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Long-term Mortality in Pediatric Firearm Assault Survivors: A Multicenter, Retrospective, Comparative Cohort Study

Ashkon Shaahinfar1,2, Irene H Yen3, Harrison J Alter4

  • 1Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|October 13, 2018
PubMed

Insights

Children surviving firearm assault (FA) or nonfirearm assault (NFA) face higher long-term mortality risks than those surviving unintentional trauma (UT). Assault, regardless of firearm use, is a significant risk factor for long-term death in pediatric trauma survivors.

Area of Science:

  • Pediatric Trauma Research
  • Public Health
  • Epidemiology of Violence

Background:

  • Pediatric assault survivors face unique long-term health challenges.
  • Understanding mortality risks after pediatric trauma is crucial for intervention.

Purpose of the Study:

  • To compare long-term mortality in children surviving firearm assault (FA), nonfirearm assault (NFA), and unintentional trauma (UT).
  • To identify factors associated with long-term mortality in pediatric trauma survivors.

Main Methods:

  • Retrospective cohort study of pediatric patients (0-16 years) across three California trauma centers (2000-2009).
  • Utilized Social Security Death Master File and state vital statistics for mortality follow-up through 2014.
  • Multivariate Cox proportional hazards regression analyzed assault exposure and long-term mortality.

Main Results:

  • 75 deaths occurred among 413 FA, 405 NFA, and 7,062 UT survivors.
  • Homicide accounted for two-thirds of long-term deaths.
  • Assault (with or without firearm) was an independent risk factor for long-term mortality (AHR=1.9), particularly in adolescents.

Conclusions:

  • Pediatric assault survivors, including those of firearm assault, exhibit increased long-term mortality compared to unintentional trauma survivors.
  • Adolescent age, male sex, Black race/ethnicity, and public insurance are independent risk factors for long-term mortality.
Abstract

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