M. Hoof1, J. Friedman1, A. A. Smith1, K. Ibraheem1, D. Tatum2, J. Duchesne1, R. Schroll1, C. Guidry1, P. McGrew1 1Tulane University School Of Medicine,Surgery,New Orleans, LA, USA 2Our Lady of The Lake,Surgery,Baton Rouge, LA, USA
Introduction: Prior studies have shown that African American (AA) and uninsured patients have worse outcomes among pediatric victims of firearm injury. However, whether racial and socioeconomic disparities exist in prehospital mortality in pediatric firearm injury (PFI) is unknown. The objective of this study was to determine if the disparities that exist in overall mortality are already present on-scene.
Methods: The National Emergency Medical Services Information Systems (NEMSIS) database was queried for all pediatric (age 0-18) firearm incidents from 2010-2015. A linear regression was carried out using variables associated with mortality on univariate analysis to identify factors associated with prehospital mortality.
Results: 16,808 firearm injuries met study criterion, though information on race and insurance status was only available for 12,268 and 3,080 events, respectively. Victims were more likely to be AA and uninsured. White (CA) children made up a higher proportion of suicide attempts and accidental injuries, whereas most assault victims were AA. CA children had a higher mortality on both univariate and multivariate analysis (MVA). Uninsured children had higher mortality on univariate analysis. On MVA, the odds ratio (OR) of death for uninsured children was 2.169, though this was not significant (p = 0.051). Other factors associated with mortality included anatomic location of injury and intention of injury, with suicide attempts having the highest mortality.
Conclusion: To our knowledge this is the largest study of prehospital mortality in pediatric firearm injury. Uninsured children had higher on-scene mortality on univariate analysis. On MVA, uninsured victims were twice as likely to die as their insured counterparts, though this only approached significance (p = 0.051), perhaps due to insufficient sample size. This trend supports the idea that poor preinjury health status may affect outcome following trauma. However, we did not see higher prehospital mortality in AA children, which has been observed in studies on overall PFI mortality. Therefore, it is possible that the outcomes disparities noted in those studies are related to in-hospital factors. Further studies are needed to examine this topic.
