child Neurology, Department of Neurology, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
| | - Juan G Tejada
- Division of Pediatric Neuroradiology, Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Katrina A Ducis
- Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont
| | - Mesha L Martinez
- Division of Pediatric Neuroradiology, Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
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Theodorou CM, Brown EG, Jackson JE, Castle SL, Chao SD, Beres AL. Unintended Consequences of COVID-19 on Pediatric Falls from Windows: A Multicenter Study. J Surg Res 2022; 279:187-192. [PMID: 35779448 PMCID: PMC9149047 DOI: 10.1016/j.jss.2022.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/19/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
Abstract
Introduction In attempts to quell the spread of COVID-19, shelter-in-place orders were employed in most states. Increased time at home, in combination with parents potentially balancing childcare and work-from-home duties, may have had unintended consequences on pediatric falls from windows. We aimed to investigate rates of falls from windows among children during the first 6 mo of the COVID-19 pandemic. Methods Patients <18 y old admitted to three pediatric trauma centers (two - level 1, one - level 2) between 3/19/20 and 9/19/20 (COVID-era) were compared to a pre-COVID cohort (3/19/19 to 9/19/19). The primary outcome was the rate of falls from windows. Secondary outcomes included injury severity score (ISS), injuries sustained, and mortality. Results Of 1011 total COVID-era pediatric trauma patients, 36 (3.6%) sustained falls from windows compared to 23 of 1108 (2.1%) pre-COVID era patients (OR 1.7, P = 0.05). The median ISS was seven pre-COVID versus four COVID-era (P = 0.43). The most common injuries sustained were skull fractures (30.5%), extremity injuries (30.5%), and intracranial hemorrhage (23.7%). One-fifth of patients underwent surgery (21.7% pre-COVID versus 19.4% COVID-era, P = 1.0). There was one mortality in the COVID-era cohort and none in the pre-COVID cohort (P = 1.0). Conclusions Despite overall fewer trauma admissions during the first 6 mo of the COVID-19 pandemic, the rate of falls from windows nearly doubled compared to the prior year, with substantial associated morbidity. These findings suggest a potential unintended consequence of shelter-in-place orders and support increased education on home safety and increased support for parents potentially juggling multiple responsibilities in the home.
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Affiliation(s)
- Christina M Theodorou
- University of California Davis Medical Center, Division of Pediatric General, Thoracic, and Fetal Surgery, Sacramento, California.
| | - Erin G Brown
- University of California Davis Medical Center, Division of Pediatric General, Thoracic, and Fetal Surgery, Sacramento, California
| | - Jordan E Jackson
- University of California Davis Medical Center, Division of Pediatric General, Thoracic, and Fetal Surgery, Sacramento, California
| | - Shannon L Castle
- Valley Children's Hospital, Division of Pediatric Surgery Madera, California
| | - Stephanie D Chao
- Stanford School of Medicine, Department of Surgery, Division of Pediatric Surgery, Palo Alto, California
| | - Alana L Beres
- University of California Davis Medical Center, Division of Pediatric General, Thoracic, and Fetal Surgery, Sacramento, California
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Afif IN, Gobaud AN, Morrison CN, Jacoby SF, Maher Z, Dauer ED, Kaufman EJ, Santora TA, Anderson JH, Pathak A, Sjoholm LO, Goldberg AJ, Beard JH. The changing epidemiology of interpersonal firearm violence during the COVID-19 pandemic in Philadelphia, PA. Prev Med 2022; 158:107020. [PMID: 35301043 PMCID: PMC8920109 DOI: 10.1016/j.ypmed.2022.107020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/26/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
Recent increases in firearm violence in U.S. cities are well-documented, however dynamic changes in the people, places and intensity of this public health threat during the COVID-19 pandemic are relatively unexplored. This descriptive epidemiologic study spanning from January 1, 2015 - March 31, 2021 utilizes the Philadelphia Police Department's registry of shooting victims, a database which includes all individuals shot and/or killed due to interpersonal firearm violence in the city of Philadelphia. We compared victim and event characteristics prior to the pandemic with those following implementation of pandemic containment measures. In this study, containment began on March 16, 2020, when non-essential businesses were ordered to close in Philadelphia. There were 331 (SE = 13.9) individuals shot/quarter pre-containment vs. 545 (SE = 66.4) individuals shot/quarter post-containment (p = 0.031). Post-containment, the proportion of women shot increased by 39% (95% CI: 1.21, 1.59), and the proportion of children shot increased by 17% (95% CI: 1.00, 1.35). Black women and children were more likely to be shot post-containment (RR 1.11, 95% CI: 1.02, 1.20 and RR 1.08, 95% CI: 1.03, 1.14, respectively). The proportion of mass shootings (≥4 individuals shot within 100 m within 1 h) increased by 53% post-containment (95% CI: 1.25, 1.88). Geographic analysis revealed relative increases in all shootings and mass shootings in specific city locations post-containment. The observed changes in firearm injury epidemiology following COVID-19 containment in Philadelphia demonstrate an intensification in firearm violence, which is increasingly impacting people who are likely made more vulnerable by existing social and structural disadvantage. These findings support existing knowledge about structural causes of interpersonal firearm violence and suggest structural solutions are required to address this public health threat.
