Firearm-related Injuries Research Articles

Guns, scalpels, and sutures: The cost of gunshot wounds in children and adolescents.

Firearm injuries are the second leading cause of death among US children. While injury prevention has been shown to be effective for blunt mechanisms of injury, the rising incidence of accidental gunshot wounds, school shootings, and interpersonal gun violence suggests otherwise for firearm-related injuries. The purpose of the study is to describe the incidence, injury severity, and institutional costs of pediatric gun-related injuries in Colorado. Pediatric patients (≤18 years), who sustained firearm injuries between 2008 and 2018, were identified from the trauma registries of three pediatric trauma centers in Colorado. Patients were stratified based on age: those younger than 14 years were defined as children and those 15 years to 18 years as adolescents. Our cohort (n = 308) was predominantly male (87%), with a median age of 14 years. The overall mortality rate was 11% (34/308), with significantly fewer children (5%) dying from their injuries when compared with adolescents (14%; p = 0.04). Sixty-five (21%) patients required blood product transfusions, with 23 (7.4%) patients receiving a massive transfusion. Overall, 52% (161/308) required a major operation, with 15% undergoing an exploratory laparotomy. One third (4/13) of the patients who had a thoracotomy in the emergency department survived to hospital discharge. Overall, 14.0% of patients had psychiatric follow-up at both 30 days and 1 year. The readmission rate for complications was 11.6% at 30 days and 14% at 1 year. The total cost of care for all pediatric firearm-related injuries was approximately US $26 million. The survivors of pediatric firearm injuries experience high operative and readmission rates, sustain long-term morbidities, and suffer from mental health sequelae. Combining these factors with the economic impact of these injuries highlights the immense burden of disease. This burden may be palliated by a multipronged approach, which includes the development and dissemination of injury prevention strategies and better follow-up care for these patients. Epidemiological, Level III.

Annals for Educators - 1 September 2020.

Annals for Educators - 1 September 2020.

91. RESIDENTS EDUCATION ON FIREARMS SAFETY COUNSELING: CURRENT STATUS, PERCEIVED BARRIERS, AND SUGGESTED RESOURCES

Background Firearm (FA) related deaths & injuries are national public health crises. FA is the leading cause of death among black children & teens. FA safety counseling has positive impact on increasing gun safety at home. It is crucial for Residents in training (RES) to learn skills of counseling with regards to this topic. Methods Cross sectional survey at Brookdale Hospital, NY including RES from all specialties. Questionnaire based on literature review was sent using “SurveyMonkey”. Comparison of responses among subgroups of RES was done using Chi-squared or Fisher's exact test. Results Of 244 RES, 134 (55%) responded to survey [51% males, 34% from pediatrics (PED) (Table 1-A)]. Nearly all RES agree that gun violence is a problem in their community (96%). Unavailability of FA safety training in residency programs was reported in 66% (less in PED vs. non-PED, Table 2). Overall, only few RES felt confident to counsel about FA (14%). Majority of respondents (67%) were interested in receiving additional education (more in PED vs. non-PED). Methods of FA training in the RES’ programs as well as topics covered are shown in Table 1-B (PED reported more CME/grand rounds and less case-based scenarios / or standardize patient, table 2). RES were similarly interested in receiving education in FA safety counseling, independent of the PGY level (Table 3). There was no difference in perceived barriers, except that PGY1 were more likely to “worry about upsetting families if asked about FA” (Table 3). Also, PGY1 were less likely to choose “workshops” & “grand rounds” as resources to increase FA education. US graduates (USG) & non-USG had same perception on barriers to FA safety counseling and resources to increase FA safety education. Similarly, there was no difference on responses to these questions between RES raised in North America vs. those that did not. In contrast, RES who are non USG, or those raised without FA at home were more likely to agree with gun violence being a problem in the community & interested in receiving FA safety education (Table 4-A,B). Conclusion Regardless of subspecialty, majority of RES reported no FA safety education received during their training. PED RES were more likely to indicate interest in training, which they thought it is their program's responsibility. Only few RES felt comfortable & confident counseling on FA safety.

A retrospective analysis of firearms injuries during the period from 2016 to 2019 in the Fayoum Governorate, Egypt.

