Firearm related injuries amongst children: estimates from the Nationwide Emergency Department Sample

Department of Pediatric Critical Care and Pharmacology, Rainbow Babies and Children's Hospital, University Hospitals, Case Medical Center, United States.
Injury (Impact Factor: 2.14). 11/2011; 43(12):2051-4. DOI: 10.1016/j.injury.2011.10.040
Source: PubMed


The objective of this study is to provide estimates of firearm related injuries in children seeking care in hospital based emergency departments.
The Nationwide Emergency Department Sample (NEDS) for the year 2008 was used for the current study. All ED visits occurring amongst children aged less than or equal to 18 years and that had an External Cause of Injury (E-Code) for any of the firearm related injuries were selected for analysis.
A total of 14,831 ED visits (in children) in the United States had a firearm injury. The average age of the ED visits was 15.9 years. Males constituted a predominant proportion of all ED visits (89.2%). A total of 494 patients died in the emergency departments (3.4% of all ED visits) whilst 323 died following in-patient admission into the same hospital (6% of all inpatient admissions). The most frequently documented firearms were assaults by firearms and explosives (55% of all ED visits), accidents caused by firearms and air gun missiles (33.6%), and injuries by firearms that were undetermined (7.4%). The average charge for each ED visit was $3642 (25th percentile is $1146, median is $2003, and 75th percentile is $4404). The mean charge for those visits that resulted in in-patient admission into the same hospital was $70,164 (25th percentile is $16,704, median is $36,111, and 75th percentile is $74,165) and the total charges for the entire United States was about $371.33 million.
The current study used the largest all-payer hospital based emergency department dataset to provide national estimates of firearm related injuries amongst children in the United States during the year 2008 and highlights the public health impact of such injuries.

Full-text preview

Available from:
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The estimates of patients who present with transient ischemic attacks (TIA) in the emergency departments (EDs) of United States and their disposition and factors that determine hospital admission are not well understood. OBJECTIVE: We used a nationally representative database to determine the rate and predictors of admission in TIA patients presenting to EDs. METHODS: We analyzed data from the National Emergency Department Sample (2006-2008) for all patients presenting with a primary diagnosis of TIA in the United States. Samples were weighted to provide national estimates of TIA hospitalizations and identify factors that increase the odds of hospital admission including age, sex, type of insurance, median household income, and hospital type (urban teaching, urban nonteaching, and nonurban). Multivariate logistic regression analysis was used to identify independent predictors of hospital admission. RESULTS: There were 812908 ED visits for primary diagnosis of TIA; mean age (±SD), 70.3 ± 14.9 years; and 57.9% were women from 2006 to 2008. Of these ED visits, 516837 (63.5%) were admitted to the hospital, whereas 296071 (36.5%) were discharged from the ED to home. In the multivariate logistic regression analysis adjusting age, sex, and medical comorbidities, independent factors associated with hospital admissions were median household income $64000 or higher (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.22-1.44; P = .003), Medicare insurance type (OR, 1.19; 95% CI, 1.14-1.26; P < .0001), and metropolitan teaching hospital ED (OR, 2.17; 95% CI, 1.90-2.48; P < .0001). CONCLUSION: From 2006 to 2008, approximately 64% of all patients presenting with TIAs to the EDs within United States were admitted to the hospital. Factors unrelated to patients' condition such as median household income, insurance status, and ED affiliated hospital type play an important role in the decision to admit TIA patients to the hospitals.
    No preview · Article · Feb 2013 · The American journal of emergency medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To characterize gout-related emergency department (ED) utilization using a nationally representative sample and to examine factors associated with the frequency and charges of gout-related ED visits. Methods: Using the National Emergency Department Sample data from 2006-2008, the weighted national frequency of gout visits was calculated along with the median ED charge and total national ED-related charges. Associations of several patient- and facility-level factors were examined with the occurrence of gout visits using multivariable logistic regression and with ED-related charges using multivariable linear regression. Results: Gout was the primary indication for 168,410 ED visits in 2006, 171,743 visits in 2007, and 174,823 visits in 2008, accounting for ∼0.2% of all visits annually and generating ED charges of more than $128 million in 2006, $144 million in 2007, and $166 million in 2008. Age, male sex, household income <$39,000, private insurance, and hospital locations in nonmetropolitan areas and the southern US were associated with an increased propensity for ED utilization in gout. Higher ED-related charges for gout were associated with female sex, age, a higher number of coded diagnoses, and a metropolitan residence. Conclusion: Gout accounts for a substantial proportion of ED visits, leading to significant health care charges. Effective strategies to reduce gout burden in EDs could potentially benefit by targeting groups characterized by factors demonstrated to be related to a higher ED utilization in gout as identified by our study.
    Full-text · Article · Apr 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Firearm injuries to children and adolescents remain an important cause of morbidity and mortality in the USA. The objectives of this study were to describe the prevalence of and epidemiologic risk factors associated with firearm injuries to children and adolescents evaluated in a nationally representative sample of US emergency departments and ambulatory care centres. We performed a retrospective cross-sectional analysis of data from the National Hospital Ambulatory Medical Care Survey from 2001 to 2010. Firearm injury-related visits in patients 0-19 years old were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification firearm injury codes. The primary outcome was the prevalence of firearm-related injuries. We used multivariate logistic regression to analyse demographic risk factors associated with these injuries. From 2001 to 2010, there were a total of 322 730 927 (95% CI 287 462 091 to 357 999 763) paediatric US outpatient visits; 198 969 visits (0.06%, 95% CI 120 727 to 277 211) were for firearm injuries. Fatal firearm injuries accounted for 2% of these visits; 36% were intentionally inflicted. There were increased odds of firearm injuries to men (OR 10.2, 95% CI 5.1 to 20.5), black children and adolescents (0-19 years) (OR 3.2, 95% CI 1.5 to 6.7) and adolescents 12-19 years old (all races) (OR 16.6, 95% CI 6.3 to 44.3) on multivariable analysis. Firearm injuries continue to be a substantial problem for US children and adolescents, with non-fatal rates 24% higher than previously reported. Increased odds for firearm-related visits were found in men, black children and those 12-19 years old.
    No preview · Article · Dec 2013 · Archives of Disease in Childhood
Show more