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Affiliation(s)
- Iman N Afif
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Ariana N Gobaud
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Christopher N Morrison
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sara F Jacoby
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Zoë Maher
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Elizabeth D Dauer
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas A Santora
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jeffrey H Anderson
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Abhijit Pathak
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Lars Ola Sjoholm
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Amy J Goldberg
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jessica H Beard
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.
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Magee LA, Lucas B, Fortenberry JD. Changing epidemiology of firearm injury: a cohort study of non-fatal firearm victimisation before and during the COVID-19 pandemic, Indianapolis, Indiana. BMJ Open 2022; 12:e059315. [PMID: 35321899 PMCID: PMC8943482 DOI: 10.1136/bmjopen-2021-059315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine victimisation rates, geographic patterns and neighbourhood characteristics associated with non-fatal firearm injury rates before and during the COVID-19 pandemic. DESIGN A retrospective cohort study. SETTING City of Indianapolis, Indiana, USA, 1 January 2017-30 June 2021. PARTICIPANTS Intentional non-fatal firearm injury victims from Indianapolis Metropolitan Police Department records. The study included information on 2578 non-fatal firearm injury victims between ages 0 and 77 years. Of these victims, 82.5% were male and 77.4% were black. PRIMARY AND SECONDARY OUTCOME MEASURES Rates of non-fatal firearm injuries per 100 000 population by victim age, race, sex and incident motive. Prepandemic and peripandemic non-fatal firearm injury rates. RESULTS Non-fatal shooting rates increased 8.60%, from 57.0 per 100 000 person-years in prepandemic years to 65.6 per 100 000 person-years during the pandemic (p<0.001). Rates of female victims (15.2 vs 23.8 per 100,000; p<0.001) and older victims (91.3 vs 120.4 per 100,000; p<0.001) increased significantly during the pandemic compared with the prepandemic period. Neighbourhoods with higher levels of structural disadvantage (IRR: 1.157, 95% CI 1.012 to 1.324) and prepandemic firearm injury rates (IRR: 1.001, 95% CI 1.001 to 1.002) was positively associated with higher rates of non-fatal firearm injuries during the pandemic, adjusting for neighbourhood characteristics. CONCLUSIONS Non-fatal firearm injuries increased significantly during the COVID-19 pandemic, particularly among female and older victims. Efforts are needed to expand and rethink current firearm prevention efforts that both address the diversification of victimisation and the larger societal trauma of firearm violence.
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Affiliation(s)
- Lauren A Magee
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Bailee Lucas
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - James Dennis Fortenberry
- Department of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Abstract
The authors review trend and cohort surveys and administrative data comparing prevalence of mental disorders during, versus, and before the COVID-19 pandemic and changes in mental health disparities. Best evidence suggests clinically significant anxiety-depression point prevalence increased by relative-risk (RR) = 1.3 to 1.5 during the pandemic compared with before. This level of increase is much less than the implausibly high RR = 5.0 to 8.0 estimates reported in trend studies early in the pandemic based on less-appropriate comparisons. Changes in prevalence also occurred during the pandemic, but relative prevalence appears not to have changed substantially over this time.
