Pediatric firearm injury related emergency department visits and hospitalizations: a population-based study in the United States

Goel, Ruchika; Zhu, Xianming; Makhani, Sarah; Josephson, Cassandra D.; White, Jodie L; Karam, Oliver; Goel, Ruchika; Gehrie, Eric A.; Sherpa, Mingmar; Crowe, Elizabeth; Bloch, Evan M.; Tobian, Aaron A.R.

doi:10.1016/j.lana.2023.100503

Cited by 1 publication

(8 citation statements)

References 33 publications

(44 reference statements)

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“…These findings are consistent with other studies documenting similar increases over time, some in relation to the start of COVID-19 ( 9 , 10 , 13 , 40 ) and others not ( 1 , 18 ). In the present study, and consistent with past literature, patients in our sample were majority male, Black, publicly insured, and injured by assault and unintentional shootings ( 19 ). Our sample was younger in age compared to national samples, where a majority of pediatric patients with FRI are in the older adolescent age group ( 19 , 41 ).…”

Section: Discussionsupporting

confidence: 89%

“…In the present study, and consistent with past literature, patients in our sample were majority male, Black, publicly insured, and injured by assault and unintentional shootings ( 19 ). Our sample was younger in age compared to national samples, where a majority of pediatric patients with FRI are in the older adolescent age group ( 19 , 41 ). This is due, in-part, to our trauma center’s proximity to adult trauma centers; patients 15 years-old and older are often routed to adult centers.…”

Section: Discussionsupporting

confidence: 89%

“…Studies have found that among the U.S., Southern states have the highest rates of pediatric FRI incidence ( 19 ), have worsening pediatric FRI mortality rates ( 1 ), and have one of the highest rates of pediatric firearm homicide ( 16 ). It has been estimated that 49% of Georgia households own a firearm ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of neighborhood income level, Black children still have higher rates of FRI compared to White children ( 17 ). Within the U.S., Southern states have a disproportionately high volume of pediatric firearm incidents ( 18 , 19 ).…”

Section: Introductionmentioning

confidence: 99%

“…Social determinants of health (SDH), the non-medical, environmental, and social conditions we live in, drive health inequalities in disease and injury ( 20 ) and FRI is no exception. Recent studies have shown that neighborhood poverty and deprivation associates with increased pediatric FRI risk and mortality ( 1 , 19 , 21 , 22 ). Additionally, prior studies have shown that insurance associates with mortality following FRI ( 23 ) and in pediatric trauma ( 24 , 25 ).…”

Section: Introductionmentioning

confidence: 99%

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Trends in pediatric firearm-related injuries and disparities in acute outcomes

Mulugeta,

Bailey,

Parsons

et al. 2024

Front. Public Health

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BackgroundFirearm-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.MethodsRetrospective 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.ResultsMajority 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).ConclusionPediatric 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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