Comparing Firearm and Stabbing Injuries in the Pediatric Trauma Population Using Propensity Matching
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Published on: January 8, 2020
Derek C Lumbard1, Ashley P Marek1, Nicholas S Roetker2
1From the Department of Surgery, Hennepin Healthcare.
Insights
Pediatric firearm injuries lead to higher mortality and need for long-term care compared to stab wounds. Insurance status also significantly impacts mortality risk in injured children.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Public Health
Background:
- Penetrating injuries in children present significant mortality and morbidity challenges.
- Understanding disparities in outcomes based on injury mechanism and socioeconomic factors is crucial for targeted interventions.
Purpose of the Study:
- To compare mortality and non-home discharge rates in pediatric patients with firearm versus stab injuries.
- To evaluate the influence of insurance status on these outcomes in pediatric trauma.
Main Methods:
- Propensity score matching was used to compare pediatric patients (0-17 years) with firearm and stab injuries from the National Trauma Data Bank (2007-2015).
- Logistic regression analysis assessed the association of injury type and insurance status with mortality and discharge to long-term care.
Main Results:
- Firearm injuries were associated with increased odds of discharge to long-term care (aOR, 2.07) and higher mortality (aOR, 1.85) compared to stab injuries.
- Self-pay insurance status independently increased mortality risk (aOR, 2.41).
- Self-pay patients with firearm injuries had a substantially higher mortality risk (aOR, 5.25) than commercially insured stab wound patients.
Conclusions:
- Pediatric firearm violence victims face greater risks of death and need for post-discharge care than those with other penetrating injuries.
- Insurance status, particularly self-pay, is a significant determinant of mortality in pediatric trauma patients.
Objectives:
The objective of this study was to compare differences in mortality and nonhome discharge in pediatric patients with firearm and stab injuries, while minimizing bias. Our secondary objective was to assess the influence of insurance on these same outcomes.
Methods:
Patients aged 0 to 17 years included in the National Trauma Data Bank (2007-2015) with firearm and stabbing injury were matched by propensity score. Logistic regression was used to assess associations of injury type and insurance with long-term care discharge and death.
Results:
The average age was 14.8 years, 19.2% were female, 48% were African American, 58.4% had an injury severity score ≤8, and assaults accounted for 73.1% of cases. Firearm injuries were associated with a higher risk of discharge to long-term care (adjusted odds ratio [aOR], 2.07) compared with propensity-matched patients who were stabbed. Similarly, we found a higher risk of mortality in those with firearm injuries compared with stabbing injuries (aOR, 1.85). Regardless of mechanism, self-pay insurance status was associated with a higher risk of mortality (aOR, 2.41). When compared with stab wound patients with commercial insurance, self-pay firearm-injured patients were found to have an increased risk of mortality (aOR, 5.25).
Conclusions:
Pediatric victims of firearm violence were more likely to die or need additional care outside the home than victims of other types of penetrating injury when accounting for confounding characteristics to minimize bias.
