Variability in firearm injury among major pediatric trauma centers across the USA

Kiesha Fraser Doh; Sofia Chaudhary; Stephanie M Ruest; Ashkon Shaahinfar; Thomas Chun; Nicholas Cooper; Joel Fein; Alayna Feng; Katherine Feske-Kirby; Janet Figueroa; Colleen K Gutman; Jacqueline Grupp-Phelan; Ghid Kanaan; Nora Keathley; Naghma Khan; Katherine McGlamry; Sage Myers; Michael Nance; Katherine Russell; Kelli Rowker; Erica Sheline; Harold K Simon; Claudia R Morris

doi:10.1136/tsaco-2022-001014

Variability in firearm injury among major pediatric trauma centers across the USA

Trauma Surg Acute Care Open. 2023 May 30;8(1):e001014. doi: 10.1136/tsaco-2022-001014. eCollection 2023.

Authors

Kiesha Fraser Doh^{1

2}, Sofia Chaudhary^{1

2}, Stephanie M Ruest^{3

4}, Ashkon Shaahinfar⁵, Thomas Chun^{6

7}, Nicholas Cooper⁸, Joel Fein^{9

10}, Alayna Feng¹¹, Katherine Feske-Kirby¹², Janet Figueroa¹³, Colleen K Gutman¹⁴, Jacqueline Grupp-Phelan¹⁵, Ghid Kanaan⁷, Nora Keathley¹⁶, Naghma Khan^{1

2}, Katherine McGlamry¹⁷, Sage Myers^{9

12}, Michael Nance^{9

12}, Katherine Russell¹⁸, Kelli Rowker², Erica Sheline^{19

20}, Harold K Simon^{1

2}, Claudia R Morris^{1

2}

Affiliations

¹ Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
² Children's Healthcare of Atlanta Inc, Atlanta, Georgia, USA.
³ Department of Emergency Medicine, Brown University, Providence, Rhode Island, USA.
⁴ Department of Emergency Medicine, Hasbro Children's Hospital, Providence, Rhode Island, USA.
⁵ Departments of Emergency Medicine and Pediatrics, University of California San Francisco, San Francisco, California, USA.
⁶ Department of Emergency Medicine and Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
⁷ Hasbro Children's Hospital, Providence, Rhode Island, USA.
⁸ SUNY Upstate Medical University Hospital, Syracuse, New York, USA.
⁹ University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁰ Division of Emergency Medicine and Center for Violence Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹¹ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
¹² The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹³ Department of Pediatrics, Emory University, Atlanta, Ga, USA.
¹⁴ University of Florida College of Medicine, Gainesville, Florida, USA.
¹⁵ University of California San Francisco, San Francisco, California, USA.
¹⁶ Imagen, Manhattan, New York, USA.
¹⁷ Northside Pediatrics, Atlanta, Georgia, USA.
¹⁸ Rollins School of Public Health, Atlanta, Georgia, USA.
¹⁹ University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
²⁰ Children's Hospital Colorado, Aurora, Colorado, USA.

Abstract

Objectives: In 2020, firearm injuries surpassed automobile collisions as the leading cause of death in US children. Annual automobile fatalities have decreased during 40 years through a multipronged approach. To develop similarly targeted public health interventions to reduce firearm fatalities, there is a critical need to first characterize firearm injuries and their outcomes at a granular level. We sought to compare firearm injuries, outcomes, and types of shooters at trauma centers in four pediatric health systems across the USA.

Methods: We retrospectively extracted data from each institution's trauma registry, paper and electronic health records. Study included all patients less than 19 years of age with a firearm injury between 2003 and 2018. Variables collected included demographics, intent, resources used, and emergency department and hospital disposition. Descriptive statistics were reported using medians and IQRs for continuous data and counts with percentages for categorical data. χ² test or Fisher's exact test was conducted for categorical comparisons.

Results: Our cohort (n=1008, median age 14 years) was predominantly black and male. During the study period, there was an overall increase in firearm injuries, driven primarily by increases in the South (S) site (β=0.11 (SE 0.02), p=<0.001) in the setting of stable rates in the West and decreasing rates in the Northeast and Mid-Atlantic sites (β=-0.15 (SE 0.04), p=0.002; β=-0.19 (SE0.04), p=0.001). Child age, race, insurance type, resource use, injury type, and shooter type all varied by regional site.

Conclusion: The incidence of firearm-related injuries seen at four sites during 15 years varied by site and region. The overall increase in firearm injuries was predominantly driven by the S site, where injuries were more often unintentional. This highlights the need for region-specific data to allow for the development of targeted interventions to impact the burden of injury.Level of Evidence: II, retrospective study.

Keywords: Firearms; Wounds, Gunshot; pediatrics.