Comparison of Injury Severity and Resource Utilization in Pediatric Firearm and Sharp Force Injuries

Abstract

Importance: Pediatric firearm injuries are a serious and growing public health problem. Firearm injuries have a high case-fatality, but we lack a full knowledge of their injury severity and healthcare utilization compared to other penetrating injuries, especially among critically injured children. Objective: Describe resource utilization, injury severity, and short-term clinical outcomes for pediatric firearm injuries and compare those to non-firearm penetrating sharp force injuries in children. Design: Retrospective cohort study utilizing the National Trauma Data Bank (NTDB) data years 2007-2016. Setting: Multicenter database study. Participants: Encounters for firearm injury or cut/pierce injury in children 17 years or younger. Exposure: Firearm injury encounters were compared to cut/pierce injury encounters. Outcomes: Intensive care unit (ICU) admission, hospital and ICU length of stay (LOS), and injury severity score (ISS). Results: We identified 25,155 encounters for firearm injuries and 21,270 encounters for cut/pierce injuries. The majority of firearm injuries and cut/pierce injuries were suffered by males (85.8% vs. 74.6%) and adolescents aged 15-17 (74.8% vs. 51.2%). A greater proportion of those with firearm injuries were African-American (61.3%) than those with cut/pierce injuries (31.1%). A greater proportion of firearm injuries (30.5%) than cut/pierce injuries (12.8%) were admitted to the ICU. Firearm injuries resulted in a higher mean Injury Severity Score (ISS), longer mean hospital and ICU length of stay (LOS) compared to cut/pierce injuries. Firearm injuries accounted for 126,027 hospital days and 39,255 ICU days while cut/pierce injuries accounted for 58,705 hospital days and 8,353 ICU days. After adjusting for age, sex, year, and hospital, firearm injuries were 2.3 (95% CI: 2.1-2.5) times more likely to require ICU admission and were associated with higher ISS scores compared to cut/pierce injuries, even among critical injuries. Multinomial logistic regression demonstrated higher risk of prolonged hospital (RRR 4.11 95%CI: 3.46-4.89) and ICU LOS (RRR 2.16 95%CI: 1.91-2.45) for firearm injuries compared to cut/pierce injuries. Conclusions and Relevance: Pediatric firearm injuries carry a greater injury severity and health care utilization compared to other penetrating injuries even among critical injuries, demonstrating that mechanism of injury is an important consideration in pediatric penetrating trauma. This highlights the importance of public health measures to reduce the risk of pediatric firearm injuries.