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Rivara FP, Hink AB, Kuhls DA, Banks S, Agoubi LL, Kirkendoll S, Winchester A, Hoeft C, Patel B, Nathens A. Firearm injuries treated at trauma centers in the United States. J Trauma Acute Care Surg 2024; 96:955-964. [PMID: 37872675 DOI: 10.1097/ta.0000000000004172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND While firearm injuries and deaths continue to be a major public health problem, the number of nonfatal firearm injuries and the characteristics of patients are not well-known. The American College of Surgeons Committee on Trauma leveraged an existing data system to collect additional data on fatal and nonfatal firearm injuries presenting to trauma centers. This report provides an overview of this initiative and highlights the challenges associated with capturing actionable data on firearm-injured patients. METHODS A total of 128 trauma centers that are part of the American College of Surgeons Trauma Quality Improvement Program collected data on individuals of any age arriving alive between March 1, 2021, and February 28, 2022, with a firearm injury. In addition to the standard data collected for Trauma Quality Improvement Program, abstractors also extracted additional data specific to this study. We linked data from the Distressed Community Index to patient records using zip code of residence. RESULTS A total of 17,395 patients were included, with mean (SD) age of 30.2 (13.5) years, 82.5% were male, and the majority were Black and non-Hispanic. The mean proportion of variables with missing data varied among trauma centers, with a mean of 20.7% missing data. Injuries occurred most commonly in homes (31.2%) or on the street (26.6%); 70.4% of injuries were due to assaults. Nearly one third of patients were discharged from the emergency department, 25.9% were admitted directly to the operating room, and 10.9% were admitted to the intensive care unit; 5.9% died in the emergency department, and 10.3% died overall during their course of care. Nearly two thirds of patients lived in the two highest distressed categories of communities; only 7.5% lived in the least distressed quintile. CONCLUSION Using trauma center data can be a valuable tool to improve our knowledge of firearm injuries if clinical practices and documentation of patient risks and circumstances are standardized. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Frederick P Rivara
- From the Harborview Medical Center (F.P.R.); Department of Pediatrics (F.P.R.), Department of Epidemiology (F.P.R.), Firearm Injury and Policy Research Program (F.P.R.), University of Washington, Seattle, Washington; Department of Surgery (A.B.H.), Medical University of South Carolina, Charleston, South Carolina; Department of Surgery (D.A.K.), Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada; Firearm Injury and Policy Research Program (S.B.), Harborview Injury Prevention and Research Center (L.L.A.), Department of Surgery (L.L.A.), University of Washington, Seattle, Washington; Department of Surgery (S.K.), Northwestern Feinberg School of Medicine; American College of Surgeons (A.W., C.H., B.P.), Chicago, Illinois; and Sunnybrook Health Sciences Center (A.N.), University of Toronto, Toronto, Ontario, Canada
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Sakran JV, Bornstein SS, Dicker R, Rivara FP, Campbell BT, Cunningham RM, Betz M, Hargarten S, Williams A, Horwitz JM, Nehra D, Burstin H, Sheehan K, Dreier FL, James T, Sathya C, Armstrong JH, Rowhani-Rahbar A, Charles S, Goldberg A, Lee LK, Stewart RM, Kerby JD, Turner PL, Bulger EM. Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach. J Am Coll Surg 2023; 236:1242-1260. [PMID: 36877809 DOI: 10.1097/xcs.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Joseph V Sakran
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD (Sakran)
| | - Sue S Bornstein
- American College of Physicians, Philadelphia, PA (Bornstein)
| | - Rochelle Dicker
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of California Los Angeles, Los Angeles, CA (Dicker)
| | - Frederick P Rivara
- Department of Pediatrics, University of Washington, Seattle, WA (Rivara)
| | - Brendan T Campbell
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT (Campbell)
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI (Cunningham)
| | - Marian Betz
- Department of Emergency Medicine, University of Colorado, Aurora, CO (Betz)
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (Hargarten)
| | - Ashley Williams
- Department of Surgery, University of South Alabama, Mobile, AL (Williams)
| | - Joshua M Horwitz
- Johns Hopkins Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Horwitz)
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
| | - Helen Burstin
- Council of Medical Specialty Societies, Washington, DC (Burstin)
| | - Karen Sheehan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL (Sheehan)
| | - Fatimah L Dreier
- The Health Alliance for Violence Intervention, Jersey City, NJ (Dreier)
| | - Thea James
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA (James)
| | - Chethan Sathya
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Cohen Children's Medical Center, Northwell Health, Queens, NY (Sathya)
| | - John H Armstrong
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Armstrong)
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA (Rowhani-Rahbar)
| | - Scott Charles
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Amy Goldberg
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Lois K Lee
- Department of Emergency Medicine, Boston Children's Hospital, Boston, MA (Lee)
| | - Ronald M Stewart
- Department of Surgery, University of Texas San Antonio, San Antonio, TX (Stewart)
| | - Jeffrey D Kerby
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL (Kerby)
| | - Patricia L Turner
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
| | - Eileen M Bulger
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
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Conrick KM, Gause E, Rivara FP, Rowhani-Rahbar A, Moore M. Social Workers' Perspectives on Extreme Risk Protection Orders. SOCIAL WORK 2023:7142892. [PMID: 37186012 DOI: 10.1093/sw/swad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/01/2022] [Accepted: 09/23/2022] [Indexed: 05/17/2023]
Abstract
Extreme risk protection orders (ERPOs), which allow for the temporary restriction of firearm access for individuals at substantial risk of harming themselves and/or others, are a promising policy tool to address increasing rates of firearm-related suicide, homicide, and mass shootings. Social workers frequently assess clients at risk of firearm-related harm, positioning social workers to play a key role in ERPO implementation. This study sought to understand social workers' perspectives on ERPOs. Authors invited 6,910 licensed social workers in Washington state to participate in a survey in May and June of 2021 about facilitators and barriers to their willingness to counsel clients' family members, contact law enforcement, or independently file ERPOs for clients at risk of harm to self (HTS) or others (HTO). Of the 1,381 survey participants, most were willing to counsel (96 percent for HTS; 96 percent HTO), contact law enforcement (84 percent for HTS; 87 percent for HTO), or independently file an ERPO (78 percent for HTS; 79 percent for HTO). Common barriers associated with willingness were lack of understanding about the ERPO process and concerns with involving the legal system/law enforcement. Key facilitators included training social workers about ERPOs and availability of legal experts for consultations. Social workers are willing to incorporate ERPOs into their practice for clients, but remaining barriers need to be addressed to support the practice.
