Child Firearm Injury Circumstances and Associations With Violence Intervention Program Enrollment.

INTRODUCTION: Pediatric firearm injuries are the leading cause of death among American children. While assault is the most commonly cited cause, few studies have investigated circumstances surrounding such injuries. Violence intervention programs (VIPs) have been utilized to combat firearm violence, though a similar lack of knowledge exists regarding possible associations between firearm injury circumstances and youth VIP enrollment. METHODS: This cross-sectional study included children aged 6-17 y who presented to an urban level 1 pediatric trauma center with firearm injuries from 2014 to 2017. Victim demographics and enrollment in a VIP were obtained from medical records, as well as circumstances surrounding the injuries based on account of the victim, victim's family/friends, and/or police present at the hospital. Circumstances included location of the shooting, if the shooter was known to the victim, and if the shooting was confirmed by the victim or their contacts to have been accidental or an intentional assault. Medical record numbers were used to locate victims in our trauma registry in order to obtain their assigned international classification of disease codes. Wilcox-rank sum, Pearson's chi-squared and Fisher's exact tests were used to detect associations between demographics, VIP enrollment, and shooting circumstances. RESULTS: 156 victims of firearm injury were described, including primarily Black adolescent males. 72% of victims were shot outdoors by an unknown shooter, the motivation of which was unknown in 93% of cases. 36% of these shootings were "drive-by". The majority of victims received international classification of disease codes for assault, though shootings that were confirmed by the victim to have been intentional assaults were relatively uncommon (13.4%). Most children lived in the same zip code in which they were shot (71%), and three particular zip codes accounted for 40% of shootings. 26% of victims chose to enroll in the VIP, and those that were victims of confirmed assaults (odds ratio 3.5) as well as those admitted to the hospital (odds ratio 2.4) were significantly more likely to enroll. CONCLUSIONS: Based on victim account, children living in an urban setting are more frequently victims of unclearly motivated, outdoor neighborhood shootings rather than intentional assaults. More accurate understanding of the causes of pediatric firearm injuries should inform both recruitment into VIPs, as well as a balancing of VIPs with community-level interventions to address firearm violence.

COVID-19 Pandemic Effects on the Epidemiology and Mortality of Pediatric Firearm Injuries; A Single Center Study.

BACKGROUND: The COVID-19 pandemic has been associated with increased firearm injuries amongst adults, though the pandemic's effect on children is less clearly understood. METHODS: This cross-sectional study was performed at a Level 1 Pediatric Trauma Center and included youths 0-19 years. The trauma registry was retrospectively queried for firearm injuries occurring pre-COVID-19 pandemic (March 2015-February 2020). Baseline data was compared to prospectively collected data occurring during the COVID-19 pandemic (March 2020-March 2022). Fischer's exact, Pearson's Chi-square and/or correlation analysis was used to compare pre and post-COVID-19 firearm injury rates and intent, victim demographics and disposition. Temporal relationships between firearm injury rates and local COVID-19 death rates were also described. RESULTS: 413 pre-COVID-19 firearm injuries were compared to 259 pandemic firearm injuries. Victims were mostly Black males with a mean age of 13.4 years. Compared to the 5 years pre-pandemic, monthly firearm injury rates increased 51.5% (6.8 vs 10.3 shootings/month), including a significant increase (p = 0.04) in firearm assaults/homicides and a relative decrease in unintentional shootings. Deaths increased 29%, and there were significantly fewer ED discharges and more admissions to OR and/or PICU (p = 0.005). There was a significant increase in Black victims (p = 0.01) and those having Medicaid or self-pay (p<0.001). Firearm injury spikes were noted during or within the 3 months following surges in local COVID-19 death rates. CONCLUSIONS: The COVID-19 pandemic was associated with an increase in the frequency and mortality of pediatric firearm injuries, particularly assaults amongst Black children following surges in COVID death rates. Increased violence-intervention services are needed, particularly amongst marginalized communities. LEVEL OF EVIDENCE: This is a prognostic study, evaluating the effects of the COVID-19 pandemic on pediatric firearm injuries, including victim demographics, injury intent and mortality. This study is retrospective and observational, making it Oxford Level III evidence.

Implementation of a clinical guideline for nonoperative management of isolated blunt renal injury in children.

BACKGROUND: The aim was to evaluate the impact of a standardized nonoperative management protocol by comparing patients with isolated blunt renal injury before and after implementation. METHODS: We retrospectively reviewed the trauma registry at our Level 1 pediatric trauma center. We compared consecutive patients (≤ 18 years) managed nonoperatively for blunt renal injury Pre (1/2010-9/2014) and Post (10/2014-3/2020) implementation of a clinical guideline. Outcomes included length of stay, intensive care unit admission, urinary catheter use, and imaging studies. RESULTS: We included 48 patients with isolated blunt renal injuries (29 Pre, 19 Post). There were no differences in age, sex, injury grade, or mechanism (P > .05). Postprotocol had decreased length of stay (P = .040), intensive care unit admissions (P = .015), urinary catheter use (P = .031), and ionizing radiation imaging (P < .001). CONCLUSION: These data suggest improved outcomes and resource utilization following implementation of a nonoperative management protocol of pediatric isolated blunt renal injuries.