Background: Firearm related injuries continue to increase throughout the world and become the first or second cause of mortality worldwide. The present study aimed to determine factors that affect mortality in firearm injuries. Methods:A retrospective review was conducted on data obtained from 100 firearm injured patients who were recorded to Forensic Medical Authority in Fayoum Governorate, between January 2016 and October 2019. Results: This research shows slight increase of fire arm injuries. In years 2016 and 2017 ,they recorded to be 22 cases (22%) while in year 2018, firearm injuries were 27 cases (27%) and in year 2019, firearm injuries were 28 cases (28%). The study revealed that firearm injuries were more common in males than females. There percentages were 91.0%, 91.3%, 85.19% and 78.57% in years 2016, 2017, 2018 and 2019 respectively. This research recorded that, firearm injuries were more common in the age group between (20-40) years they included 60 males (86.96%) and 9 females (13.04%). This study revealed that, rural areas were the main place for firearm injuries. In 2016, 14 cases (63.64%) were from rural areas while 8 cases (36.36%) were from urban. In 2017, 17 cases (73.91%) were from rural but 6 cases (26.08%) were in urban. In 2018, 21cases (77.77.3%) were from rural but 6 cases (22.23%) were from urban. In 2019, 20 cases (71.42%) were from rural but 8 cases (28.58%) were in urban. female and male victims of firearm injuries were mainly in rural places. The study revealed that most of firearm injured cases were accidental in year 2016. In year 2017, 2018, 2019 cases were mainly homicidal. Conclusion: Our research found that during the period 2016-2019, there is slight increase of firearm injuries mostly homicidal male victims in rural area. Limbs were main sites of injuries. The slight increase of firearm injuries which was non-significant increase mean that there is current tight weapon law guidelines in Egypt

Is the firearm epidemic in the US getting worse?

Abstract Background The US is the least regulated firearm market in the Western world and firearm violence is a major public health issue. Firearms account for 40,000 deaths in the US annually, which is higher than other high-income countries. Although most of the gun-related deaths in the US are the result of suicide attempts and self-inflicted injuries, nearly 40% of them come from accidents, assaults, or police intervention. Methods We measured the number of non-self-inflicted firearm-related ED visits, by including patients discharged with diagnostic ICD-9-CM (ICD-10 for 2016) codes of accidents, assaults or legal intervention resulting in firearm injuries between 2006-2016. We used data from the Healthcare Cost and Utilization Project (HCUPnet). From the CDC Wide-ranging Online Data for Epidemiologic Research we obtained data on non-suicidal firearm-related deaths over the period 2006-2017. To identify the cause of death we used the ICD-10 codes. Temporal changes of rates of ED visits and deaths were evaluated using Joinpoint Software. Results In 2006 there were a total of 79,998 ED visits with a diagnostic code of firearm-related injury, and this number showed a non-significant 2.7% annual decline between 2006-2013 (p = 0.06) followed by a significant 19.4% annual increase between 2013-2016 (p < 0.05), resulting in 111.305 visits in 2016. The number of non-suicidal firearm-related deaths showed a significant 2.2% annual decline between 2006-2014 (p < 0.05), followed by a significant 10.3% APC (p < 0.05) between 2014-2017. Conclusions Data showed steady rates until 2013 and a striking increasing trend starting from 2013. Firearm-related deaths followed the same trends. Our data show that in the last four detectable years there has been a new concerning wave of gun violence and consequently a higher number of fatalities. Analysis limitations: we used national-level aggregate data and coding accuracy may be not consistent nationwide. Key messages In the last four detectable years there has been a new concerning wave of gun violence and consequently a higher number of fatalities nationwide. The US firearm related deaths epidemic urges for new policies and preventive measures, such as stricter background checks and restrictions on guns ownership.

