260 - Pediatric Subspecialty Utilization Following Firearm Injury: Insights from a Tertiary Care Center

Publication Number: 2250.260

Alexis N. Roach, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Eliana John, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; DAVID MARK. SPIRO, UAMS, Little Rock, AR, United States; Dirk T. Haselow, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Deidre Wyrick, Arkansas Children's Hospital, Little Rock, AR, United States; Lee J. Crawley, AR Children's hospital, CONWAY, AR, United States; Elizabeth Storm, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Amber Morse, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States

Background: In the United States, firearm-related injury is the leading cause of death among children and adolescents. Nonfatal injuries occur at nearly twice the frequency of fatal injuries yet remain poorly characterized. While prior research has largely focused on mental health utilization and healthcare expenditures, subspecialty medical service use following firearm injury has not been well defined.

Objective: To assess pediatric subspecialty utilization following firearm injury.

Design/Methods: Children aged 0-18 years who had an inciting firearm injury between January 1, 2015 and December 31, 2020 in the state of Arkansas were included in this retrospective analysis. Subspecialty utilization four years prior to the inciting injury was compared to four years following the injury. Factors contributing to subspecialty care utilization included subspecialty clinic visits, emergency department (ED) visits, hospital admissions, and surgical or procedural encounters. Chi-squared analysis was utilized to determine if adolescents, aged 15-18 years, had increased subspecialty utilization when compared to children aged 0-15 years. Multivariable logistic regression was performed to identify predictors of increased subspecialty care. Institutional Review Board approval was obtained with exempt status.

Results: A total of 215 children met the inclusion criteria, including 85 children aged 0-15 years and 130 adolescents aged 15-18 years. Children aged 0-18 years had increased subspecialty clinic visits (p < 0.0001), surgical or procedural encounters (p < 0.0001), and hospital readmissions (p = 0.0046) in the four years following injury when compared to four years preceding injury. However, ED visits did not significantly increase (p= 0.7498). These findings were consistent when stratified by age group. Chi-squared analysis revealed that children aged 0–15 years demonstrated greater subspecialty outpatient clinic utilization compared to adolescents (p = 0.0428), while no significant differences were observed in surgical or procedural encounters, hospital admissions, or ED visits between these two age groups.

Conclusion(s): This study found that children who suffer from nonfatal firearm injuries require increased subspecialty care for up to four years following their injury. This increased need for long-term, multidisciplinary care highlights the burden firearm injuries place on patients, families, and healthcare systems. Future efforts should focus on strengthening care coordination, addressing barriers to follow-up, and expanding injury prevention initiatives to reduce the incidence and impact of pediatric firearm injuries.