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Ng G, Castro CM, Hamdan M, Salazar H, Joseph S, Thakur B, Nemir S, Tyroch A. Evaluating the change in patterns of traumatic injury in the setting of pandemic and social distancing restrictions: An analysis of a level 1 trauma center. Am J Surg 2022; 224:120-124. [PMID: 35400529 PMCID: PMC8957315 DOI: 10.1016/j.amjsurg.2022.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Abstract
Background Social distancing measures and quarantine during the COVID-19 pandemic have led to reported changes in traumatic injury patterns. We set to examine the effects of these restrictive guidelines in our trauma center. Methods This is a retrospective chart review of all patients evaluated for traumatic injuries at a Level 1 trauma center during two time periods: March–June 2020 (COVID) and March–June 2019 (Pre-COVID). Results Overall trauma volume did not differ significantly between the two time periods. Changes seen during COVID included increases in penetrating injuries (12.5% vs 6.7%, p < 0.001), particularly those due to firearms (7.5% vs 3.7%, p < 0.001). Hospital length of stay, intensive care unit length of stay, and days on the ventilator remained consistent between the two groups. Trends toward increased injuries in the home and non-accidental trauma were not statistically significant. Conclusion Traumatic injury patterns have changed as a result of social distancing in both the adult and pediatric trauma populations. Analyzing the effects of social distancing on trauma can lead to a better development of preventive strategies.
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Affiliation(s)
- Grace Ng
- Department of Surgery Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave. MSC 41031, El Paso, TX, 79905, USA.
| | - Christian M Castro
- Paul L. Foster School of Medicine, 5001 El Paso Dr. El Paso, TX, 79905, USA.
| | - Marah Hamdan
- Paul L. Foster School of Medicine, 5001 El Paso Dr. El Paso, TX, 79905, USA.
| | - Humberto Salazar
- Paul L. Foster School of Medicine, 5001 El Paso Dr. El Paso, TX, 79905, USA.
| | - Sharon Joseph
- Paul L. Foster School of Medicine, 5001 El Paso Dr. El Paso, TX, 79905, USA.
| | - Bhaskar Thakur
- Division of Biostatistics and Epidemiology, Paul L. Foster School of Medicine, 5001 El Paso Dr. El Paso, TX, 79905, USA.
| | - Stephanie Nemir
- Department of Surgery Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave. MSC 41031, El Paso, TX, 79905, USA.
| | - Alan Tyroch
- Department of Surgery Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave. MSC 41031, El Paso, TX, 79905, USA.
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Chaudhari PP, Anderson M, Ourshalimian S, Goodhue C, Sudharshan R, Valadez S, Spurrier R. Epidemiology of pediatric trauma during the coronavirus disease-2019 pandemic. J Pediatr Surg 2022; 57:284-290. [PMID: 34742575 PMCID: PMC8500847 DOI: 10.1016/j.jpedsurg.2021.09.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE We aimed to describe the epidemiology of trauma activations and variations in injury patterns, injury severity, and hospital length-of-stay for injured children in Los Angeles (LA) County during the coronavirus-disease-19 (COVID-19) pandemic. METHODS We conducted a retrospective cross-sectional study of children aged < 18-years evaluated in 15 trauma centers from 2019 to 2020 and entered in the LA County trauma registry. We defined 01/01/2019-03/18/2020 as pre-pandemic and 03/19/2020-12/31/2020 as the pandemic period. Our primary outcome was pediatric trauma activations. We analyzed demographic and clinical data, including types and severity of injuries sustained. We conducted unadjusted bivariate analyzes of injury patterns between periods. Segmented linear regression models were used to test rates (per 100,000 LA County children) of trauma activations pre-pandemic versus the pandemic period. RESULTS We studied 4399 children with trauma activations, 2695 of which occurred pre-pandemic and 1701 in the pandemic period. Motor vehicle collisions, gunshot wounds, and burns increased during the pandemic (all p-values< 0.05), while sports injuries decreased (p < 0.001). Median injury severity scores (p = 0.323) and Glasgow Coma Scales (p = 0.558) did not differ between periods, however mortality (p = 0.023) decreased during the pandemic. Segmented linear regression estimates demonstrated that rates of trauma activations pre-pandemic were similar to the pandemic period (p = 0.384). CONCLUSION Pediatric trauma activations in LA County did not significantly differ during the COVID-19 pandemic, but types and severity of injuries varied between pre-pandemic and pandemic periods. With lockdown restrictions being lifted and novel SARS-CoV-2 variants circulating, our investigation describes this recent epidemiologic phenomenon to aid future preparation for healthcare systems. LEVEL OF EVIDENCE Level III TYPE OF STUDY: Retrospective cross-sectional study.
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Affiliation(s)
- Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mail Stop 113, Los Angeles, CA 90027, USA,Keck School of Medicine of the University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA,Corresponding author at: Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mail Stop 113, Los Angeles, CA 90027, USA
| | - Melissa Anderson
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Shadassa Ourshalimian
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Catherine Goodhue
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Rasika Sudharshan
- Keck School of Medicine of the University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Sara Valadez
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Ryan Spurrier
- Keck School of Medicine of the University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA,Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
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