M. D. Price1, K. M. McDermott1, R. Gorijavolu2, I. Nasr1,3 1The Johns Hopkins Hospital, Department Of Surgery, Baltimore, MD, USA 2The Johns Hopkins Hospital, School Of Medicine, Baltimore, MD, USA 3The Johns Hopkins Hospital, Division Of Pediatric Surgery, Baltimore, MD, USA
Introduction: Pediatric firearm injuries are a critical public health concern in the United States and repeat firearm injuries in children are associated with especially high morbidity and mortality. Prior studies of firearm injury recidivism are largely limited to single institutions. We sought to identify risk factors for firearm injury recidivism among the statewide pediatric population of Maryland.
Methods: Pediatric patients (age 0-19 years) who presented to any hospital in Maryland with a firearm injury between October 1, 2015 and December 31st, 2019 were identified in the Maryland Health Services Cost Review Commission database using ICD-10 external causes of injury codes. This cohort was followed for repeat firearm injuries through March 31st, 2020. Univariate and multivariable logistic regression were used to assess index demographic and injury characteristics associated with increased odds for firearm recidivism.
Results: Of 1,351 index presentations for firearm injuries, 102 (7.3%) patients died during the index hospitalization. Among the surviving 1,249, 40 (3.1%) re-presented with a 2nd firearm injury and 10 (25%) of these injuries were fatal. Median time to reinjury was 149 days [IQR: 73-617]. The group who experienced recidivism was older (age 15-19) (90% vs 76%) and comprised a higher proportion of African Americans (90% vs 69%), were more commonly male (100% vs 87%), and publicly insured (90% vs 68%) (all p<0.05). Additionally, the majority of individuals who experienced recidivism lived in highly deprived neighborhoods (area deprivation index (ADI) above the 75th percentile, 58% vs 34%, p<0.05) and had a primary residence in Baltimore City (75%, Figure 1). Univariate analysis showed increased odds for recidivism among those age 15-19 (OR 2.8, 95% CI: 1.1-8.0), of African American race (OR: 3.9, 95% CI: 1.2-12.8), publicly insured (OR 4.9, 95% CI: 1.2-20.7), living in the most deprived ADI quartile (OR 3.3, 95% CI: 1.1-9.7) and those whose index injury intent was determined to be assault (OR 1.9, 95% CI: 1.1-3.6). Multivariable models did not show a significant difference in odds for any single risk factor.
Conclusion: Firearm injury recidivism in the pediatric population in Maryland is uncommon but highly morbid, with a 25% mortality among 2nd presentation firearm injuries in the current study. While prior single-center studies have shown black race to be independently associated with firearm re-injury, we found the effect of race was entirely attenuated after controlling for neighborhood deprivation. Our results suggest geography-based targets for violence intervention may best address the complex interplay of sociodemographic and geographic factors that contribute to firearm recidivism.
