Firearms Screening in the Pediatric Inpatient Setting

Abstract

Firearm-related deaths remain a top cause of mortality in American children and adolescents. In a 2012 policy statement, the American Academy of Pediatrics urged pediatricians to incorporate questions about the availability of firearms into their patient history taking. We aim to evaluate the frequency of screening for home firearms in an academic tertiary-care hospital inpatient setting. METHODS: This retrospective chart review examined patients with the following pediatric diagnoses admitted to a tertiary-care pediatric hospital from 2006 to 2015: asthma, bronchiolitis, cellulitis, jaundice, single liveborn infant, bacterial and viral pneumonia, and all mood disorders. Data analysts then searched the patient charts that met these inclusion criteria for documentation of firearm screening as indicated by use of the terms "firearm," "pistol," "gun," "handgun," "bullet," "ammunition," or "rifle" in the admissions history and physical. RESULTS: Evidence of screening for firearms in the home was found in 1196 of the 40 658 charts included in the study (2.94%). The most frequently screened diagnosis and admitting service were mood disorders and child psychiatry, respectively (1159 of 3107; 37.3%). Only 19.8% of identified gun-owning families received specific anticipatory guidance. CONCLUSIONS: Firearm screening and gun safety education occurred infrequently in the inpatient setting. Inpatient encounters may provide an opportunity for increased screening and education because the hospital environment also includes additional resources, exposure to a greater number of providers, and the presence of more family members or caregivers. Further studies are warranted to explore barriers to inpatient screening and possible mechanisms for improvement.

Updates in Firearms Access Screening

“…Since our initial study, research teams demonstrated that pediatric residents’ rates of screening for access to firearms was low in other settings, including inpatient wards 5 and primary care clinics. 6 However, similar to our follow-up study, 2 quality improvement methodology successfully increased the rate of screening.…”

Our power to reduce gun violence

“…Several outpatient initiatives have demonstrated success in increasing provider screening rates and producing safer storage practices 13,14 . It is vital that we expand this approach to other phases of care, including during hospitalization, where screening rates have been estimated to be as low as 3% 15 . Table 1 lists inpatient‐specific approaches to the action items listed above.…”

“…13,14 It is vital that we expand this approach to other phases of care, including during hospitalization, where screening rates have been estimated to be as low as 3%. 15…”

Pediatric Hospitalists at the Front Line of Gun Violence Prevention: Every Patient Encounter Is an Opportunity to Promote Safe Gun Storage

“…Considering the number of childhood firearm deaths in 2016 (3143) in the context of the number of childhood asthma deaths in 2016 (169), it is hard to argue that hospitalists should not be focused on finding solutions to this public health epidemic. 1,9 As this study by Monroe et al 8 reveals, hospitalists have significant room for improvement in firearm screening and safe storage counseling. Even modest improvements in screening and counseling rates could have a significant impact on child health, particularly in states with high rates of gun ownership.…”