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Cited by 95Gun Ownership and Violence ResearchInjury Epidemiology and PreventionTrauma and Emergency Care Studies

Individual and Neighborhood Characteristics of Children Seeking Emergency Department Care for Firearm Injuries Within the PECARN Network

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Carter, Patrick M., Cook, Lawrence J., Macy, Michelle L., Zonfrillo, Mark R., Stanley, Rachel M., Chamberlain, James M., Fein, Joel A., Alpern, Elizabeth R. +2 more·2017·Academic Emergency Medicine
DOI 10.1111/acem.13200PMC PMC5515362
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Abstract

Objective: The objective was to describe the characteristics of children seeking emergency care for firearm injuries within the PECARN network and assess the influence of both individual and neighborhood factors on firearm‐related injury risk. Methods: This was a retrospective, multicenter cross‐sectional analysis of children (<19 years old) presenting to 16 pediatric ED s (2004–2008). ICD‐9‐CM E‐codes were used to identify and categorize firearm injuries by mechanism/intent. Neighborhood variables were derived from home address data. Multivariable analysis examined the influence of individual and neighborhood factors on firearm‐related injuries compared to nonfirearm ED visits. Injury recidivism was assessed. Results: A total of 1,758 pediatric ED visits for firearm‐related injuries were analyzed. Assault (51.4%, n = 904) and unintentional injury (33.2%, n = 584) were the most common injury mechanisms. Among children with firearm injuries, 68.3% were older adolescents (15–19 years old), 82.3% were male, 68.2% were African American, and 76.3% received public insurance/were uninsured. Extremity injuries were most common (75.9%), with 20% sustaining injuries to multiple body regions, 48.1% requiring admission and 1% ED mortality. Multivariable analysis identified firearm injury risk factors, including adolescent age (p < 0.001), male sex (p < 0.001), non‐Caucasian race/ethnicity (p < 0.001), public payer/uninsured status (p < 0.001), and higher levels of neighborhood disadvantage (p < 0.001). Among children with firearm injuries, 12‐month ED recidivism for any reason was 22.4%, with < 1% returning for another firearm injury. Conclusion: Among children receiving ED treatment within the PECARN network, there are distinct demographic and neighborhood factors associated with firearm injuries. Among younger children (<10 years old), unintentional injuries predominate, while assault‐type injuries were most common among older adolescents. Overall, among this PECARN patient population, male adolescents living in neighborhoods characterized by high levels of concentrated disadvantage had an elevated risk for firearm injury. Public health efforts should focus on developing and implementing initiatives addressing risk factors at both the individual and the community level, including ED‐based interventions to reduce the risk for firearm injuries among high‐risk pediatric populations.

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  • The comprehensive and representative sample may account for the higher recurrent injury observed in this study compared to others reporting recurrent firearm injury ranging from one to 10% across a variety of clinical and geographic settings and time periods.

    “This may account for the higher recurrent injury observed in this study compared to others reporting recurrent firearm injury ranging from one to 10% across a variety of clinical and geographic settings and time periods.15,18,33-44”

    From Incidence of and Factors Associated With Recurrent Firearm Injury Among Patients Presenting to St. Louis Trauma Centers, 2010 to 2019 (2023) · cites this paper as [39]

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  • Two proxy measures commonly used in the existing literature are ED visits and time between firearm injury encounters.

    “Two proxy measures commonly used in the existing body of literature are (1) ED visits and (2) time between firearm injury encounters.2,4-9”

    From Machine learning classification of new firearm injury encounters in the St Louis region: 2010-2020 (2024) · cites this paper as [9]

    The Methods (Data Analysis; page unavailable) identify repeat ED visits within 12 months of an index firearm injury, and the Results (Emergency Department Outcomes and Recidivism; page unavailable) report subsequent visits and firearm injuries. This supports ED visits as a measure, but the paper does not report time between separate firearm injury encounters as a measured interval; its 12-month follow-up window is not that measure. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • The time-based approach is most often applied to studies of firearm injury recurrence, with days since prior injury ranging from 1 to 90 days depending on the study.

    “The time-based approach is most often applied to studies of firearm injury recurrence, with days since prior injury ranging from 1 to 90 days, depending on the study [7][8][9]”

    From Machine learning classification of new firearm injury encounters in the St Louis region: 2010-2020 (2024) · cites this paper as [9]

    The Methods (Data Analysis; page unavailable) use a time window to assess firearm-injury recidivism, supporting this paper as an example of a time-based approach. But the window is 12 months before and after the index visit, with returns within 72 hours excluded—not a 1-to-90-day window. This paper also does not establish how often the approach is used across studies. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Authors
Carter, P. M., Cook, L. J., Macy, M. L., Zonfrillo, M. R., Stanley, R. M., Chamberlain, J. M., Fein, J. A., Alpern, E. R., Cunningham, R. M., & the Pediatric Emergency Care Applied Research Network (PECARN)
Affiliations
  • University of Michigan (US)
  • University of Utah (US)
  • Brown University (US)
  • Nationwide Children's Hospital (US)
  • Children's National (US)
  • Children's Hospital of Philadelphia (US)
  • Northwestern University (US)
Corresponding author
Carter, Patrick M.
ORCID
Venue
Academic Emergency Medicine
Publisher
Wiley
Published
2017-05-29
Volume
24
Issue
7
Pages
803-813
ISSN
  • 1069-6563 (ISSN-L)
  • 1553-2712
DOI
10.1111/acem.13200
PMC
PMC5515362
OpenAlex
W2605757868
Cited by
95
References
5
Citations by year
2026: 4 · 2025: 9 · 2024: 10 · 2023: 23 · 2022: 13 · 2021: 13 · 2020: 9 · 2019: 9 · 2018: 5
FWCI
7.00
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Academic Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Health Resources and Services Administration
  • Maternal and Child Health Bureau
Topics
  • Social Sciences › Health › Gun Ownership and Violence Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords
children, adolescents, emergency department visits, neighborhood disadvantage, concentrated disadvantage, assault injuries, unintentional firearm injury, injury risk factors, uninsured status, racial and ethnic disparities, community-based intervention, injury prevention, extremity injuries, emergency department mortality, hospitalization, gun violence prevention
MeSH terms
Adolescent, Black or African American, Child, Cross-Sectional Studies, Emergency Service, Hospital, Emergency Treatment, Female, Firearms, Humans, Male, Residence Characteristics, Retrospective Studies, Risk Factors, Wounds, Gunshot

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