Firearm Safety

Ben Hoffman, MD, MPH
Lindsay D. Clukies, MD, FAAP
Laura Kemerling

Predictors of Repeat Pediatric Firearm Injury in St. Louis: A 10-year Retrospective Cohort Analysis

Zoe Miller
Daphne Lew
Kateri Chapman-Kramer
Ben Cooper
Lindsay D. Clukies, MD, FAAP
Kristen L. Mueller

Firearm injury is the leading cause of death among youth in the United States. Individuals who experience one firearm injury are at an increased risk of subsequent injury by firearm. As many patients receive care from multiple hospitals and health systems in a geographic region, there is need to develop comprehensive liked data sets to assess constructs such as violence-related injury. The present study aims to identify demographic and clinical risk factors associated with repeat firearm injury within the pediatric population.

This study is a 10-year retrospective observational cohort analysis of all consecutive firearm injured children who presented to one of four St. Louis adult or pediatric level I traumas hospital for acute care. Data were collected on demographics from the St. Louis-Hospital Violence Intervention Program Data Repository (STL-HVIP-DR). This multi-hospital system repository contains encounter-level data on all patients who present for a violent injury (blunt assault, stabbing, firearm injury) from 2010 onward. A Kaplan-Meier survival analysis was performed to estimate the cumulative incidence of repeat firearm injury within the study population stratified by age group. A Cox proportional hazards regression model was performed to estimate the association between repeat firearm injury and demographic and clinical risk factors.

Of the 1,340 patients treated for an initial firearm injury, 160 (12%) of patients experienced a repeat firearm injury during the study period. Among reinjured patients, 78% were Black, non-Hispanic males between the ages of 15 and 17. Youth were significantly less likely to be reinjured if they were treated at a children’s hospital in both the 10-14, X2(1, N=263) = 13.89, (p < 0.05), and the 15-17 age groups, X2 (1, N=898) = 5.84, (p < 0.05). However, older Black adolescents were less likely to be treated at a children’s hospital than white youth, X2 (1, N=1,340) = 18.58, (p < 0.05).

Among the distressingly large cohort of firearm injured youth receiving care at a partner level I trauma hospital in the St. Louis region, there were substantial race, gender and age disparities. Of note, Black teens were significantly less likely to be treated at a children’s hospital, which may have implications for receipt of age appropriate trauma informed care during and after hospitalization. Additional study is needed to examine factors perpetuating this inequitable care.

Participants will learn the epidemiology of firearm injuries nationally and locally, within the St. Louis area region. They will also learn about the STL-HVIP-DR through our regional, multi-centered HVIP program. Lastly, they will identify key disparities in demographic and clinical risk factors associated with repeat firearm injury within the pediatric population.

From Symptoms to Solutions: Why Hospital Violence Intervention Programs (HVIPs) Are Essential

Lindsay Clukies, MD
James Dodington, MD
Kristen Mueller, MD
Marlene Melzer-Lange, MD
Randi Smith, MD
Kateri Chapman-Kramer, LCSW
Laura Kemerling

Trauma and injury is the number one cause of morbidity and mortality for children in the United States. Every year thousands of injured children are treated in hospitals throughout our country and some of these injuries are considered violent in nature. Data show that victims of interpersonal violence are at elevated risk of re-injury and violence perpetration. Many of the children who have been the victim of interpersonal violence will go on to initiate violence toward others leading to unsafe communities and further injury and death.

Intervening with this patient population while in the hospital is key to a successful hospital-based intervention. Data show that patients are receptive to interventions that promote positive behavior changes during these moments in healthcare settings, making intervening during these teachable moments crucial for long-term success. Hospital-based violence intervention programs (HVIPs) are multi-disciplinary programs that identify patients at risk of repeat violent injury and then link them with hospital and community based resources aimed at addressing underlying risk factors for violence. Instead of waiting for a patient to seek out support, HVIPs bring trauma-informed care to the patient while in a hospital-based setting. The fundamental basis of HVIPs are to intervene at the bedside and set up intensive, long-term community based case management services following the injury and ultimately altering risk trajectories. They include offering follow up services including crisis intervention, mentoring, home visits, etc. and addressing the Social Determinants of Health and building partnerships with communities and survivors of violence. The support network continues once patients are discharged from the hospital with a pathway for outpatient care and other services.

As medical providers and advocates, we know that patients who are injured often need a multi-disciplinary approach to healing which is why a growing number of hospitals across the nation are embracing HVIPs. HVIP programs are even becoming the standard of care for larger hospitals. But how is such a program created? What type of funding is needed? In this session we will hear from members of some unique and successful HVIPs around our country. We will discuss the pearls and pitfalls to starting a program at your institution and how to set yourself up for long-term success. Attendees will have the opportunity to network and participate in a question and answer session with our speakers.

1. Define what a Hospital Violence Intervention Program (HVIP) is and why they are essential in caring for our patients.
2. Present different examples of unique HVIP initiatives within our IFCK network.
3. Discuss the pearls and pitfalls to starting a program and how to overcome barriers and ensure your program is set up for success.