The Association of State Firearm Legislation With the Burden of Firearm-Related Surgery

BackgroundUnited States state-level firearm legislation is linked to rates of firearm-related suicides, pediatric injuries, nonfatal injuries, hospital discharges, and mortality. Our objective was to evaluate the burden of firearm-related injuries requiring surgery for states with strict as opposed to nonstrict firearm legislation. Materials and methodsThe 2014 Healthcare Cost and Utilization Project State Inpatient Database was utilized to extract data for all available 28 states and the District of Columbia. States were dichotomized into strict and nonstrict legislative categories using the 2014 Brady and Gifford's scores (15 strict, 14 nonstrict). Patients with a firearm injury requiring surgery were identified and the incidence of surgery aggregated to the county level. Negative binomial regression with an offset for county-level residential population was used to estimate the incident rate ratio for surgical volume comparing counties in strict and nonstrict states. Models were stratified by injury intent and adjusted for county population characteristics. ResultsA total of 11,939 patients were hospitalized with firearm-related injuries, with 65% (n = 7759) undergoing an operative procedure. The adjusted incidence rate of firearm-related surgery per 100,000 people was 1.29 (95% confidence interval; 1.13-1.46, P < 0.001) times higher and the adjusted cost of hospitalization per 100,000 people was $6028.69 ($3744.61-$8312.78, P = 0.001) greater for counties in nonstrict states than those for counties in strict states. The burden of health care for these injuries is invariably shifted to state- and county-level finances. ConclusionsThe rate of firearm-related surgical intervention was higher for states with nonstrict firearm legislation than that for states with strict legislation. States should reevaluate their firearm legislation to potentially reduce the burden of firearm-related surgery and health care costs.

The Disturbing Findings of Pediatric Firearm Injuries From the National Trauma Data Bank: 2010-2016

BackgroundTrauma is the leading cause of pediatric and adolescent morbidity and mortality. Firearm-related injuries and deaths contribute substantially to the overall disease burden. This study described the intent, location, demographics, and outcomes of a nationally representative pediatric population with firearm injuries. We hypothesized that younger patients would have a higher percentage of unintentional and self-inflicted injuries with associated higher mortality rates. Materials and methodsThe National Trauma Data Bank, maintained by the American College of Surgeons, from 2010 to 2016 was utilized. All pediatric patients (0-19 y) with firearm injuries who had complete data were analyzed for mechanism, location, demographics, and outcomes. Basic descriptive statistics were used to compare subgroups. Multivariable logistic regression analysis was applied to investigate risk factors for firearm injury–caused mortality. ResultsIn the study period, 46,039 pediatric patients sustained firearm injuries (median age = 17 y). Males, Blacks, ages 15-19, and the Southern region were the most common injured demographics. However, subgroup analysis showed the demographics differ for self-inflicted and unintentional firearm injuries, which had significantly higher White patients (66.6% and 47.9%, respectively; P < 0.001). Nearly 76% of injuries were related to assaults, 14% were unintentional, 5% were self-inflicted, and 5% were undetermined. The overall mortality was nearly 12%. The youngest population had higher proportion of unintentional injuries and highest mortality rate when compared with other classifications of intent (P < 0.001). ConclusionsPediatric firearm injuries have high mortality, especially in the youngest populations. Age-tailored prevention strategies, such as strict child access prevention laws and enforced gun storage violations, may help in reducing firearm injuries and improving health outcomes.

Gunshot wound incidence as a persistent, tragic symptom of area deprivation

BackgroundMore than 30,000 Americans die every year of firearm-related injuries. Gun violence is frequently addressed by law enforcement and policing, as opposed to public health interventions that might address poverty or deprivation. Our goal was to evaluate the past 20 years of gunshot wound injury demographics seen at our level I academic trauma center and create a risk map model correlating gunshot wound incidence with area deprivation. MethodsPatients admitted for gunshot wound-related injuries between 1996 and 2017 were identified using our trauma registry. Demographic and injury data were extracted and analyzed. Multivariable logistic regression models were created to identify predictors of mortality. Geographic information system mapping of incident location and home address was completed to identify zip code hot spots of high gunshot wound incidence. Area Deprivation Indices, which reflect local income or poverty, housing, education, and employment were used as a marker of relative economic disadvantage. Spearman rank correlation was used to determine the relationship between Area Deprivation Indices score and gunshot wound rate. ResultsA total of 2,413 patients with gunshot wounds were evaluated. The cohort had a mean age of 28.8 ± 11.5 and was 89.6% male. Mean Injury Severity Score was 11 ± 12.5. gunshot wounds were most frequently a result of assault (91.1%), followed by unintentional injury (3.4%). Geographic information systems mapping revealed significant clustering of gunshot wounds. The areas with highest per capita incidence of gunshot wounds was strongly correlated with Area Deprivation Indices (0.594, P < .001). ConclusionGeographic regions of known lower socioeconomic resources have higher incidence of gunshot wounds in our community. Both Area Deprivation Indices and gunshot wound incidents in these distressed communities remained unchanged throughout the past 20 years, despite law enforcement crime suppression efforts. Gunshot wounds appear to be a symptom of area deprivation, similar to failing schools and poor health outcomes. Efforts to decrease poverty and community capacity-building may help alleviate this area deprivation.

