4 - Examining the Role of Individual and Neighborhood-Level Factors in Emergency Department Utilization After Pediatric Firearm Injury

Publication Number: 3003.4

Samaa Kemal, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; Elizabeth Alpern, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Sofia Chaudhary, Emory University School of Medicine, Decatur, GA, United States; Peter F. Ehrlich, University of Michigan Medical School, Ann Arbor, MI, United States; Joel Fein, Perelman School of Medicine, Media, PA, United States; Eric Fleegler, MassGeneral Hospital for Children, needham, MA, United States; Kelsey Gastineau, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Monika Goyal, Children's National Medical Center, Washington, DC, United States; Maya Haasz, Children's Hospital Colorado, Aurora, CO, United States; Stephen W. Hargarten, Medical College of Wisconsin - Milwaukee, WI, Shorewood, WI, United States; Jennifer A.. Hoffmann, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Christian Pulcini, University of Vermont Larner College of Medicine, Shelburne, VT, United States; Karen Sheehan, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Bonnie Zima, Child Psychiatry, UCLA-Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States; Rachel K.. Myers, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Children who suffer non-fatal firearm injuries have increased return emergency department (ED) visits, yet it remains unclear how community-level factors are associated with children's future ED utilization. The Child Opportunity Index (COI) is a composite measure of neighborhood-level indicators impacting children's health including education, physical environments, and socioeconomic resources.

Objective: Our objective was to estimate the association of COI with ED visits within 6 months of a pediatric firearm-related injury.

Design/Methods: We conducted a retrospective, cross-sectional study of ED visits for firearm injury among children (0-16 years old) treated at 43 children's hospitals using 2016-2024 Pediatric Health Information System data. The outcome was all-cause ED visits within 6 months of an index injury visit. The exposure was the COI 3.0 quintile for children's home ZIP code at the index visit, with lower scores indicating less opportunity. We used logistic regression models to measure differences in ED visits by COI, adjusting for age, urbanicity, insurance status, and index visit factors including injury severity score (ISS), disposition, length of stay (LOS), intensive care, and surgery.

Results: We identified 7,867 firearm injury index visits (Table 1). The median age was 14 years (IQR 10-15), with most children identified as male (78.8%), non-Hispanic Black (63.3%), publicly insured (78.2%), with urban residence (89.7%), and living in low COI neighborhoods (median 18, IQR 6-42). At the index visit, 58.2% required admission, 34.1% surgery, and 16.1% intensive care. Approximately one fifth of children (19.2%) had an ED visit within 6 months of the index visit. In bivariate analyses, ED visits within 6 months were associated with the lowest COI quintile, being non-Hispanic Black, public insurance, living in an urban area, and higher ISS, longer LOS, admission, surgery and intensive care at the index visit (p-values < 0.01). In adjusted analysis for association with ED visits within 6 months (Table 2), residing in the lowest COI neighborhoods trended towards, but did not meet, the threshold for statistical significance (aOR 1.39, 95% CI 0.99-1.95).

Conclusion(s): Among firearm-injured children, all-cause ED visits within 6 months were associated with sociodemographic, treatment, and community-level factors. While individual-level characteristics were more strongly associated with ED visits than community opportunity, future research is necessary to examine how specific community resources (e.g., education, health, socioeconomic) may impact children's likelihood to seek ED care.

Table 1


Table 2