Nonfatal firearm injuries: Utilization and expenditures for children pre‐ and postinjury

Abstract

Objective: Firearm injuries are one of the leading preventable causes of morbidity and mortality among children. Limited information exists about the impact of nonfatal firearm injuries on utilization and expenditures. Our objective was to compare health care encounters and expenditures 1 year before and 1 year following a nonfatal firearm injury. Methods:This was a retrospective cohort study of children 0 to 18 years with ICD-9/ ICD-10 diagnosis codes for firearm injury (excluding nonpowder) in the emergency department or inpatient setting from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included: (1) difference in health care encounters for 1 year before and 1 year after injury, (2) difference in health care expenditures, and(3) difference in complex chronic disease status. Descriptive statistics characterized patient demographics and health care utilization. Health expenditures were evaluated with Wilcoxon signed-rank tests.Results: Among 1,821 children, there were 22,398 health care encounters before the injury and 28,069 after. Concomitantly, there was an overall increase of $16.5 million in health expenditures ($9,084 per patient). There was a 50% increase in children qualifying for complex chronic condition status after firearm injury. Conclusions:Children who experience nonfatal firearm injury have increased number of health care encounters, chronic disease classification, and health care expenditures in the year following the injury. Prevention of firearm injuries in this vulnerable age group may result in considerable reductions in morbidity and health care costs.

Healthcare utilization and mental health outcomes among nonfatal shooting assault victims

“…Our findings also demonstrate older victims were more likely to be connected to mental health services post injury, whereas victims 15–19 years of age were less likely to receive a mental health diagnosis compared to victims 20–24 years of age. Pulcini and colleagues observed a similar decrease post injury mental health visits among youth but reasons for the decrease in mental health utilization post injury remains unclear ( Pulcini et al, 2021 ). Such age disparities may speak to access to mental health services and parental decision making regarding when and if youth are connected to mental health services ( Neufeld et al, 2021 ), as parents report not knowing when their child may need such services ( Bringewatt and Gershoff, 2010 ).…”

“…Similar changes in mental health utilization were found in a study of pediatric nonfatal firearm victims using Medicaid MarketScan claims over six years. For example, youth with lower preinjury utilization had more mental health utilization post injury and youth with higher preinjury utilization had less mental health utilization post injury ( Pulcini et al, 2021 , Retraction. Acad Emerg Med., 2021 ).…”

Mental Health Care Following Firearm and Motor Vehicle-related Injuries

“…Previous research has indicated low utilization of MH services and largely unmet MH needs in trauma patients. [22][23][24] Violent injuries are often associated with greater risk of MH symptoms and recurrent injury compared with nonviolent injuries. 11,12 Oddo et al 25 recently reported that ∼25% of children had a newly diagnosed MH disorder after a nonfatal firearm injury.…”

“…Furthermore, our findings, based on health care utilization claims, likely underestimate the prevalence of MH disorders. Previous research has indicated low utilization of MH services and largely unmet MH needs in trauma patients 22–24…”

A firearm violence research methodologic pitfall to avoid

“…As a group of researchers dedicated to investigating firearm injuries among children and adolescents, we recently published in Academic Emergency Medicine and then selfretracted work that inadvertently included nonpowder firearm injuries in our analysis. 7 This error was due to a failure to closely examine…”