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Population Density and Triage of Pediatric Firearm Injuries in a Rural Trauma System.

Population Density and Triage of Pediatric Firearm Injuries in a Rural Trauma System.

Authors :
Shaw TB
Cockrell HC
Carter KT
Mijalis EM
Buti Y
Sawaya D
Berch BR
Kutcher ME
Morris MW Jr
Source :
The American surgeon [Am Surg] 2023 Nov; Vol. 89 (11), pp. 4559-4564. Date of Electronic Publication: 2022 Aug 20.
Publication Year :
2023

Abstract

Background: Rural pediatric firearm injuries require regional pediatric and trauma expertise. We evaluated county-level population density associations with transport, hospital interventions, and patient outcomes at a Level I pediatric trauma center serving a rural, statewide catchment area.<br />Material and Methods: The trauma registry of the only in-state pediatric trauma center was reviewed for firearm injuries in patients < 18 between 1/2013 and 3/2020. County-level population density was classified according to the United States Office of Management and Budget definitions for rural, micropolitan, and metropolitan areas.<br />Results: 364 patients were identified, including 7 patients who were re-injured. Mean age was 11.3 ± 4.5 y and patients were 79.4% male. 59.3% were transferred from a referring hospital. Median injury severity score was 5 (IQR 1-10); 88.0% required trauma center admission, and 48.2% required operative intervention. 7.4% were injured in a rural county, 46.4% in a micropolitan county, and 46.2% in a metropolitan county. Patients from rural counties were more likely to be unintentionally injured (72.0%) than those from micropolitan (54.4%) or metropolitan counties (44.0%, P = .04). While need for inpatient admission and length of stay were similar, those transported from rural counties had significantly longer transport times ( P < .01) and less frequent need for operative intervention ( P = .03), as well as trends toward lower injury severity ( P = .08) and mortality ( P = .06).<br />Conclusion: Management of pediatric firearm injury is a unique challenge with significant regional variability. Opportunities exist for outreach, telehealth, and decision support to ensure equitable distribution of resources in rural trauma systems.<br />Level of Evidence: Epidemiological, Level III.<br />Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Details

Language :
English
ISSN :
1555-9823
Volume :
89
Issue :
11
Database :
MEDLINE
Journal :
The American surgeon
Publication Type :
Academic Journal
Accession number :
35993395
Full Text :
https://doi.org/10.1177/00031348221121554