Burden of unintentional pediatric firearm injury: an examination of the Nationwide Readmission Database

• Published in: The journal of trauma and acute care surgery
• Main Authors: Lumbard, Derek C, Nygaard, Rachel M, Richardson, Chad J, Liao, Lillian F, Stewart, Ronald M, Eastridge, Brian J, Nicholson, Susannah E
• Format: Journal Article
• Language: English
• Published: United States 01.09.2023
• ISSN: 2163-0763
• DOI: 10.1097/TA.0000000000003930

Significant increases in firearm-related mortality in the U.S. pediatric population drives an urgent need to study these injuries in order to drive prevention policies. The purpose of this study was: (1) to characterize those with and without readmissions; (2) to identify risk factors for 90-day unplanned readmission; and (3) to examine reasons for hospital readmission. The 2016-19 Nationwide Readmission Database of the Healthcare Cost and Utilization Project was used to identify hospital admissions with unintentional firearm injury in patients under age 18. 90-day unplanned readmission characteristics were assessed and detailed. Multivariable regression analysis was used to assess factors associated with unplanned 90-day readmission. Over 4 years, 1,264 unintentional firearm injury admissions resulted in 113 subsequent readmissions (8.9%). There were no significant differences in age or payor, but more females (14.7% vs 23%) and older children (13-17 years, 80.5%) had readmissions. The mortality rate during primary hospitalization was 5.1%. Survivors of initial firearm injury were more frequently readmitted if they had a mental health diagnosis (22.1% vs 13.8%; P = 0.017). Readmission diagnosis included: complications (15%), mental health or drug/alcohol (9.7%), trauma (33.6%), a combination of the prior three (28.3%), and chronic disease (13.3%). Over a third (38.9%) of the trauma readmissions were for new traumatic injury. Female children, those with longer lengths of stay, and those with more severe injuries were more likely to have unplanned 90-day readmissions. Mental health and drug/alcohol abuse diagnoses were not an independent predictor for readmission. This study provides insight into the characteristics of and risk factors for unplanned readmission in the pediatric unintentional firearm injury population. In addition to employing prevention strategies, the utilization of trauma-informed care must be integrated into all aspects of care for this population to help minimize the long-term psychological impact of surviving firearm injury. Level III, Prognostic and Epidemiologic.