Differences in intent of pediatric injuries underscore importance of safe firearm storage

ORLANDO, Fla. – Firearm-related injuries are a leading cause of injury and death in children and adolescents. Knowing more about the differences in the intent of pediatric firearm-related injury, for instance, unintentional injuries compared with injuries related to assault, can guide injury-prevention efforts.

The study abstract, “Emergency Department Visits for Pediatric Firearm-Related Injury: By Intent of Injury,” will be presented on Friday, Nov. 2, at the American Academy of Pediatrics 2018 National Conference Exhibition in Orlando, Fla.

Using a cross-sectional analysis from the Nationwide Emergency Department Sample from 2009 to 2013, researchers examined the records of 111,839 emergency department visits nationwide for pediatric firearm-related injuries.

Excluding visits related to air guns, pellet, BB or paintball guns, injuries treated during these emergency department visits were divided into intent groups: unintentional, assault or self-harm. When injuries were broken down by age, younger children were more likely to sustain unintentional firearm injuries, whereas adolescents were more likely to be victims of firearm-related assault or self-harm.

“Detailed data collection, specifically in relation to situation and context for pediatric firearm-related injuries, could inform efforts to prevent firearm-related injuries. Our study suggests that effective strategies to prevent firearm-related injury in children should focus on age and intent,” said Shilpa Patel, MD, MPH, lead study author and assistant professor, Division of Emergency Medicine, Children’s National Health System.

A total of 63 percent of injuries were defined as unintentional, 30 percent were categorized as assault and 1 percent were defined as self-harm. Unintentional injury was more common in children 12 years or younger and injuries classified as self-harm or assault were higher in adolescents ages 13 to 21 years.

Other details emerged as well:

• 89 percent of those injured were male, and the average age at injury was 18 years old
• 38 percent of injuries occurred among publicly insured youth
• 30 percent of injuries resulted in hospital admission
• 6 percent of injuries resulted in death

In addition, there were geographic differences in type of firearm injury. Odds of unintentional injury by firearm was higher in the Western region of the U.S. compared with the Northeast, and higher among publicly insured children and teens.

The data also showed that victims of unintentional injuries were more likely to be discharged after treatment, while those with injuries involving assault or self-harm were more likely to be admitted to the hospital and incur higher costs for treatment.

“Pediatricians play an important role in firearm-injury prevention. Pediatricians should continue to counsel families about safe storage of firearms in the home to prevent unintentional firearm-related injuries. Safe firearm storage techniques include trigger locks as well as keeping all firearms locked and unloaded with ammunition locked separately,” said Dr Patel. “Additionally, pediatricians and acute care providers should routinely ask about access to firearms when screening for depression and suicide risks in adolescents and should provide resources on violence prevention.”

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Dr Patel will present the abstract, available below, from 2 p.m. to 2:15 p.m. ET on Friday, Nov. 2, in room Orlando Ballroom L of the Orange County Convention Center.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media or may be preparing a longer article for submission to a journal.

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Abstract Title: Emergency Department Visits for Pediatric Firearm-Related Injury: By Intent of Injury

Shilpa Patel

Bethesda, MD

Purpose: Firearm-related injuries are a leading cause of morbidity and mortality among children and adolescents. Our objective was to describe and compare pediatric firearm-related injuries presenting to the emergency department (ED) by intent. Methods: Retrospective cross-sectional analysis using the Nationwide Emergency Department Sample (NEDS) from 2009-2013 for children ≤ 21 years. ED visits for firearm- related injury were identified by ICD-9 external-cause-of-injury codes and divided into intent groups (accidental, self-harm, assault and undetermined). We excluded visits related to air guns, pellet or BB, or paintball guns. Multivariable logistic regression was used to compare these groups. Results: During the 5- year study period, we identified 111,839 (22,367/year) ED visits for pediatric firearm-related injuries nationwide. The mean age was 18.0 (SD=0.05) years, 89.3% male, 38.5% publicly insured, 30% resulted in hospital admission, and 6.1% resulted in death. 62.8% of total injuries were categorized as accidental, 30.4% were categorized as assault, and self-harm was reported in 1.4% of injuries. Odds of accidental injury by firearm was higher in the Western region of the US compared to the Northeast (aOR 6.9 [4.0, 11.6]) and higher in publicly insured youth (aOR 1.2 [1.1, 1.3]). Odds of accidental injury were higher in younger children (0-12 years: aOR 2.3 [1.9, 2.8]; 13-17 years: aOR 1.1 [1.1, 1.2]) as compared to those 18-21 years old. In contrast, the odds of self harm and assault as a cause for firearm injury were respectively higher in ages 13-17 (aOR 2.3 [1.4, 3.7); aOR 2.1 [1.8, 2.5]) and ages 18-21 (aOR 2.0 [1.2, 3.3]); aOR 2.7 [2.2, 3.1]).

ED visit for firearm injury secondary to assault was associated with male sex (aOR 1.1 [1.0, 1.2]). (Table 1) Conclusion: Accidental pediatric firearm-related injuries are more commonly associated with younger age, Western region, and discharge from the ED. However, pediatric firearm-related injuries secondary to assault and self-harm are more commonly associated with older age and higher resource utilization. While the majority of all firearm-related injury visits were made by males, the association with male sex was only statistically significantly in the assault group. Legislation and policy to prevent firearm-related injuries in children should consider factors related to intent.