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Miller ZM, Cooper BP, Lew D, Ancona RM, Moran V, Behr C, Spruce MW, Kranker LM, Mancini MA, Vogel M, Schuerer DJE, Clukies L, Ranney ML, Foraker RE, Mueller KL. Factors Associated With Recurrent Pediatric Firearm Injury : A 10-Year Retrospective Cohort Analysis. Ann Intern Med 2024; 177:1381-1388. [PMID: 39284184 PMCID: PMC11537306 DOI: 10.7326/m24-0430] [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] [Indexed: 10/16/2024] Open
Abstract
BACKGROUND Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States. OBJECTIVE To examine the factors associated with recurrent firearm injury among children who presented with acute (index) nonfatal firearm injury in the St. Louis region. DESIGN Multicenter, observational, cohort study. SETTING 2 adult and 2 pediatric level I trauma hospitals in St. Louis, Missouri. PARTICIPANTS Pediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019. MEASUREMENTS From the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository, we collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. The Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the cumulative incidence of experiencing a recurrent firearm injury. RESULTS During the 10-year study period, 1340 children presented with an index firearm injury. Most patients were Black (87%), non-Hispanic (99%), male (84%), and between the ages of 15 and 17 years (67%). The estimated risk for firearm reinjury was 6% at 1 year and 14% at 5 years after initial injury. Male children and those seen at an adult hospital were at increased risk for reinjury. LIMITATION Our data set does not account for injuries occurring outside of the study period and for reinjuries presenting to nonstudy hospitals. CONCLUSION Children who experience an initial firearm injury are at high risk for experiencing a recurrent firearm injury. Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Zoe M Miller
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri (Z.M.M.)
| | - Benjamin P Cooper
- Institute for Public Health, Washington University in St. Louis School of Medicine, St. Louis, Missouri (B.P.C.)
| | - Daphne Lew
- Center for Biostatistics and Data Science, Washington University in St. Louis School of Medicine, St. Louis, Missouri (D.L.)
| | - Rachel M Ancona
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (R.M.A., K.L.M.)
| | - Vicki Moran
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, Missouri (V.M.)
| | - Christopher Behr
- SSM Saint Louis University Hospital, Saint Louis University School of Medicine, St. Louis, Missouri (C.B.)
| | - Marguerite W Spruce
- Section of Acute & Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis; and USA C-STARS ETL, U.S. Air Force School of Aerospace Medicine, St. Louis, Missouri (M.W.S.)
| | - Lindsay M Kranker
- Section of Acute & Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri (L.M.K., D.J.E.S.)
| | - Michael A Mancini
- Saint Louis University School of Social Work, St. Louis, Missouri (M.A.M.)
| | - Matt Vogel
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri; and School of Criminal Justice, University at Albany, State University of New York, Albany, New York (M.V.)
| | - Doug J E Schuerer
- Section of Acute & Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri (L.M.K., D.J.E.S.)
| | - Lindsay Clukies
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri (L.C.)
| | - Megan L Ranney
- Yale School of Public Health, New Haven, Connecticut (M.L.R.)
| | - Randi E Foraker
- Department of Biomedical Informatics, Biostatistics & Medical Epidemiology, University of Missouri School of Medicine, Columbia, Missouri (R.E.F.)
| | - Kristen L Mueller
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (R.M.A., K.L.M.)
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Ancona RM, Cooper BP, Foraker R, Kaser T, Adeoye O, Mueller KL. Machine learning classification of new firearm injury encounters in the St Louis region: 2010-2020. J Am Med Inform Assoc 2024; 31:2165-2172. [PMID: 38976592 DOI: 10.1093/jamia/ocae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVES To improve firearm injury encounter classification (new vs follow-up) using machine learning (ML) and compare our ML model to other common approaches. MATERIALS AND METHODS This retrospective study used data from the St Louis region-wide hospital-based violence intervention program data repository (2010-2020). We randomly selected 500 patients with a firearm injury diagnosis for inclusion, with 808 total firearm injury encounters split (70/30) for training and testing. We trained a least absolute shrinkage and selection operator (LASSO) regression model with the following predictors: admission type, time between firearm injury visits, number of prior firearm injury emergency department (ED) visits, encounter type (ED or other), and diagnostic codes. Our gold standard for new firearm injury encounter classification was manual chart review. We then used our test data to compare the performance of our ML model to other commonly used approaches (proxy measures of ED visits and time between firearm injury encounters, and diagnostic code encounter type designation [initial vs subsequent or sequela]). Performance metrics included area under the curve (AUC), sensitivity, and specificity with 95% confidence intervals (CIs). RESULTS The ML model had excellent discrimination (0.92, 0.88-0.96) with high sensitivity (0.95, 0.90-0.98) and specificity (0.89, 0.81-0.95). AUC was significantly higher than time-based outcomes, sensitivity was slightly (but not significantly) lower than other approaches, and specificity was higher than all other methods. DISCUSSION ML successfully delineated new firearm injury encounters, outperforming other approaches in ruling out encounters for follow-up. CONCLUSION ML can be used to identify new firearm injury encounters and may be particularly useful in studies assessing re-injuries.
