Firearm injury is a leading and preventable cause of death for youth in the United States. The Centers for Disease Control and Prevention web-based injury statistics query and reporting system was queried to examine changes in firearm injury mortality among youth aged 0 to 19 from 2001 to 2019. This includes assessment of overall mortality rates, mortality rates based on intent and race/ethnicity, and the proportion of deaths due to homicide, suicide, and unintentional shootings among different age groups. Regression analysis was used to identify significant differences in mortality rate over time between Black and White youth. Deaths due to firearm injury were compared with deaths due to motor vehicle traffic collisions. In 2019, firearm injuries surpassed motor vehicle collisions to become the leading cause of death for youth aged 0 to 19 years in the United States. Homicide is the most common intent across all age groups, but suicide represents a large proportion of firearm deaths in 10- to 19-year-old youth. In 2019, Black youth had a firearm mortality rate 4.3 times higher than that of White youth and a firearm homicide rate over 14 times higher than that of White youth. For each additional year after 2013, the mortality rate for Black youth increased by 0.55 deaths per 100 000 compared with White youth (time by race interaction effect P < .0001). These data indicate the growing burden of firearm injuries on child mortality and widening racial inequities with Black youth disproportionately affected by firearm violence. This public health crisis demands physician advocacy to reduce these preventable deaths among youth.
Children with high-intensity neurologic impairment (HINI) have an increased risk of urinary tract infection (UTI) and prolonged intravenous (IV) antibiotic exposure.
Children hospitalized with a mental health crisis often receive pharmacologic restraint for management of acute agitation. We examined associations between pharmacologic restraint use and race and ethnicity among children admitted for mental health conditions to acute care nonpsychiatric children's hospitals.
OBJECTIVES Despite the high incidence of firearm injuries, little is known about health care utilization after nonfatal childhood firearm injuries. This study aimed to describe health care utilization and costs after a nonfatal firearm injury among Medicaid and commercially insured youth using a propensity score matched analysis. METHODS We conducted a propensity score matched cohort analysis using 2015 to 2018 Medicaid and Commercial Marketscan data comparing utilization in the 12-months post firearm injury for youth aged 0 to 17. We matched youth with a nonfatal firearm injury 1:1 to comparison noninjured youth on demographic and preindex variables. Outcomes included inpatient hospitalizations, emergency department (ED) visits, and outpatient visits as well as health care costs. Following propensity score matching, regression models estimated relative risks of the health care utilization outcomes, adjusting for demographic and clinical covariates. RESULTS We identified 2110 youth with nonfatal firearm injury. Compared with matched noninjured youth, firearm injured youth had a 5.31-fold increased risk of inpatient hospitalization (95% confidence interval [CI] 3.93–7.20), 1.49-fold increased risk of ED visit (95% CI 1.37–1.62), and 1.06-fold increased risk of outpatient visit (95% CI 1.03–1.10) 12-months postinjury. Adjusted 12-month postindex costs were $7581 (95% CI $7581–$8092) for injured youth compared with $1990 (95% CI $1862–2127) for comparison noninjured youth. CONCLUSIONS Youth who suffer nonfatal firearm injury have a significantly increased risk of hospitalizations, ED visits, outpatient visits, and costs in the 12 months after injury when compared with matched youth. Applied to the 11 258 US youth with nonfatal firearm injuries in 2020, estimates represent potential population health care savings of $62.9 million.
Abstract African American families navigate not only everyday stressors and adversities but also unique sociocultural stressors (e.g., “toxic upstream waters” like oppression). These adverse conditions are consequences of the historical vestiges of slavery and Jim Crow laws, often manifested as inequities in wealth, housing, wages, employment, access to healthcare, and quality education. Despite these challenges, African American families have developed resilience using strength-based adaptive coping strategies, to some extent, to filter these waters. To advance the field of resilience research, we focused on the following questions: (1) what constitutes positive responses to adversity?; (2) how is resilience defined conceptually and measured operationally?; (3) how has the field of resilience evolved?; (4) who defines what, when, and how responses are manifestations of resilience, instead of, for example, resistance? How can resistance, which at times leads to positive adaptations, be incorporated into the study of resilience?; and (5) are there case examples that demonstrate ways to address structural oppression and the pernicious effects of racism through system-level interventions, thereby changing environmental situations that sustain toxic waters requiring acts of resilience to survive and thrive? We end by exploring how a re-conceptualization of resilience requires a paradigm shift and new methodological approaches to understand ways in which preventive interventions move beyond focusing on families’ capacity to navigate oppression and target systems and structures that maintain these toxic waters.
Abstract Background Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use. Objective To determine hospital‐level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. Design, Setting, and Participants We examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Hospital rates of parenteral pharmacologic restraint use per 1000 mental health bed days were determined and compared after adjusting for patient‐level and demographic factors. Cluster analysis ( k ‐means) was used to group hospitals based on overall restraint use (rate quartiles) and drug class. Hospital‐level factors for pharmacologic restraint use were compared. Results Of 29,834 included encounters, 3747 (12.6%) had pharmacologic restraint use. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175 (standard deviation: 72). Cluster analysis revealed three hospitals were high utilizers of all drug classes. No significant differences in pharmacologic restraint use were found in the hospital‐level analysis. Conclusions Children's hospitals demonstrate wide variation in pharmacologic restraint rates for mental health hospitalizations, with a 10‐fold difference in adjusted rates between highest and lowest utilizers, and high overall utilizers order medications across all drug classes.
Pediatric hospitalists have a critical role to play in the prevention of firearm death and injury in children. Gun violence is the second leading cause of death for children and adolescents.1 Just over half of these deaths are homicide, with the remaining attributed to suicide and unintentional shootings. There are more child deaths from gun violence than child deaths from cancer, heart disease, and lung disease combined.1 These startling statistics should urge all pediatricians to act, including those invested in the care of hospitalized children.
This uniquely American problem is driven, in part, by access to unsecured firearms. In America, 4.6 million children live in a household with at least 1 loaded, unlocked gun.2 Access to unsecured firearms puts children at risk for unintentional shootings and adolescents at risk for suicide.3 Responsible storage (keeping guns locked, unloaded, and separate from ammunition) can decrease these risks.3 The majority of children in gun-owning households are aware of where their parents store the gun, with more than one-third reporting previously handling the gun.4 We cannot rely on curious children to not find a gun that is “hidden” or to know what to do if they encounter a gun. Educational programs that are focused on teaching children about gun safety do not work. In fact, after completing gun safety training programs, preschool- and school-aged children are just as likely to approach and play with a handgun as those not given the training.5 Access to a firearm is key modifiable risk factor for adolescent suicide in the United States.6 Of the adolescents screened in 1 study, …
