Pediatric firearm injuries: Racial disparities and predictors of healthcare outcomes

Hughes, Byron D.; Cummins, Claire B.; Shan, Yong; Mehta, Hemalkumar B.; Radhakrishnan, Ravi S.; Bowen-Jallow, Kanika A.

doi:10.1016/j.jpedsurg.2020.02.021

Cited by 34 publications

(25 citation statements)

References 40 publications

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“…Consistent with previous literature, there were higher rates of firearm-related admissions for Black children and those with public insurance. 4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19] These associations were particularly pronounced for those injured from assault, as 87.9% (58/66) and 83.3% (55/66) of children admitted after firearm assault were Black or had public insurance respectively. These clear trends of Black children and children from deprived neighborhoods experiencing a disproportionate burden of firearm-related injury hospitalization, particularly from assault, should cause us to carefully consider the underlying root causes for these inequities.…”

Section: Discussionmentioning

confidence: 99%

“…The trend of increased self-inflicted firearm injuries in White patients is consistent with other literature. 4,6,15,19 This inequity could result from differences in underlying mental health diseasewhich would prompt further questions-or could result from differences in access to firearms whether secondary to differences in gun ownership or safe storage patterns. In fact, one study found that families of Black and Hispanic children were both less likely to own guns, and when they owned guns, they were more likely to engage is safe storage practices compared with families of White children.…”

Section: Discussionmentioning

confidence: 99%

“…There are much higher rates in males, [4][5][6][7][8][9][10][11][12][13][14][15] in older children and adolescents, [4][5][6]9,14,16 and disproportionately higher rates of firearm-and assault-related injury among Black and Hispanic children. 4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19] The most recent national data suggest that Black children account for 59.6% of all firearm-related hospitalizations and 66.8% of all firearm assault-related hospitalizations despite making up only 12.8% of the population. 6,20 Few studies have examined the impact of insurance, but those that have depict associations between public insurance, a proxy for lower SES, and hospitalization for firearm-related injury among children.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Relationships Between Socioeconomic Deprivation and Pediatric Firearm-Related Injury at the Neighborhood Level

Trinidad

Vancil

Brokamp

et al. 2022

J Trauma Acute Care Surg

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Relationships Between Socioeconomic Deprivation and Pediatric Firearm-Related Injury at the Neighborhood Level

Trinidad

Vancil

Brokamp

et al. 2022

J Trauma Acute Care Surg

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“…Our median per‐patient cost of $12,874 for inpatient firearm injury visits is 30% higher than MVC inpatient cost. This is on the lower end of reports for firearms injuries compared to median hospital cost of $10,000 to $32,000; however, the higher range of costs were associated with assault weapon use more commonly seen in adult populations 9,10 . Our ED costs were 61% ($1,048 median per‐patient cost) higher for firearm injury compared to MVC.…”

Section: Discussionmentioning

confidence: 71%

“…The percentage of firearm‐injured youth who did not survive their hospital stay speaks to firearm injuries impact compared to other forms of trauma in the pediatric population. This study noted a fatality rate of 5.1%, while other studies that include non–children's’ hospitals note a higher rate of 5.9% to 12% 9,21,25,26 . Of note, these studies measured mortality at different patient care continuum points from ED presentation to in‐hospital mortality.…”

Section: Discussionmentioning

confidence: 81%

Comparison of cost and resource utilization between firearm injuries and motor vehicle collisions at pediatric hospitals

Doh

Sheline

Wetzel

et al. 2021

Academic Emergency Medicine

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Background/Objectives Firearm injuries are converging with motor vehicle collisions (MVC) as the number one cause of death for children in the United States. Thus we examine differences in hospital cost and hospital resource utilization between motor vehicle and firearm injury. Methods This retrospective, cross‐sectional study compares hospital costs and resource utilization of motor vehicle and firearm‐injured children aged 0 to 19 years of age over a 5‐year time frame (January 1, 2013–December 31, 2017) in 35 freestanding children's hospitals that submitted data to the Pediatric Health Information System. The primary outcome was hospital‐adjusted comparative cost per patient presentation. Generalized linear mixed models were used to quantify the relationship between the type of injury and each outcome, adjusting for patient characteristics and hospital. Results There were 89,133 emergency department (ED) visits attributed to MVCs and 3,235 for firearm injury. Of the youths who presented for firearm injury, 49% were hospitalized versus 14% of youths presenting with MVC (adjusted odds ratio [aOR] = 6.6, 95% confidence interval [CI] = 6.1 to 7.2). Youths with firearm injury were more likely to be admitted to an intensive care unit (aOR = 6.7, 95% CI = 5.9 to 7.7) and had longer lengths of stays (aOR = 2.2, 95% CI = 1.9 to 2.6) compared to their MVC counterparts. Children admitted for firearm injury had more imaging and ED return visits, along with subsequent inpatient admission within 3 days (aOR = 3.4, 95% CI = 2.1 to 5.5) and 1 year (aOR = 2.5, 95% CI = 2.1 to 2.9). The mean relative per‐patient costs were nearly fivefold higher for the firearm‐injured group. Conclusions Hospital costs and markers of resource utilization were higher for youths with firearm injury compared to MVC. High medical resource utilization is one of several important reasons to advocate for a comparable national focus and funding on firearm‐related injury prevention.

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Supporting Victims of Firearm Violence and Structural Racism Beyond the Hospital Walls and Journal Pages

Golisch

Tatebe

2023

JAMA Surg

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Gun violence disproportionately affects racial and ethnic minority communities, with individuals in Black and Latinx populations more likely to be murdered with a firearm. 1 Additionally, structural racism influences firearm homicide with higher rates in Black individuals regardless of income status. 2 The work by Ghio et al 3 serves to fill the gap in the literature about the intersection of structural racism and mass shooting events. The authors found mass shooting events was associated with higher segregation index, percentage of Black or African American population, children in single-parent household, violent crime rate, and structural racism in major metropolitan statistical areas. The results have implications for targeted interventions to address firearm violence at community and national levels.The study's limitations note its cross-sectional methods and absence of available sources to provide consistent and up-to-date data. Another element lacking was examining other racial and ethnic minority populations, such as Latinx populations, that also have a higher likelihood of being involved in firearm homicides. 4 However, the main question that arises from these results in conjunction with prior literature is, how can we move beyond "further investigation" statements to enact change? While this study provides further evidence to support interventions to decrease the downstream effects of structural racism, it is time to focus on supporting patients beyond the hospital and research.In 2020, the Eastern Association for the Surgery of Trauma called for generating a systematic review and injury preven-

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Pediatric firearm injuries: Racial disparities and predictors of healthcare outcomes

Cited by 34 publications

References 40 publications

Relationships Between Socioeconomic Deprivation and Pediatric Firearm-Related Injury at the Neighborhood Level

Relationships Between Socioeconomic Deprivation and Pediatric Firearm-Related Injury at the Neighborhood Level

Comparison of cost and resource utilization between firearm injuries and motor vehicle collisions at pediatric hospitals

Supporting Victims of Firearm Violence and Structural Racism Beyond the Hospital Walls and Journal Pages

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