Long‐term Mortality in Pediatric Firearm Assault Survivors: A Multicenter, Retrospective, Comparative Cohort Study

Shaahinfar, Ashkon; Yen, Irene H.; Alter, Harrison J.; Gildengorin, Ginny; Pan, Sun-Ming J; Betts, James M.; Fahimi, Jahan

doi:10.1111/acem.13631

Cited by 14 publications

(5 citation statements)

References 36 publications

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“…Generally, older age, male sex, Black race, and public insurance have been found to be associated with assault-related injuries (Chong et al 2015 ; Tellez et al 1995 ; Carter et al 2017 ; Esparaz et al 2021 ; Patel et al 2021 ). These same factors also portend a higher risk of long-term mortality in those injured by assaults (Shaahinfar et al 2018 ). Other aspects that are important for consideration of more risk include prior violent or weapon experience, episodes of aggression, prior substance use, mental health illness, involvement with child welfare or the juvenile court system, and family or peer conflict (Cunningham et al 2014 ; Kironji et al 2021 ; McCart et al 2006 ; Voith et al 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Characteristics and neighborhood-level opportunity of assault-injured children in Milwaukee

Georgeades,

Farazi,

Bergner

et al. 2023

Inj. Epidemiol.

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Background Multiple studies have explored demographic characteristics and social determinants of health in relation to the risk of pediatric assault-related injuries and reinjury. However, few have explored protective factors. The Child Opportunity Index (COI) uses neighborhood-level indicators to measure ‘opportunity’ based on factors such as education, social environment, and economic resources. We hypothesized that higher ‘opportunity’ would be associated with less risk of reinjury in assault-injured youth. Methods This was a single-institution, retrospective study at a Level 1 Pediatric Trauma Center. Trauma registry and electronic medical record data were queried for children ≤ 18 years old with assault-related injuries from 1/1/2016 to 5/31/2021. Reinjured children, defined as any child who sustained more than one assault injury, were compared to non-reinjured children. Area Deprivation Index (ADI), a marker of socioeconomic status, and COI were determined through census block and tract data, respectively. A post-hoc analysis examined COI between all assault-injured children, unintentionally injured children, and a state-based normative cohort representative of non-injured children. Results There were 55,862 traumatic injury encounters during the study period. Of those, 1224 (2.3%) assault injured children were identified, with 52 (4.2%) reinjured children and 1172 (95.8%) non-reinjured children. Reinjured children were significantly more likely to be older (median age 15.0 [IQR 13.8–17.0] vs. median age 14.0 [IQR 8.8–16.0], p < 0.001) and female (55.8% vs. 37.5%, p = 0.01) than non-reinjured children. COI was not associated with reinjury. There were also no significant differences in race, ethnicity, insurance status, ADI, or mechanism and severity of injury between cohorts. Post-hoc analysis revealed that assault-injured children were more likely to live in areas of lower COI than the other cohorts. Conclusions Compared to children who sustained only one assault during the study period, children who experienced more than one assault were more likely to be older and female. Furthermore, living in an area with more or less opportunity did not influence the risk of reinjury. However, all assault-injured children were more likely to live in areas of lower COI compared to unintentionally injured and a state-based normative cohort. Identification of factors on a social or environmental level that leads to assaultive injury warrants further exploration.

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Section: Discussionmentioning

confidence: 99%

Characteristics and neighborhood-level opportunity of assault-injured children in Milwaukee

Georgeades,

Farazi,

Bergner

et al. 2023

Inj. Epidemiol.

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“…Compared to youth exposed to non-violent trauma, survivors of firearm violence are at increased risk for post-injury adverse outcomes, such as post-traumatic stress disorder (PTSD), injury recidivism, and long-term mortality. 4,10,12,13…”

Section: Introductionmentioning

confidence: 99%

Recovery of Pediatric Patients After Firearm Injury: Can Health Systems Do More?

