Clinical Medicine Research

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Rural Versus Urban Pediatric Firearm Injuries: A 10-year Review at a Level 1 Trauma Center

Received: 20 September 2021    Accepted: 15 October 2021    Published: 05 November 2021
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Abstract

While hospitalization rates in rural versus urban pediatric firearm injuries nationwide has been previously investigated, studies highlighting the differences across the spectrum of pediatric care are limited. The purpose of this study is to describe the epidemiology of pediatric firearm injuries in a North Texas level 1 trauma center in rural versus urban settings and supplement knowledge for injury prevention. Retrospective review of the trauma registry was done to identify children 0-18 years of age admitted to the Emergency department, inpatient service, or clinics between 2009-2019 for firearm injuries. Data points were cross-referenced through chart reviews. A descriptive analysis was conducted on data collected and stratified by location of injury; rural vs urban. Demographic data, type of firearm used (air propelled or powder propelled), shooter relationship, and injury severity scores were also collected. A chi-square analysis was conducted to determine associations and logistic regression analysis to determine the odds ratio of associations. A total of 247 patients met study criteria. Males accounted for 73% of all victims, of which 58% were in urban areas. Stratified by race, 36% of patients were Hispanic, followed by 30% White (p<0.001). Patients were slightly younger in rural areas 8.2±3.74 compared to their urban counterparts 9.2±4.34 (p=0.129). Air propelled firearms were used most often in both rural (52.2%) and urban (54.2%) areas (p=0.808). Black children were 3.6 times (CI: 1.8-7.5) more likely to sustain injuries from powder propelled firearms as compared to their White counterparts (p<0.001). Most shooters in both rural and urban areas were family members (57.5% and 39.7% respectively: p=0.112). Most injuries were unintentional; 95.6% of rural and 74.5% of urban injuries (p<0.002). Most injuries were classified as minor according to the injury severity score: rural 42.2% and urban 71.1%. However, injuries occurring in rural areas had a higher percentage in the moderate (28.9%), serious (11.1%) and severe (17.8%) categories respectively (p<0.001). In conclusion, firearm injuries occurred mostly in urban areas. The mean age of the patients was younger than 10 years. Additionally, injuries were often unintentional, caused by family members. More seriously injured children were in rural areas. This highlights the importance of firearm education to families with children.

DOI 10.11648/j.cmr.20211006.11
Published in Clinical Medicine Research (Volume 10, Issue 6, November 2021)
Page(s) 173-179
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Ballistic, Emergency Department, Firearm, Injury, Injury Severity Score

References
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[3] Robert, Steinbrook, Stern Rachel J., and Redberg Rita F. 2017. “Firearm Violence: A JAMA Internal Medicine Series.” JAMA Internal Medicine, no. 1: 19. doi: 10.1001/jamainternmed.2016.7180.
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[6] Cunningham RM, Carter PM, Ranney ML, Walton M, Zeoli AM, Alpern ER, Branas C, Beidas RS, Ehrlich PF, Goyal MK, Goldstick JE, Hemenway D, Hargarten SW, King CA, Massey L, Ngo Q, Pizarro J, Prosser L, Rowhani-Rahbar A, Rivara F, Rupp LA, Sigel E, Savolainen J, Zimmerman MA. Prevention of Firearm Injuries Among Children and Adolescents: Consensus-Driven Research Agenda from the Firearm Safety Among Children and Teens (FACTS) Consortium. JAMA Pediatr. 2019 Aug 1; 173 (8): 780-789. doi: 10.1001/jamapediatrics.2019.1494. PMID: 31180470; PMCID: PMC6901804.
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[8] Miller M, Azrael D, Hemenway D, Vriniotis M. Firearm storage practices and rates of unintentional firearm deaths in the United States. Accident Analysis & Prevention. 2005; 37 (4): 661-667. doi: 10.1016/j.aap.2005.02.003.
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[13] Brewer JW Jr, Cox CS, Fletcher SA, Shah MN, Sandberg M, Sandberg DI. Analysis of pediatric gunshot wounds in Houston, Texas: A social perspective. Journal Of Pediatric Surgery. 2019; 54 (4): 783-791. doi: 10.1016/j.jpedsurg.2018.10.061.
[14] Firearm-Related Injuries Affecting the Pediatric Population. Pediatrics. 2000; (4, Part 1 of 2): 888.
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[16] David C. G, Donald T. R, Stephanie A. B. Self-inflicted and Unintentional Firearm Injuries Among Children and Adolescents: The Source of the Firearm. Archives of Pediatrics & Adolescent Medicine. 1999; (8): 875.
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Author Information
  • Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA

  • St. Davis Children’s Hospital, Austin, USA

  • Children’s Medical Center, Dallas, USA

  • Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA

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    Chelsea Day, Andrea Diebel, Oluwaseun Oke, Jo-Ann Nesiama. (2021). Rural Versus Urban Pediatric Firearm Injuries: A 10-year Review at a Level 1 Trauma Center. Clinical Medicine Research, 10(6), 173-179. https://doi.org/10.11648/j.cmr.20211006.11

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    Chelsea Day; Andrea Diebel; Oluwaseun Oke; Jo-Ann Nesiama. Rural Versus Urban Pediatric Firearm Injuries: A 10-year Review at a Level 1 Trauma Center. Clin. Med. Res. 2021, 10(6), 173-179. doi: 10.11648/j.cmr.20211006.11

