Pediatric Trauma Society

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Accidents versus Assaults: The Driving Forces in Recidivism for Firearm Injuries
Usman Aslam, MS1; Marcelo Cerullo, MD2; Isam W. Nasr, MD3
1Johns Hopkins University Bloomberg School of Public Health, Selden, NY; 2Duke Department of Surgery, Durham, NC; 3Johns Hopkins, Baltimore, MD

Background: Firearm injuries in children have garnered national attention in recent years. However, no studies have examined the relative contributions of accidental and non-accidental circumstances among pediatric patients who suffer from repeat injuries, i.e. recidivism. The objective of this study was to identify the trends in firearm injury intent among both recidivists and nonrecidivists.

METHODS: This retrospective cohort study was conducted among patients < 19 years of age presenting with penetrating firearm injuries in the Maryland Health Services Cost Review Commission database FY2012-2017. Population-level trends were calculated against sociodemographic and injury-specific variables.

RESULTS: Exactly 888 patients were identified, of which 23% re-presented with another firearm injury during the study period. Overall, 538 (61%) index events were assaults while 292 (33%) were unintentional injuries. Among recidivists, 107 (51.9%) index injuries were intentional, while among non-recidivists, 431 (63.2%) of index injuries were intentional. Alternatively, 81 (39.3%) recidivist index-injuries were unintentional while a lower percentage of non-recidivist index injuries, 211 (30.94%), were unintentional. Across age-groups, assaults were more prevalent in non-recidivists, while unintentional injuries were more prevalent in recidivists (Figure).

CONCLUSIONS: In a statewide population-level study of pediatric patients with firearm injuries, the relationship between the etiology of injuries (assaults versus unintentional), is a complex one. Recidivists were more likely to suffer unintentional injury when compared with non-recidivists, highlighting one potential driver of trauma recidivism in pediatric patients.

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