Firearm-related hospitalizations in children represent a heavy burden

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1. Hospitalizations due to firearm-related injuries is a major cause of morbidity and mortality, affecting 8.87 per 100 000 individuals under age 20.

2. The major causes of firearm-related hospitalizations were unintentional injuries in younger children and assault in adolescents.

3. Males, black children, and those receiving Medicaid were most likely to experience a firearm-related hospitalization.

Evidence Rating Level: 2 (Good)

Study Rundown: Firearm injuries are among the top 3 causes of pediatric deaths in  America and represent a major, preventable cause of emergency department visits and hospitalizations of  children. However, research is scarce regarding the burden of firearm-related hospitalizations in children and adolescents. The current study sought to evaluate the frequency, causes, and demographic patterns of these hospitalizations.  Results indicated that firearm-related hospitalizations are associated with significant morbidity and mortality in children and adolescents, affecting 8.87 per 100 000 individuals under age 20. The major causes of firearm-related hospitalizations were unintentional injuries in younger children and assault in adolescents. Males, black children, and those on Medicaid were most likely to experience a firearm-related hospitalization. In addition, these injuries have a large economic burden, with the cost of hospitalizations surpassing $146 000 000 in 2009 and nonfatal injuries resulting in ongoing disability costs. One limitation of the current study is the lack of long-term health information for the patients included. These findings highlight the importantance of physician discussions regarding firearm safety and injury prevention with parents, children, and adolescents.

Click to read the study published today in Pediatrics                

Relevant Reading: AAP Policy Statement: Firearm-Related Injuries Affecting The Pediatric Population

Study Author, Dr. John M. Leventhal, MD, talks to 2 Minute Medicine: Department of Pediatrics, Yale School of Medicine, New Haven, CT.

“These data highlight the toll of gun-related injuries that extends beyond high-profile cases, and those children and adolescents who die before being hospitalized. Pediatricians and other health care providers can play an important role in preventing these injuries through counseling about firearm safety, including safe storage.”

In-Depth [retrospective cohort study]: Data was obtained from the 2009 Kids’ Inpatient Database (KID), a nationally representative data sample from 4121 hospitals serving children and teens in 44 states. In 2009, an estimated 7391 hospitalizations of children and adolescents were due to firearm injuries (95% CI: 6523-8259). A total of 6.1% of these hospitalizations resulted in death. Assaults (61.7%) were the most frequent cause of hospitalization due to firearm-related injury, while suicide attempts (3.7%) were the least frequent. Gender and racial differences were noted: 89.2% of all hospitalizations were in males and 47.2% occurred in black children, more than double that of other races. Unintentional firearm injuries (75.4%) were the most common cause of hospitalization in children aged <10 years. Younger children were also more likely to have a traumatic brain injury (20.8% in children aged <5 years vs. 8.3% in those aged 15-19 years; p < .0001). Of all hospitalizations, 49.6% were covered by Medicaid, while 25.3% were covered by private insurance and 16.6% were paid for out-of-pocket.  The average cost per firearm-related hospitalization was $19 775, with an estimated direct hospital cost of $146  710 029.

By Cordelia Y. Ross and Leah H. Carr

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