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Affiliation(s)
- Kelsey M Conrick
- MPH, is a PhD candidate, School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA 98105, USA
| | - Emma Gause
- MS, MA, was a research scientist at the time this study was conducted, Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- MD, MPH, is vice chair and professor of pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- PhD, MD, MPH, is professor of epidemiology, Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Megan Moore
- Sidney Miller endowed associate professor in direct practice, School of Social Work, University of Washington, Seattle, WA, USA
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Thomas AC, Siry-Bove BJ, Barnard LM, Rooney L, McCarthy M, Mustafa A, Rowhani-Rahbar A, Rivara FP, Betz ME, Knoepke C. A Qualitative study on diverse perspectives and identities of firearm owners. Inj Prev 2022; 28:434-439. [PMID: 35470245 PMCID: PMC9492625 DOI: 10.1136/injuryprev-2022-044522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Research surrounding firearm ownership is often contextualised within the perspectives of older white men. We expand this description using the perceptions of a diverse group of firearm-owning stakeholders. METHODS We conducted semistructured interviews from October 2020 to May 2021 with Colorado/Washington State stakeholders representing (1) firearm ranges/retailers; (2) law enforcement agencies or (3) relevant state/national firearm organisations. Data were analysed using standard qualitative techniques and included 25 participants, representing varied sociocultural groups including racial and ethnic minorities, political minorities and sexual minorities. RESULTS Participants for this analysis were of different self-identified sociocultural groups including racial and ethnic minorities (African American, Hispanic and Asian), political minorities (liberal) and sexual minorities, defined as Lesbian, Gay, Bisexual, and Transgender (LGBT). Perspectives on firearm ownership included an idea of gun culture as a component of (1) personal identity, (2) an expression of full citizenship and (3) necessary for self-protection. A strong subtheme was the intersection of minority group and firearm owner identities, creating a need for divergent social communities because of ideas on traditional gun culture. These communities are a safe place for individuals belonging to minority groups to escape negative external and internal group associations with firearms. CONCLUSION Perspectives on firearms and firearm ownership in the secondary analysis were heterogeneous and related to personal experiences, external and internal group pressures that influence individual behaviour. Understanding the breadth of perspectives on firearm ownership is imperative to engaging individuals for risk reduction. This study adds to the literature by expanding an understanding of the motivation for firearm ownership among diverse communities.
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Affiliation(s)
- Arielle C Thomas
- American College of Surgeons, Chicago, Wisconsin, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bonnie J Siry-Bove
- Emergency Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Leslie M Barnard
- Department of Epidemiology, University of Colorado Health, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Lauren Rooney
- Firearm Injury and Policy Research, University of Washington School of Medicine, Seattle, Washington, USA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
| | - Megan McCarthy
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Ayah Mustafa
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
- Firearm Injury and Policy Research, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Christopher Knoepke
- Department of Cardiology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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Dukleska K, Borrup K, Campbell BT. Childhood injury prevention: Where we've been and where we need to be. Semin Pediatr Surg 2022; 31:151220. [PMID: 36371841 DOI: 10.1016/j.sempedsurg.2022.151220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Injury remains the leading cause of death for children and adolescents in the US, and firearm injury has overtaken motor-vehicle crashes as the leading mechanism in the US since the topic of injury prevention was last reviewed in this journal. The success of injury prevention efforts relies on multidisciplinary collaboration, and pediatric surgeons play a central role as clinicians who provide and coordinate the care for injured children, as trauma program leaders, and as advocates for children's health and safety. This review will provide a concise history of injury prevention in the US and highlights three areas where pediatric surgeons have an opportunity to impart impactful change in their communities that could lead to lower injury rates.
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Affiliation(s)
- Katerina Dukleska
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Kevin Borrup
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Brendan T Campbell
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA; Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
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