Firearm injuries in children: a missed opportunity for firearm safety education

Abstract

BackgroundSurgeons frequently care for children who have sustained gunshot wounds (GSWs). However, firearm safety education is not a focus in general surgery training. We hypothesised that firearm safety discussions do not routinely take place when children present to a trauma centre with a GSW.MethodA retrospective review of patients <18 years presenting with GSWs to a level 1 paediatric trauma centre from 2009 to 2019 was performed. The primary outcome was discussion of firearm safety with the patient or family. The secondary outcome was notification of child protective services (CPS).ResultsA total of 226 patients with GSWs were identified, 22% were unintentional and 63% were assault. Firearm safety discussions took place in 10 cases (4.4%). Firearm safety discussions were more likely to occur after unintentional injuries compared with other mechanisms (16.0% vs 1.3%, p<0.001). CPS was contacted in 29 cases (13%). CPS notification was more likely for unintentional injuries compared with other mechanisms (40% vs 3.9%, p<0.001) and for younger patients (7 years vs 15 years, p<0.001).ConclusionAt a paediatric trauma centre, firearm safety discussions occurred in 4.4% of cases of children presenting with a GSW. There is a significant room for improvement in providing safety education interventions.

The hidden mortality of pediatric firearm violence

“…Children and adolescents with prior mental health disorders, of male sex, in urban environments particularly in the southern United States, had the highest rate of hospitalization for self-inflicted firearm injury in the Kids' Inpatient Database [12]. Unsafe firearm storage is associated with higher rates of intentional and unintentional self-inflicted firearm injuries in children and adolescents [13], and there is significant room for improvement in firearm safety discussions aimed at pediatric trauma patients and their families [14].…”

“…For statewide data, non-fatal injury data is not yet available after 2015, thus case fatality rates cannot be calculated beyond that timepoint. Additionally, injury intent is classified as self-inflicted, unintentional, and assault; a granular analysis of other mechanisms such as unintentional self-inflicted injuries, an unfortunately common problem in the pediatric population [14], is not possible. Lastly, as the CDPH Overall Injury Surveillance tool is an epidemiological instrument, clinical data on these patients is not available.…”

Unintended Consequences of COVID-19 on Pediatric Falls From Windows: A Multicenter Study

“…Efforts should be made by providers to ensure routine well child visits continue to occur at regularly scheduled intervals to ensure children have access to mandated reporters to identify cases of potential abuse or neglect. In light of the above findings of increased firearm injury prevalence in the pediatric population, families must be counseled on safe firearm storage to avoid tragic and preventable deaths 27 . While these measures have always been critical, the heightened stressors of the pandemic and the changing landscape of school, work, and day-to-day life imposed by the COVID-19 pandemic have made home safety measures of paramount importance in protecting children from preventable injury.…”

The Important Role for Physicians as Advocates for Firearm and Road Traffic Injury Prevention

“…6 In addition to patient visits to physicians, there are good opportunities to intervene with education and counseling when treating injured firearm and other injury victims at trauma centers and other locations. 10 Trauma centers are excellent venues for injury prevention education as this is a requirement for verification by the American College of Surgeons. Success has been shown with these educational endeavors.…”