Critical Moments: Factors Associated With Referral to Postdischarge Services in Pediatric Patients With Firearm...

Firearm-related injuries are the leading cause of death in children aged 1-19 y in the United States. Access to post-discharge services (PDS) may be an important factor in preventing recurrent injuries. However, it is unclear which factors in patient care influence referral to PDS.

We conducted a retrospective study of pediatric firearm injuries using the American College of Surgeons Firearms Study Database (2021-2022). We used chi-square, Kruskal-Wallis, and Mann-Whitney U tests for bivariate comparisons. We conducted a multivariable logistic regression to determine independent factors associated with PDS referral.

Of the 2988 pediatric firearm injuries meeting inclusion criteria, the median age was 16 (14-17) y with injuries predominantly occurring in non-Hispanic Black individuals (67%) injured by assault (75%). A history of prior firearm injury occurred in 20% of patients and was associated with increased referral (49.4% referral versus 43.4% no referral, P = 0.02) and mortality (11.4% history of prior injury versus 5.2% no prior injury, P = 0.003). Approximately one-third of youth (36%) were referred to services. PDS were less commonly referred to those who were self-pay (6.9%) compared to those insured by Medicaid (70.9%) or private insurance (19.6% P = 0.002). Referrals to PDS were more common in those with a higher injury severity score (9 [1-14] versus 5[1-10], P < 0.01). Independent factors increasing likelihood of referral to PDS included prior firearm injury (1.67 [1.23-2.28], P < 0.01), Black race (1.66 [1.05-2.62], P < 0.05), Hispanic ethnicity (1.84 [1.20-2.83], P < 0.01), self-inflicted mechanism (3.78 [1.19-12.0], P < 0.05), and severe injury (injury severity score >15; 2.61 [1.46-4.67], P < 0.01).

Youth who are insured, suffer a severe injury, or have a repeat firearm injury are more likely to be referred to PDS. Expansion of discharge service programs is crucial to prevent cycles of repeated violence in this vulnerable population.