Variation in Acute Pain Management of Youth With Nonfatal Firearm Injuries

Firearm injuries are a leading cause of morbidity among youth, yet acute pain management practices have not been well characterized. Our objective was to evaluate acute pain medication administration by key sociodemographic characteristics and injury severity after nonfatal firearm injuries.

We performed a retrospective cross-sectional analysis utilizing Pediatric Health Information System at 40 US children's hospitals from 2016 to 2021. We included inpatient and emergency department (ED) only encounters for patients 0-21 years old with a firearm injury diagnosis. The main outcome was administration of analgesic medications: none, nonopioid only, or at least 1 opioid. We included sociodemographic and injury severity score. Multivariable logistic regression was utilized to determine characteristics associated with the outcome.

We included 4924 patients with nonfatal firearm injuries. By ED discharge versus admission, 39.0% versus 3.5% received no analgesia. For the 2522 patients discharged from the ED, younger children were more likely to receive no analgesia. Non-Hispanic White and Hispanic patients were more likely to receive no analgesia compared to non-Hispanic Black patients (adjusted odds ratios [aOR] 1.67 [95% confidence intervals 1.31, 2.31]; aOR 1.53 [1.18, 1.98], respectively). Receipt of opioids was lower among 5-9-year-old patients (aOR 0.40 [0.29, 0.54]), females (aOR 0.77 [0.62, 0.97]), and non-Hispanic White (aOR 0.59 [0.62, 0.75) and Hispanic patients (aOR 0.52 [0.40, 0.67]).

Among youth with nonfatal firearm injuries, analgesia administration varied greatest in the ED-discharged population. This suggests a need for further investigation into pain management practices focused on differences and potential undertreatment of pain in youth with nonfatal firearm injury.