Osteomielitis por Candida auris: reporte de caso

Introducción. Candida auris es una levadura oportunista asociada a múltiples infecciones que, en 2009, fue descrita por primera vez en Tokio, Japón. Dado que tiene una gran resistencia antifúngica a los azoles y a la anfotericina B, su manejo es limitado, por lo que se debe considerar iniciar un tratamiento empírico con equinocandinas como la micafungina.Presentación de caso. Caso inusual de osteomielitis por C. auris en un hombre de 48 años de Popayán, Colombia, con antecedentes de fractura de cabeza de fémur, paraplejia por herida con arma de fuego y vejiga neurogénica. El paciente tenía cuadro clínico de 15 días de evolución consistente en salida abundante de líquido purulento fétido en úlcera derecha por presión trocantérica. Mediante resonancia magnética se identificaron miositis y alteraciones de intensidad ósea, por lo que fue diagnosticado con osteomielitis.Debido a la identificación de aislamientos repetidos de Candida haemulonii en varias muestras óseas, se inició manejo antifúngico; sin embargo, ya que no se observó ninguna mejora en la condición del paciente, el cultivo fue enviado al Instituto Nacional de Salud para confirmar la identificación del patógeno debido a aislamientos repetidos de C. haemulonii y su aparente resistencia a los antifúngicos. Finalmente, el patógeno identificado fue C. auris.Conclusión. La osteomielitis por C. auris es una entidad inusual cuyo diagnóstico debe ser considerado en pacientes con factores de riesgo predisponente, como aquellos con larga estancia hospitalaria, ya que esta es una infección oportunista asociada a pacientes hospitalizados.

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

BackgroundPenetrating injury independently predicts the need for surgeon presence (NSP) upon arrival. Penetrating injury is often used as a trauma triage indicator, however, it includes a wide range of specific mechanisms of injury. We sought to compare firearm-related and non-firearm related pediatric penetrating injuries with respect to NSP, ISS and mortality. MethodsPatients <18 from the 2016 National Trauma Quality Improvement Program Database were included. Penetrating injury was identified and grouped using ICD-10 mechanism codes into firearm and non-firearm related injury. NSP, ISS, and mortality were compared between the two groups. ResultsA total of 1715 (4.2%) patients with penetrating injury were; 832 firearm-related and 883 non-firearm. No deaths occurred among the non-firearm group compared to 94 (11.3%) among firearm-related patients. Among non-firearm patients, 22.7% had a NSP indicator compared to 51.2% of patients injured by a firearm. ConclusionThere is a significantly higher proportion of severe injury and mortality with firearm penetrating injury when compared to non-firearm pediatric penetrating injury. Consideration should be given to dividing it into firearm and non-firearm penetrating injury.

Firearm-related injuries in children and adolescents: an emergency and critical care perspective.

Firearms are a leading cause of death and injury in children, especially in the United States. Many of these injuries present to emergency departments and pediatric ICUs, prompting a need for updated prevention, interventions, and trauma-informed care. This review explores the evidence for prevention and screening for access to firearms, types of injuries, and considerations for mass casualty events. Firearm-related injuries lead to over 20 000 emergency department visits annually in children and carry a higher risk of severe injury or death. Screening high-risk patients for access to firearms is suboptimal, despite evidence showing reduction in suicide deaths and increased safe storage. While mass casualty shootings represent a low proportion of all firearm-related morbidity, they have brought heightened attention to focus on quality research. Firearm-related injury is a public health crisis and presents a unique risk to children and adolescents. A firearm in the home, especially one with children, significantly increases the risk of death by homicide or suicide. Research on gun violence is leading to important national conversations on gun control and the role of physicians in the prevention of injury and advocacy for effective interventions and legislation.

