Abstract
Introduction
Several studies have evaluated differences in firearm injury patterns among children
based on regionalization. However, many of these studies exclude patients who die
before arriving at a trauma center. We therefore hypothesize that important population-based
differences in pediatric firearm injuries may be uncovered with the inclusion of both
prehospital firearm mortalities and patients treated at a tertiary children's hospital.
Methods
Patients less than 15 y of age who sustained a firearms-related injury/death between
the years 2012 and 2018 were identified in: (1) death certificates from the Office
of Vital Statistics State of Indiana and (2) Riley Hospital for Children at Indiana
University Health Trauma Registry. Counties of injury were classified as either urban,
midsized, or rural based on the National Center for Health Statistic's population
data. Significant variables in univariate analysis were then assessed using multivariate
logistic regression models.
Results
A total of 222 patients were identified. Median age of firearm injury survivors was
13 (interquartile range 7-14), while the median age of nonsurvivors was 14 (interquartile
range 11-15), P = 0.040. The proportion of suicide was significantly higher in rural counties (P < 0.001). When controlling for shooter intent, patients from a rural or midsized
county had statistically significant higher odds of dying before reaching a hospital
than their urban counterpart (rural odds ratio [OR] 5.67 [95% confidence interval
{CI} 2.23, 14.38]; midsized OR 6.53 [95% CI 2.43, 17.46]; P < 0.001).
Conclusions
Important differences exist between pediatric firearm injuries based on where they
occur. Public health initiatives aimed at reducing pediatric firearm injury and death
should not exclude rural pediatrics patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Surgical ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The major causes of death in children and adolescents in the United States.N Engl J Med. 2018; 379: 2468-2475
- Webbased injury statistics query and reporting system (WISQARS).(Available at:)
- Firearm injuries in the United States.Prev Med. 2015; 79: 5-14
- Rural versus urban hospitalizations for firearm injuries in children and adolescents.Pediatrics. 2018; 142: e2017-e3318
- Variation in pediatric and adolescent firearm mortality rates in rural and urban US counties.Pediatrics. 2010; 125: 1112-1118
- Hospitalizations due to firearm injuries in children and adolescents.Pediatrics. 2014; 133: 219-225
- Urban–rural shifts in intentional firearm death: different causes, same results.Am J Public Health. 2004; 94: 1750-1755
- Childhood firearm injuries in the United States.Pediatrics. 2017; 140: e20163486
- FACTS Consortium. State of the science: a scoping review of primary prevention of firearm injuries among children and adolescents.J Behav Med. 2019; 42: 811-829
- Access to pediatric trauma care in the United States.Arch Pediatr Adolesc Med. 2009; 163: 512-518
- Association between access to pediatric trauma care and motor vehicle crash death in children.J Trauma Acute Care Surg. 2021; 91: 84-92
- A comparison of adolescent penetrating trauma patients managed at pediatric versus adult trauma centers in a mature trauma system.J Trauma Acute Care Surg. 2020; 88: 725-733
- Pediatric trauma center verification improves quality of care and reduces resource utilization in blunt splenic injury.J Pediatr Surg. 2019; 54: 155-159
- Report from the childress summit of the pediatric trauma society, April 22-24, 2013.J Trauma Acute Care Surg. 2014; 77: 504-509
- Proceedings of the second Childress Summit on pediatric trauma: operationalizing the vision.J Trauma Acute Care Surg. 2016; 81: 795-801
- Centers for Disease Control and Prevention.(Available at:)https://www.cdc.gov/nchs/data_access/urban_rural.htmDate accessed: July 16, 2019
- 2010 Standards for delineating metropolitan and micropolitan statistical areas.(Available at:)
- R: A Language and Environment for Statistical Computing.R Foundation for Statistical Computing, Vienna, Austria2020
- Trends in healthcare utilisation for firearm-related injuries among a cohort of publicly insured children in Ohio.J Epidemiol Community Health. 2021; 75: 906-909
- Firearm storage practices in households of adolescents with and without mental illness.J Adolesc Health. 2017; 61: 583-590
- Is it time for firearm injury to Be a separate activation criteria in children? An assessment of penetrating pediatric trauma using need for surgeon presence.Am J Surg. 2021; 221: 21-24
- Violent trauma recidivism: does all violence escalate?.Eur J Trauma Emerg Surg. 2018; 44: 851-858
- Pediatric firearm incidents: it is time to decrease on-scene mortality.J Trauma Acute Care Surg. 2019; 86: 791-796
- Trauma deaths in a mature urban vs rural trauma system. A comparison.Arch Surg. 1997; 132 (discussion 81-2): 376-381
Tessler, R. A., S. Arbabi, E. M. Bulger, B. Mills, and F. P. Rivara. "Trends in firearm injury and motor vehicle crash case fatality by age group, 2003-2013." JAMA Surg 154: 305-310.
- Twenty years of pediatric gunshot wounds in our community: have we made a difference?.J Pediatr Surg. 2019; 54: 160-164
- Pediatric firearm injuries: a midwest experience.J Pediatr Surg. 2020; 55: 2140-2143
- Declines in pediatric mortality fall short for rural us children.Health Aff (Millwood). 2019; 38: 2069-2076
- Mortality in a cohort of 3.1 million children, adolescents and young adults.J Epidemiol Community Health. 2020; 74: 260-268
- Pediatric prehospital care in urban and rural areas.Pediatrics. 1991; 88: 681-690
- Pediatric Trauma Centers: Availability, Outcomes, and Federal Support Related to Pediatric Trauma Care.United States Government Accountability Office, Washington, DC2017: 1-35
- The impact of short prehospital times on trauma center performance benchmarking: an ecologic study.J Trauma Acute Care Surg. 2016; 80 (discussion 94-6): 586-594
- Prehospital trauma scene and transport times for pediatric and adult patients.West J Emerg Med. 2020; 21: 455-462
- “Public reports.” NEMSIS, National Emergency Medical Services Information System.(Available at:)https://nemsis.org/view-reports/public-reports/Date accessed: September 2, 2020
- Epidemiology of out-of hospital pediatric cardiac arrest due to trauma.Prehosp Emerg Care. 2012; 16: 230-236
- An analysis of prehospital deaths: who can we save?.J Trauma Acute Care Surg. 2014; 77: 213-218
- Emergency department pediatric readiness and mortality in critically ill children.Pediatrics. 2019; 144: e20190568
- Access to high pediatric-readiness emergency care in the United States.J Pediatr. 2018; 194: 225-232
- Pediatric readiness in critical access hospital emergency departments.J Rural Health. 2019; 35: 480-489
- The Health Resources and Services Administration. U.S. Department of Health and Human Services Program Support Center, Visual Communications Branch.U.S. Department of Health and Human Services, Washington, DC2006
- Trauma system regionalization improves mortality in patients requiring trauma laparotomy.J Trauma Acute Care Surg. 2017; 82: 58-64
- International injury care improvement initiative. Impact of trauma system structure on injury outcomes: a systematic review and meta-analysis.World J Surg. 2018; 42: 1327-1339
- Consequences of pediatric undertriage and overtriage in a statewide trauma system.J Trauma Acute Care Surg. 2017; 83: 662-667
Article info
Publication history
Published online: November 09, 2022
Accepted:
October 15,
2022
Received in revised form:
August 22,
2022
Received:
April 7,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
