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

Autor:	Fraser Doh K; Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Children's Healthcare of Atlanta Inc, Atlanta, Georgia, USA., Chaudhary S; Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Children's Healthcare of Atlanta Inc, Atlanta, Georgia, USA., Ruest SM; Department of Emergency Medicine, Brown University, Providence, Rhode Island, USA.; Department of Emergency Medicine, Hasbro Children's Hospital, Providence, Rhode Island, USA., Shaahinfar A; Departments of Emergency Medicine and Pediatrics, University of California San Francisco, San Francisco, California, USA., Chun T; Department of Emergency Medicine and Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.; Hasbro Children's Hospital, Providence, Rhode Island, USA., Cooper N; SUNY Upstate Medical University Hospital, Syracuse, New York, USA., Fein J; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.; Division of Emergency Medicine and Center for Violence Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Feng A; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA., Feske-Kirby K; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Figueroa J; Department of Pediatrics, Emory University, Atlanta, Ga, USA., Gutman CK; University of Florida College of Medicine, Gainesville, Florida, USA., Grupp-Phelan J; University of California San Francisco, San Francisco, California, USA., Kanaan G; Hasbro Children's Hospital, Providence, Rhode Island, USA., Keathley N; Imagen, Manhattan, New York, USA., Khan N; Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Children's Healthcare of Atlanta Inc, Atlanta, Georgia, USA., McGlamry K; Northside Pediatrics, Atlanta, Georgia, USA., Myers S; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Nance M; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Russell K; Rollins School of Public Health, Atlanta, Georgia, USA., Rowker K; Children's Healthcare of Atlanta Inc, Atlanta, Georgia, USA., Sheline E; University of Colorado Denver School of Medicine, Aurora, Colorado, USA.; Children's Hospital Colorado, Aurora, Colorado, USA., Simon HK; Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Children's Healthcare of Atlanta Inc, Atlanta, Georgia, USA., Morris CR; Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Children's Healthcare of Atlanta Inc, Atlanta, Georgia, USA.
Jazyk:	angličtina
Zdroj:	Trauma surgery & acute care open [Trauma Surg Acute Care Open] 2023 May 30; Vol. 8 (1), pp. e001014. Date of Electronic Publication: 2023 May 30 (Print Publication: 2023).
DOI:	10.1136/tsaco-2022-001014
Abstrakt:	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. χ 2 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. Competing Interests: Competing interests: KFD discloses an honorarium received to discuss gun violence for a medical education podcast. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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