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Surgical and Critical Care Resource Utilization After Firearm Injury: An Age-Based Analysis
Zachary T O'Connor1, Alyssa Green2, Myron L Rolle3
1University of South Florida College of Arts and Sciences, Tampa, Florida.
Insights
Firearm injuries frequently require surgery and critical care. Children with firearm injuries are more likely to need central nervous system (CNS) procedures and blood transfusions than adults.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Public Health
Background:
- Firearm injuries necessitate urgent surgical and critical care, with varying hospital readiness, especially for pediatric patients.
- This study examines resource utilization in firearm injuries across different age groups.
Purpose of the Study:
- To investigate and compare resource utilization in firearm injuries across diverse age demographics.
- To identify age-specific differences in surgical and critical care interventions.
Main Methods:
- Analysis of the Florida statewide Agency for Healthcare Administration database (2015-2021) for firearm injury hospitalizations.
- Categorization of patients by age: children (0-13), young adolescents (14-15), older adolescents (16-17), adults (18-64), and elderly (65+).
- Comparison of surgical procedure and critical care intervention rates using multivariable logistic regression.
Main Results:
- 72% of 16,263 firearm injuries required surgery; 36% needed critical care interventions (intubation, tube thoracostomy, blood transfusion).
- Children (0-13) had the highest rate of central nervous system (CNS) surgical procedures (8%).
- Children were more likely than adults to undergo CNS procedures (OR 2.24) and receive blood transfusions (OR 1.44), adjusted for covariates.
Conclusions:
- Firearm injuries pose a high risk for surgical and critical care interventions across all ages.
- Children with firearm injuries have a significantly higher likelihood of requiring CNS surgical procedures compared to adults.
- Hospitals must be prepared for immediate stabilization, including advanced interventions, for all firearm injury victims, with a focus on pediatric neurosurgical needs.
Introduction:
Firearm injuries affect all ages and may require urgent stabilization and surgical care at the nearest hospital. Hospitals vary in their readiness to deliver surgical and critical care resources, especially for younger children. This study investigated resource utilization in a broad statewide cohort of firearm injuries and compared utilization by age group.
Methods:
Patients admitted to hospitals with a firearm injury between 2015 and 2021 from the Florida statewide Agency for Healthcare Administration database were reviewed and categorized by age in years: children (0-13), young adolescents (14-15), older adolescents (16-17), adults (18-64), and elderly (65+). Rates of surgical procedures and critical care interventions were compared between age groups. Multivariable logistic regression modeling was used to evaluate the independent effect of age on resource utilization.
Results:
Of 16,263 hospitalized firearm injuries, 72% required a surgical procedure and 36% required a critical care intervention (endotracheal intubation, tube thoracostomy, or blood transfusion). Surgical procedures on the central nervous system (CNS) were highest for children (8%), but similar for older adolescents (4%), adults (3%), and elderly (3%). Intubation, tube thoracostomy, and blood transfusion were required for 24%, 12%, and 15%, respectively. On logistic regression adjusted for sex, race/ethnicity, insurance, transfer status, shooting intent, firearm type, hospital type, and injury severity score, CNS procedures (odds ratio 2.24, 95% confidence interval: 1.41-3.57) and blood transfusions (odds ratio: 1.44, 95% confidence interval: 1.06-1.94) were more likely among children compared to adults.
Conclusions:
Firearm injuries carried a high risk of surgical procedures and critical care interventions. The odds of CNS surgical procedures in younger children were over twofold higher than that of adults, highlighting the importance of appropriate pediatric neurosurgical care. Hospitals must maintain readiness to provide immediate stabilizing care, including blood transfusion and endotracheal intubation, to firearm injury victims of all ages.
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