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Population Density And Triage Of Pediatric Firearm Injuries In A Predominantly Rural State Trauma System
*Taylor Shaw, Hannah Cockrell, Kristen Carter, David Sawaya, Michael Morris, *Matthew Kutcher, Barry Berch
University of Mississippi Medical Center, Jackson, MS

Purpose: Rural pediatric firearm injuries frequently require regional pediatric and trauma expertise. We evaluated county-level population density associations with transport and hospital interventions and outcomes in a predominantly rural state.Methods: The trauma registry of the only in-state pediatric trauma center serving a predominantly rural catchment was reviewed for firearm injuries in patients age <18 from 1/2013 to 3/2020. County-level population density was classified according to the United States Office of Management and Budget definitions for rural, micropolitan, and metropolitan areas.Results: 362 patients were identified, including 7 patients who were re-injured. Median age was 13 (interquartile range 8-15) and patients were 80% male. 7% were injured in a rural county; 46% in a micropolitan county; and 46% in a metropolitan county. 58% were transferred from a referring hospital. Median ISS was 5 (IQR 1-10); 88% required trauma center admission and 26% required intensive care. Law enforcement and child protective services were involved in 80% and 39% of cases, respectively. Those transported from rural counties had significantly longer dispatch and transport times (p<0.01). On-scene times and rates of pre-arrival interventions were similar between groups. Trauma center operative intervention was lowest in the rural group (p<0.03).
Conclusions: Management of pediatric firearm injury is a unique challenge for rural trauma systems. Opportunities exist for outreach, telehealth, and decision support to ensure equitable distribution of trauma center resources.


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