Partnering With Patients to Reduce Firearm-Related Death and Injury.

In the United States, nearly 40,000 deaths per year are firearm related. Among these fatalities are approximately 1300 children. In addition, there are more than 20,000 unintentional firearm injuries per year. Osteopathic physicians have a unique opportunity to affect this public health concern through patient education. Several evidenced-based recommendations can be incorporated at the bedside to reduce firearm injuries and deaths, including gun education, safe storage, and proper disposal.

4256 Association Between Injury Intent and Emergency Department and Hospital Charges for Pediatric Firearm Injuries in the United States

OBJECTIVES/GOALS: In 2016, more than 3,100 children died, and an estimated 17,000 children had non-fatal injuries, from firearms in the United States. In this study, we used hospital charges as a proxy for medical resource utilization, and compared differences in charges by intent of firearm injury among children. METHODS/STUDY POPULATION: In this cross-sectional study of the 2016 Nationwide Emergency Department Sample, we identified firearm injury cases among children aged 19 years or younger using ICD-10-CM external cause of morbidity codes. Injury intent was characterized as unintentional, assault, self-inflicted, undetermined, or due to legal intervention. We included patients treated and released from the emergency department (ED) or admitted alive to the hospital, and excluded those who were transferred or died in the ED. We used linear regressions with survey weighting to compare differences in mean healthcare charges by firearm injury intent, with and without adjustment for ED disposition. RESULTS/ANTICIPATED RESULTS: Among 12,469 cases in the weighted sample, mean age was 16.5 years, a majority were male (88.2%) and Medicaid-insured (57.8%), and 64% were discharged from the ED and 36% admitted. Injuries were 49.0% unintentional, 45.1% assault-related, and 1.8% self-inflicted. Compared to children with self-inflicted injuries (charges $115,224), children with assault-related injuries (charges $55,052; p&lt;0.007) and unintentional injuries (charges $38,643; p&lt;0.001) had lower mean charges per visit. Differences in charges were no longer significant after adjusting for ED disposition, as 85.8% of self-inflicted injuries were admitted, compared to 46.5% of assault-related and 24.3% of unintentional injuries. DISCUSSION/SIGNIFICANCE OF IMPACT: Although the majority of pediatric firearm-related injuries resulting in emergency department care are unintentional or assault-related, self-inflicted injuries result in greater per visit hospital charges, attributable to higher hospitalization rates, and likely due to more severe injuries.

A Credible Messenger: The Role of the Violence Intervention Specialist in the Lives of Young Black Male Survivors of Violence

For hospital-based violence intervention programs (HVIPs), gun violence intervention and the treatment of firearm-related injuries for male survivors require a sui generis network of team members t...

Engagement and Leadership in Firearm-Related Violence Prevention: The Role of the Pediatric Hospitalist.

Gun violence is a US public health crisis. Approximately 7000 children are hospitalized each year because of firearm-related injuries. As pediatric hospitalists, we are poised to address this crisis, whether we care directly for patients who are victims of gun violence. In this article, we aim to provide practical tools and opportunities for pediatric hospitalists to address the epidemic of gun safety and gun violence prevention, including specifics related to the inpatient setting. We provide a framework to act within 4 domains: clinical care, advocacy, education and research.

A National Research Strategy to Reduce Firearm-Related Injury and Death: Recommendations from the Health Policy Research Subcommittee of the Society of General Internal Medicine (SGIM).

Injury due to firearms is a serious health issue in the USA, leading to nearly 40,000 deaths annually and many more non-fatal injuries. Despite the significant impact on morbidity and mortality, relatively little research funding is dedicated to understanding the impact of firearm-related injury and to developing strategies to mitigate harm. In part, research has been stymied by decades-old language in federal legislation that was interpreted as prohibiting federal funding for firearm injury-related research. This paper, prepared by members of the Society of General Internal Medicine (SGIM), calls for support for research that seeks to understand the nature of firearm-related injury and resources to develop effective approaches to prevent it. We outline recommendations to develop evidence to inform policymakers and the medical and public health communities. These recommendations include (1) development of a shared national research agenda to address firearm-related injury and death; (2) allocation of federal funds specifically for research related to firearm injury; (3) support for the career development of researchers studying firearm-related injury; and (4) facilitating access to comprehensive data sources needed for developing evidence.

