P3.129: Associational Analysis for Pediatric Firearm Injury Risk

Background: Nationally, children and youth have experienced significant increases in injuries related to firearms and motor vehicle crashes (MVCs). A midwestern pediatric health system observes similar trends, with many patients with firearm injury presenting with a history of MVC-related injuries and other violent injuries with growing frequency. To investigate the potential relationship between injury types and identify predictive factors for subsequent firearm injuries, authors conducted secondary analyses focused on potential associations between injuries and the role of injury severity across repeat encounters. A deeper understanding of injury patterns and their risk factors may facilitate the development of targeted early interventions and preventive strategies.

Methods: A four-year retrospective study was conducted of 0–17-year-old patients presenting in the Emergency Department (ED) with violent and MVC injuries from January 1, 2018 through December 31, 2022. Study methods include descriptive, correlation, and chi-squared analyses to examine demographics and the association between MVC and firearm injury, with stepwise logistic regression modeling to identify predictive factors for future firearm injury.

Results: Nearly one in four patients (23.6%) with firearm injury had more than one encounter in the ED for firearm, non-firearm violent, or MVC injury within the four-year timeframe. Chi-square tests for independence indicate a statistically significant association between MVC and firearm injury (2 (1, n = 2614) = 9.683). Regression analysis indicate a statistically significant model with five predictive factors for firearm injury at a third ED encounter: age, first encounter MVC injury, first encounter acuity, second encounter violent injury, and second encounter acuity (2 (11, n = 84) = 31.228, p = .001). After adjusting for all other factors in the model, with each worsening in acuity score at first encounter patients have twelve times greater risk for firearm injury at third encounter (OR = .083, p < .05, 95% CI: .010, .691), and patients with a violent injury at second encounter have ten times greater risk for firearm injury at third encounter (OR = 10.298, p < .10, 95% CI: .685, 154.737).

Conclusion: These findings reveal a significant association between MVC and firearm injury, with MVC and violent injuries serving as predictors for subsequent firearm injury. These results underscore the importance of early intervention in addressing the risk of firearm injury. Further investigation is needed to identify best practices for connecting resources for youth presenting with MVC and non-firearm violent injuries to prevent future firearm injury and death. Additionally, opportunities exist to explore risk stratification within clinical and community practice to focus limited resources on patients at higher risk for firearm injury and death. Leveraging this data to inform clinical and community intervention decision-making can prevent further injury, reduce financial costs to health systems, and improve individual and community health outcomes.