Guns and Kids: Treatment of Pediatric Firearm and Air Gun Missile Injuries in the Emergency Department
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PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractBackground: A recent inpatient data analysis found 16 US children are hospitalized with firearm-related injuries each day. We hypothesized a higher number children are treated in the ED. Therefore, we sought to examine incidence and outcomes of pediatric firearm injuries treated in the ED. Methods: All pediatric (age, 0-18 years) firearm-related injuries were identified from the most recent available 2013 Nationwide Emergency Department Sample database. Results: A total of 16,917 firearm injury cases were identified, estimating 46 cases per day. 11,586 (68.5%) were accidental injuries, 4,090 (24.2%) were assault injuries, and 385 (2.3%) were suicidal injuries. Overall mortality was 575 (3.4%), with 366 (2.2%) deaths in the ED and 209 (1.2%) deaths after hospitalization. Using multivariable logistic regression age less than 2 years, self-pay payer status, multiple injuries, and assault injury were found to be independent predictors for mortality. The highest odds ratio for mortality was found in patients less than 2 years (OR 16.521, CI 10.789-25.300, p<0.001). Mean total charges for ED services were $3,258.70 ($3,076.1, $3,441.3, p<0.001). Conclusion: Approximately 46 children are treated in the ED every day for firearm-related injuries. This is significantly higher than previously reported hospitalization estimates of 16 per day. We also found that children younger than 2 years of age are high risk population for mortality. Future studies including firearm access, safe storage laws, and socioeconomic risk factors are paramount in decreasing pediatric firearm related injuries