No place like home: A national study on firearm-related injuries in the American household

BackgroundWe aimed to examine the prevalence of, and describe factors associated with, firearm-related injuries in American households. MethodsUsing the 2010–2016 ACS-TQIP database, all ICD-9/10 external causes of injury for firearm-related injuries were queried with the place of occurrence designated as “home”. Causes of injury were identified as assault, intentional self-injury, and unintentional injury. Univariate then multivariable regression analyses were performed to identify factors associated with each injury type. Results12,657 firearm-related injuries in households were identified. Of those, 49.9% were victims of assault, 35.7% were intentional self-injury, and 14.4% were unintentional. Mortality was highest among self-inflicted injuries (52.4%), followed by assault (12.9%), and unintentional injuries (5.9%). On multivariable analysis, age <45 years, African-American race, and drug use were independently associated with an injury secondary to assault. Age >65 years, White race, psychiatric illness, and alcohol use disorder were independently associated with intentional self-injury. White and American-Indian race were independently associated with unintentional injuries. ConclusionsAssault is the most common cause of home-related firearm injury requiring hospitalization, while intentional self-injury is the most lethal.

States tap pharmacists to combat human trafficking.

Florida’s 2019 legislative session closed with an unexpected but welcome mandate for pharmacists to receive training on how to identify and help patients who are victims of human trafficking. Kathy Baldwin, legal and regulatory affairs council chair for the Florida Society of Health-System Pharmacists (FSHP), said the organization was taken by surprise to learn of a new law requiring licensed health professionals to complete an hour of continuing education (CE) on human trafficking by January 2021. “Our lobbyists weren’t following it,” she said. “I didn’t even know that [trafficking] was a public health issue until recently.” Trafficking was one of the topics that members of ASHP’s councils discussed in September at a special Policy Week 2019 session on preventing workplace violence and firearm-related injury and death. Some council members said their workplace requires certain health professionals to undergo training to identify victims of human trafficking. Baldwin said that after the Florida pharmacy board notified FSHP about the new CE requirement, her team analyzed the legislation and concluded it was a positive development for the profession.

Beyond Band-Aids for Bullet Holes: Firearm Violence As a Public Health Priority.

To review the public health approach to preventing and treating firearm violence. Peer-reviewed, published scholarship and federal data systems. English-language, indexed research articles on the epidemiology, risk, prevention, and consequences of firearm violence. This narrative review includes findings related to the epidemiology and impact of firearm violence, focusing on short- and long-term outcomes. Evidence supporting interventions at the individual, agent, and environmental level to reduce firearm-related harm was examined. Firearm violence is a major public health challenge in the Unites States. The consequences of firearm violence reach beyond the nearly 40,000 firearm-related deaths and 90,000 firearm-related injuries each year. Firearm violence, including self-harm, assault, and unintentional injury, affects the health of individuals, families, communities, and health systems. Data sources remain inadequate, however, to fully capture these impacts. Treating firearm violence as a disease and taking a public health approach to prevention and treatment is key to reducing the harms of firearm violence. Using a public health framework not only recognizes the physical and mental consequences of firearm violence but also focuses our attention on underlying causes and on innovative, multi-level interventions to reduce the harms of firearm violence. The public health approach positions clinicians to change the conversation from political diatribe of pro-gun and anti-gun to systematically reducing injury and death. To achieve comparable success, we must design, test, and implement effective interventions at the environmental, policy, technological, and individual levels to prevent firearm violence. We must collect robust data on firearm violence and its consequences. And we must reckon with the conditions of inequality and disadvantage that feed violence through all means.

Firearm-Facilitated Sexual Assault: Using Emergency Department Data to Provide a Novel Perspective of the Problem

Firearm-related injury is a significant public health problem within the United States. Efforts to reduce the burden of firearm injury and violence are limited in large part by a lack of robust dat...