Risk factors for recurrent firearm injury among children

1. In this retrospective observational cohort study of children in St. Louis, those with the highest risk of firearm injury were older, Black, non-Hispanic males.

2. Children who were treated at an adult hospital had an increased risk of recurrent firearm injury compared to children treated at a children’s hospital.

Evidence Rating Level: 2 (Good)

Study Rundown: Firearm injury is the leading cause of death among children in the United States, with injury rates further increasing during the COVID-19 pandemic. Previous research suggests that race, sex, and economic disadvantage are associated with recurrent firearm injury across all ages, but literature detailing risk factors specifically within the pediatric population is limited. This study sought to identify predictors of recurrent firearm injury in children near St. Louis, Missouri, a city with one of the highest rates of violence and most severe racial and socioeconomic segregation in the country. It was found that the majority of children who were initially treated for firearm injury were older, non-Hispanic, Black males; this demographic was mirrored in the recurrent injury cohort. After statistical adjustment, male sex and treatment at an adult hospital were found to be associated with increased risk for reinjury. Further, the reinjury rates at 1 year and 5 years were also found to be substantially higher compared to the nationwide average, suggesting a need for intervention in this region. This study was limited by its retrospective design, lack of data on comorbidities, and a relatively short follow-up period. Overall, these findings emphasize the large number of children affected by firearm injury and point to racial and socioeconomic disparities within this group.

Click here to read the study in AIM

Relevant Reading: Youth firearm injury

In-Depth [retrospective cohort]: This study analyzed all children aged between 0 and 17 years who presented to 1 of the 4 St. Louis adult or pediatric level I trauma hospitals for an index firearm injury between January 2010 and December 2019. Data were drawn from the St. Louis Region-Wide Hospital Based Violence Intervention Program Data Repository (STL-HVIP-DR). A total of 1340 patients were included, with the majority being Black, male, and between the ages of 15 and 17 (87%, 84%, and 67% respectively). Of these patients, 1287 (96%) were discharged, and 169 (13%) of this subset were subsequently reinjured with a firearm. The risk of reinjury from a firearm at 1 year, 5 years, and 8 years after the index injury was 6% (95% confidence interval [CI], 5% to 8%) 14% (CI, 12% to 17%) and 19% (CI, 16% to 22%) respectively. Compared to females who experienced a firearm injury, males had an increased risk for reinjury (hazard ratio [HR], 2.7 [CI, 1.4 to 5.5]). Similarly, children who presented to an adult hospital for post-injury care had an increased risk for reinjury versus those who received care at a children’s hospital (HR for adult hospital 1, 1.8 [CI, 1.2 to 2.9]; HR for adult hospital 2, 1.7 [CI, 1.0 to 2.9]). Overall, these results confirmed the high rates of recurrent pediatric firearm injury as well as the racial disparities within this cohort.

Image: PD

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