Prevention of Firearm Injuries Among Children and Adolescents: Consensus-Driven Research Agenda from the Firearm Safety Among Children and Teens (FACTS) Consortium.

IMPORTANCE: Firearm injuries are the second leading cause of death among US children and adolescents. Because of the lack of resources allocated to firearm injury prevention during the past 25 years, research has lagged behind other areas of injury prevention. Identifying timely and important research questions regarding firearm injury prevention is a critical step for reducing pediatric mortality. OBJECTIVE: The Firearm Safety Among Children and Teens (FACTS) Consortium, a National Institute for Child Health and Human Development-funded group of scientists and stakeholders, was formed in 2017 to develop research resources for the field, including a pediatric-specific research agenda for firearm injury prevention to assist future researchers and funders, as well as to inform cross-disciplinary evidence-based research on this critical injury prevention topic. EVIDENCE REVIEW: A nominal group technique process was used, including 4 key steps (idea generation, round-robin, clarification, and voting and consensus). During idea generation, stakeholders and workgroups generated initial research agenda topics after conducting scoping reviews of the literature to identify existing gaps in knowledge. Agenda topics were refined through 6 rounds of discussion and survey feedback (ie, round-robin, and clarification steps). Final voting (using a 5-point Likert scale) was conducted to achieve consensus (≥70% of consortium ranking items at 4 or 5 priority for inclusion) around key research priorities for the next 5 years of research in this field. Final agenda questions were reviewed by both the stakeholder group and an external panel of research experts not affiliated with the FACTS Consortium. Feedback was integrated and the final set of agenda items was ratified by the entire FACTS Consortium. FINDINGS: Overall, 26 priority agenda items with examples of specific research questions were identified across 5 major thematic areas, including epidemiology and risk and protective factors, primary prevention, secondary prevention and sequelae, cross-cutting prevention factors, policy, and data enhancement. CONCLUSIONS AND RELEVANCE: These priority agenda items, when taken together, define a comprehensive pediatric-specific firearm injury prevention research agenda that will guide research resource allocation within this field during the next 5 years.

Intentional Injury and the Risk of Subsequent Hospitalization for Attempted Suicide.

OBJECTIVE: Trauma patients are at increased risk of suicidal behavior. The association between assault injury and subsequent suicidal behavior relative to unintentional injury remains under-studied. This study hypothesized that trauma patients with assault injuries would demonstrate greater risk of subsequent suicide attempt hospitalization compared to patients with unintentional injury. METHOD: Trauma patients hospitalized in Washington State were identified via administrative records. Proportional hazard analysis was conducted to test differences in risk of suicide attempt hospitalization up to 5 years after the initial trauma hospitalization, and time to onset of first suicide attempt hospitalization by subgroup. RESULTS: Approximately 2% (n = 1264) of trauma inpatients were subsequently hospitalized for attempted suicide, and 0.3% died by suicide (n = 177) during the follow-up period. Relative to patients with unintentional injuries, those with assault-related injuries (aHR = 1.38, 95% CI: 1.02 to 1.86), and self-inflicted injuries (aHR = 8.22, 95% CI: 7.24 to 9.33) demonstrated greater risk of suicide attempt hospitalization after discharge. CONCLUSION: These findings demonstrate a greater risk of suicidal behavior among trauma patients with assault injuries relative to patients with unintentional injuries. This suggests the importance of intentional cause of injury as a risk factor for suicidal behavior to be considered in assessment of suicidality and discharge planning for trauma patients.

Posttraumatic stress, problem drinking, and functional outcomes after injury.

HYPOTHESIS: Patients undergoing trauma surgery for injury who have subsequent posttraumatic stress disorder (PTSD) or problem drinking will demonstrate significant impairments in functional outcomes compared with patients without these disorders. DESIGN: Prospective cohort study. SETTING: Level I academic trauma center. PARTICIPANTS: One hundred one randomly selected survivors of intentional and unintentional injuries were interviewed while hospitalized and again 1 year later. The investigation achieved a 73% 1-year follow-up rate. MAIN OUTCOME MEASURES: Posttraumatic stress disorder was assessed with the Post-traumatic Stress Disorder Checklist and problem drinking was assessed with the Alcohol Use Disorder Identification Test. Functional status was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS: One year after injury, 30% of patients (n = 22) met symptomatic criteria for PTSD and 25% (n = 18) had Alcohol Use Disorder Identification Test scores indicative of problem drinking. Patients with PTSD demonstrated significant adverse outcomes in 7 of the 8 domains of the Medical Outcomes Study 36-Item Short-Form Health Survey compared with patients without PTSD. In multivariate models that adjusted for injury severity, chronic medical conditions, age, sex, preinjury physical function, and alcohol use, PTSD remained the strongest predictor of an adverse outcome. Patients with problem drinking did not demonstrate clinically or statistically significant functional impairment compared with patients without problem drinking. CONCLUSIONS: Posttraumatic stress disorder persisted in 30% of patients 1 year after traumatic injury and was independently associated with a broad profile of functional impairment. The development of treatment intervention protocols for trauma patients with PTSD is warranted.