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    AMA Style

    Chelsea Day, Andrea Diebel, Oluwaseun Oke, Jo-Ann Nesiama. Rural Versus Urban Pediatric Firearm Injuries: A 10-year Review at a Level 1 Trauma Center. Clin Med Res. 2021;10(6):173-179. doi: 10.11648/j.cmr.20211006.11

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  • @article{10.11648/j.cmr.20211006.11,
      author = {Chelsea Day and Andrea Diebel and Oluwaseun Oke and Jo-Ann Nesiama},
      title = {Rural Versus Urban Pediatric Firearm Injuries: A 10-year Review at a Level 1 Trauma Center},
      journal = {Clinical Medicine Research},
      volume = {10},
      number = {6},
      pages = {173-179},
      doi = {10.11648/j.cmr.20211006.11},
      url = {https://doi.org/10.11648/j.cmr.20211006.11},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.cmr.20211006.11},
      abstract = {While hospitalization rates in rural versus urban pediatric firearm injuries nationwide has been previously investigated, studies highlighting the differences across the spectrum of pediatric care are limited. The purpose of this study is to describe the epidemiology of pediatric firearm injuries in a North Texas level 1 trauma center in rural versus urban settings and supplement knowledge for injury prevention. Retrospective review of the trauma registry was done to identify children 0-18 years of age admitted to the Emergency department, inpatient service, or clinics between 2009-2019 for firearm injuries. Data points were cross-referenced through chart reviews. A descriptive analysis was conducted on data collected and stratified by location of injury; rural vs urban. Demographic data, type of firearm used (air propelled or powder propelled), shooter relationship, and injury severity scores were also collected. A chi-square analysis was conducted to determine associations and logistic regression analysis to determine the odds ratio of associations. A total of 247 patients met study criteria. Males accounted for 73% of all victims, of which 58% were in urban areas. Stratified by race, 36% of patients were Hispanic, followed by 30% White (p<0.001). Patients were slightly younger in rural areas 8.2±3.74 compared to their urban counterparts 9.2±4.34 (p=0.129). Air propelled firearms were used most often in both rural (52.2%) and urban (54.2%) areas (p=0.808). Black children were 3.6 times (CI: 1.8-7.5) more likely to sustain injuries from powder propelled firearms as compared to their White counterparts (p<0.001). Most shooters in both rural and urban areas were family members (57.5% and 39.7% respectively: p=0.112). Most injuries were unintentional; 95.6% of rural and 74.5% of urban injuries (p<0.002). Most injuries were classified as minor according to the injury severity score: rural 42.2% and urban 71.1%. However, injuries occurring in rural areas had a higher percentage in the moderate (28.9%), serious (11.1%) and severe (17.8%) categories respectively (p<0.001). In conclusion, firearm injuries occurred mostly in urban areas. The mean age of the patients was younger than 10 years. Additionally, injuries were often unintentional, caused by family members. More seriously injured children were in rural areas. This highlights the importance of firearm education to families with children.},
     year = {2021}
    }
    

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    AU  - Chelsea Day
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    AB  - While hospitalization rates in rural versus urban pediatric firearm injuries nationwide has been previously investigated, studies highlighting the differences across the spectrum of pediatric care are limited. The purpose of this study is to describe the epidemiology of pediatric firearm injuries in a North Texas level 1 trauma center in rural versus urban settings and supplement knowledge for injury prevention. Retrospective review of the trauma registry was done to identify children 0-18 years of age admitted to the Emergency department, inpatient service, or clinics between 2009-2019 for firearm injuries. Data points were cross-referenced through chart reviews. A descriptive analysis was conducted on data collected and stratified by location of injury; rural vs urban. Demographic data, type of firearm used (air propelled or powder propelled), shooter relationship, and injury severity scores were also collected. A chi-square analysis was conducted to determine associations and logistic regression analysis to determine the odds ratio of associations. A total of 247 patients met study criteria. Males accounted for 73% of all victims, of which 58% were in urban areas. Stratified by race, 36% of patients were Hispanic, followed by 30% White (p<0.001). Patients were slightly younger in rural areas 8.2±3.74 compared to their urban counterparts 9.2±4.34 (p=0.129). Air propelled firearms were used most often in both rural (52.2%) and urban (54.2%) areas (p=0.808). Black children were 3.6 times (CI: 1.8-7.5) more likely to sustain injuries from powder propelled firearms as compared to their White counterparts (p<0.001). Most shooters in both rural and urban areas were family members (57.5% and 39.7% respectively: p=0.112). Most injuries were unintentional; 95.6% of rural and 74.5% of urban injuries (p<0.002). Most injuries were classified as minor according to the injury severity score: rural 42.2% and urban 71.1%. However, injuries occurring in rural areas had a higher percentage in the moderate (28.9%), serious (11.1%) and severe (17.8%) categories respectively (p<0.001). In conclusion, firearm injuries occurred mostly in urban areas. The mean age of the patients was younger than 10 years. Additionally, injuries were often unintentional, caused by family members. More seriously injured children were in rural areas. This highlights the importance of firearm education to families with children.
    VL  - 10
    IS  - 6
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