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Affiliation(s)
- Rachel M Ancona
- Department of Emergency Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Benjamin P Cooper
- Institute for Public Health, Washington University in St Louis, St Louis, MO 63110, United States
| | - Randi Foraker
- Department of Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Taylor Kaser
- Department of Emergency Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Opeolu Adeoye
- Department of Emergency Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Kristen L Mueller
- Department of Emergency Medicine, Washington University in St Louis, St Louis, MO 63110, United States
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Miller ZM, Chapman-Kramer K, Cooper BP, Coffey M, Page K, Meyers JE, Vogel M, Mancini M, Mueller K. Personal goals of young survivors of violent injury: implications for practice. Inj Prev 2024; 30:313-319. [PMID: 38290779 DOI: 10.1136/ip-2023-045032] [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: 07/03/2023] [Accepted: 12/10/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Firearm injuries are the leading cause of death among young people in the USA and disproportionately impact communities of colour and those experiencing socioeconomic distress. Understanding the personal goals of violently injured patients is essential to identifying protective factors and developing interventions that promote them. However, limited research characterising these personal goals exists. OBJECTIVE The objective of this study was to use qualitative thematic analysis to analyse and describe the personal goals of young people who enrolled in a region-wide hospital-based violence intervention programme after surviving a violent injury. METHODS A qualitative coding framework was developed, evaluated, and implemented using data from Life Outside of Violence, the St. Louis Area Hospital-Based Violence Intervention Programme. Chart abstraction procedures were used to compile qualitative data on Life Outside of Violence participants' personal goals documented by clinical case managers during individual treatment planning sessions with participants (n=168). Descriptive analyses are reported and implications for practice are discussed. RESULTS Key findings reveal that (1) violent injury survivors have unmet therapeutic and resource needs, indicating the importance of having service providers with both clinical and case management skills, (2) anger management is a common clinical goal, and (3) employment opportunities are a common resource need. CONCLUSIONS Findings from this study inform the implementation of the Life Outside of Violence programme and offer a roadmap to other hospital-based violence intervention programmes operating nation-wide. Our results provide insight into participants' needs, desires, and motivations, allowing unique opportunities for improved participant engagement and service delivery.
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Affiliation(s)
- Zoe Maya Miller
- Institute for Public Health, Washington University in St Louis, St Louis, Missouri, USA
| | - Kateri Chapman-Kramer
- Institute for Public Health, Washington University in St Louis, St Louis, Missouri, USA
| | - Benjamin P Cooper
- Institute for Public Health, Washington University in St Louis, St Louis, Missouri, USA
| | - Melik Coffey
- Social Work, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri, USA
| | - Keyria Page
- Social Work, St Louis Children's Hospital, St Louis, Missouri, USA
| | - Jessica E Meyers
- St. Louis Area Violence Prevention Commission, Saint Louis, Missouri, USA
| | - Matt Vogel
- Sociology, University at Albany School of Criminal Justice, Albany, New York, USA
| | - Michael Mancini
- School of Social Work, Saint Louis University, Saint Louis, Missouri, USA
| | - Kristen Mueller
- Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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Hartline J, Cosgrove CT, O'Hara NN, Ghulam QM, Hannan ZD, O'Toole RV, Sciadini MF, Langhammer CG. Socioeconomic status is associated with greater hazard of post-discharge mortality than race, gender, and ballistic injury mechanism in a young, healthy, orthopedic trauma population. Injury 2024; 55:111177. [PMID: 37972486 DOI: 10.1016/j.injury.2023.111177] [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: 05/12/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To explore the utility of legacy demographic factors and ballistic injury mechanism relative to popular markers of socioeconomic status as prognostic indicators of 10-year mortality following hospital discharge in a young, healthy patient population with isolated orthopedic trauma injuries. METHODS A retrospective cohort study was performed to evaluate patients treated at an urban Level I trauma center from January 1, 2003, through December 31, 2016. Current Procedure Terminology (CPT) codes were used to identify upper and lower extremity fracture patients undergoing operative fixation. Exclusion criteria were selected to yield a patient population of isolated extremity trauma in young, otherwise healthy individuals between the ages of 18 and 65 years. Variables collected included injury mechanism, age, race, gender, behavior risk factors, Area Deprivation Index (ADI), and insurance status. The primary outcome was post-discharge mortality, occurring at any point during the study period. RESULTS We identified 2539 patients with operatively treated isolated extremity fractures. The lowest two quartiles of socioeconomic status (SES) were associated with higher hazard of mortality than the highest SES quartile in multivariable analysis (Quartile 3 HR: 2.2, 95% CI: 1.2-4.1, p = 0.01; Quartile 4 HR: 2.2, 95% CI: 1.1-4.3, p = 0.02). Not having private insurance was associated with higher mortality hazard in multivariable analysis (HR 2.0, 95% CI: 1.3-3.2, p = 0.002). The presence of any behavioral risk factor was associated with higher mortality hazard in univariable analysis (HR: 1.8, p < 0.05), but this difference did not reach statistical significance in multivariable analysis (HR: 1.4, 95%: 0.8-2.3, p = 0.20). Injury mechanism (ballistic versus blunt), gender, and race were not associated with increased hazard of mortality (p > 0.20). CONCLUSION Low SES is associated with a greater hazard of long-term mortality than ballistic injury mechanism, race, gender, and medically diagnosable behavioral risk factors in a young, healthy orthopedic trauma population with isolated extremity injury.
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Affiliation(s)
- Jacob Hartline
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Christopher T Cosgrove
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Qasim M Ghulam
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Zachary D Hannan
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Marcus F Sciadini
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Christopher G Langhammer
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
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