Borthwell

Olanrewaju

Putnam

et al. 2021

The American Surgeon™

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Background Firearm injuries are the second leading cause of death among youth in the United States. Nonfatal firearm injuries far outnumber fatalities, yet data detailing the recovery and post-injury needs of pediatric patients after hospital discharge are limited. This study evaluated health system support of pediatric patients after firearm injury, from acute hospitalization to outpatient follow-up. Methods We conducted a retrospective chart review of patients <18 years who presented to an urban level 1 trauma center between 2014 and 2019. Cases were categorized as accidental or intentional (stratified as assault-related or “crossfire” injuries). Outcomes included biopsychosocial assessment (BA) utilization, trauma psychology service consultation, and linkage to outpatient services. Results Among 115 patients, 94% were victims of community violence. Black (50%) and Latinx (44%) patients were disproportionately affected, as were males aged 15-16 years (71%). Overall mortality was 8%. Biopsychosocial assessment and trauma psychology consultations occurred in 43% and 20% of cases, respectively. Of eligible patients, 71% received referral to post-hospitalization support services. The most commonly identified needs were counseling, gang intervention, and help with the carceral system. Conclusion Health systems should support long-term recovery of pediatric patients after firearm injury, particularly addressing social and structural determinants of health. Inpatient-to-outpatient linkages should be strengthened, and prospective follow-up is needed.

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“…[8] Mortuary statistics in the Western Cape from 2015 revealed that firearm victims outnumbered victims due to road traffic crashes and penetrating injuries, [9] and in 2018/2019, 46% of all homicides were due to firearm injuries. [10] Long-term mortality is likely higher for survivors of firearm injuries than other injury profiles, [11,12] and injury surveillance systems are essential to develop, implement and monitor strategies that reduce preventable trauma. [13] Unfortunately, barriers exist in low-and middle-income countries, and an attempt at implementing such a system at a district hospital in Cape Town concluded that it was not sustainable.…”

mentioning

confidence: 99%

The burden and outcomes of firearm injuries at two district-level emergency centres in Cape Town, South Africa: A descriptive analysis

Bush,

Hendrikse,

Van Koningsbruggen

et al. 2024

S Afr Med J

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Background. In South Africa (SA), injuries are the second leading cause of years of healthy life lost, and interpersonal violence dominates the SA injury profile. Half of all injury-related deaths in SA are intentional, and firearms contribute to a quarter of these deaths. Injury surveillance systems are essential to develop, implement and monitor strategies that reduce preventable trauma. Objectives. To describe the burden of patients with firearm injuries and their outcomes at district-level emergency centres in the Western Cape. Methods. This study was a retrospective analysis of a prospectively collected database. All patients who presented to two district-level emergency centres with a firearm injury over a 12-month period (1 January 2019 - 31 December 2019) were eligible for inclusion. Results. Firearm injuries represented 5.7% of the trauma burden at the two district emergency centres. Of the 776 patients with firearm injuries who were included, the median age was 27 years, and 91% were male. A total of 520 (67%) patients self-presented, and there were 18 (2.3%) deaths in the emergency centre and a further 23 (3%) as inpatients. Of the total where wound location was determined (n=595), 30.4% sustained more than one firearm injury, and 112 out of the 167 admitted to Mitchells Plain Hospital required at least one visit to theatre. This accounted for 413 theatre hours and 1 376 inpatient bed days at Mitchells Plain Hospital. A significant proportion of patients (n=219, 29%) were transferred from the emergency centres to a tertiary service for further care. Conclusion. Firearm injuries represent a substantial proportion of the trauma burden at district emergency centres in the Western Cape Province. Managing patients with firearm injuries is resource intensive, as evident by their high acuity, the need for operative care, the long length of stay, the high burden on emergency medical services with interfacility transfers and the high demand for tertiary care. Data from this study aid our understanding of the prevalence and burden of firearm injuries at district level emergency centres, and multisectoral action, supported by evidence-based primary and secondary preventive strategies, is required to reduce the burden of firearm injuries, and mitigate their effects.

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Long‐term Mortality in Pediatric Firearm Assault Survivors: A Multicenter, Retrospective, Comparative Cohort Study

Cited by 14 publications

References 36 publications

Characteristics and neighborhood-level opportunity of assault-injured children in Milwaukee

Characteristics and neighborhood-level opportunity of assault-injured children in Milwaukee

Recovery of Pediatric Patients After Firearm Injury: Can Health Systems Do More?

The burden and outcomes of firearm injuries at two district-level emergency centres in Cape Town, South Africa: A descriptive analysis

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