Pradip P Kamat1, Mathew T Santore2, Katherine E M Hoops3, Martha Wetzel4, Courtney McCracken4, Dennis Sullivan5, Matthew Hall6, Jocelyn R Grunwell7. 1. Department of Pediatrics, Division of Critical Care Medicine, Emory University School of Medicine, Atlanta, GA. Electronic address: pradip.kamat@choa.org. 2. Department of Surgery, Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA. 3. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD. 4. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 5. Children's Healthcare of Atlanta, Atlanta, GA. 6. Children's Hospital Association, Kansas City, MO. 7. Department of Pediatrics, Division of Critical Care Medicine, Emory University School of Medicine, Atlanta, GA.
Abstract
BACKGROUND/ PURPOSE: To assess trends and resource use attributable to firearm-related injuries in US pediatric intensive care units (PICUs). METHODS: Retrospective data from Pediatric Health Information Systems (PHIS) database from 2004 to 2017. RESULTS: Of 5,984,938 admissions to 28 children's hospitals, 3707 were for firearm injuries. A total of 1088 of 3707 hospitalizations (29.9%) required PICU admission. Median PICU length of stay was 2 days (IQR, 1-6 days), and the median cost for PICU patients was $37,569.31 (IQR, $19,243.83-$77,856.32). Use of mechanical ventilation (674/1088 admissions [61.9%]), surgical procedures (744/1088 admissions [68.3%]), blood transfusions (429/1088 admissions [39.9%]), and intracranial pressure monitoring devices (30/1088 admissions [2.8%]) increased in PICU patients. Computed tomography showed an overall increase (197/287 [68.6%] to 138/177 [78%], P = .037) from 2004 to 2007 to 2016-2017. Mortality among PICU patients (140/1058 [13.23%]) attributable to firearm-related injuries increased insignificantly (34/285 (11.93%] to 25/172 [14.53%], P = .746). CONCLUSIONS: Using PHIS data, we found a significant increase in median cost per hospitalization and an increase in critical care resource use, including the frequency of invasive mechanical ventilatory assistance, neuromonitoring, operations performed, and transfusion of blood products. Further research is needed to continue to characterize the burden of pediatric critical firearm injury. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level III.
BACKGROUND/ PURPOSE: To assess trends and resource use attributable to firearm-related injuries in US pediatric intensive care units (PICUs). METHODS: Retrospective data from Pediatric Health Information Systems (PHIS) database from 2004 to 2017. RESULTS: Of 5,984,938 admissions to 28 children's hospitals, 3707 were for firearm injuries. A total of 1088 of 3707 hospitalizations (29.9%) required PICU admission. Median PICU length of stay was 2 days (IQR, 1-6 days), and the median cost for PICU patients was $37,569.31 (IQR, $19,243.83-$77,856.32). Use of mechanical ventilation (674/1088 admissions [61.9%]), surgical procedures (744/1088 admissions [68.3%]), blood transfusions (429/1088 admissions [39.9%]), and intracranial pressure monitoring devices (30/1088 admissions [2.8%]) increased in PICU patients. Computed tomography showed an overall increase (197/287 [68.6%] to 138/177 [78%], P = .037) from 2004 to 2007 to 2016-2017. Mortality among PICU patients (140/1058 [13.23%]) attributable to firearm-related injuries increased insignificantly (34/285 (11.93%] to 25/172 [14.53%], P = .746). CONCLUSIONS: Using PHIS data, we found a significant increase in median cost per hospitalization and an increase in critical care resource use, including the frequency of invasive mechanical ventilatory assistance, neuromonitoring, operations performed, and transfusion of blood products. Further research is needed to continue to characterize the burden of pediatric critical firearm injury. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level III.
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