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Pediatric Firearm Violence In Wisconsin: To Admit Or Not To Admit?
*Katherine Flynn-O'Brien, *Carisa Bergner, *Christina Georgeades, *Mike Levas, *Laura Cassidy
Medical College of Wisconsin, Milwaukee, WI

OBJECTIVE(S): Fatal and non-fatal pediatric firearm injuries are increasing nationwide. Services available in the Emergency Department (ED) to respond to the complex biopsychosocial needs of a child and their family affected by firearm violence are limited. The aim of this study was to understand the burden of firearm injury in children in Wisconsin and to compare populations discharged and admitted from the Children’s Wisconsin (CW) ED to understand possible unmet need for services.
METHODS: The CW Trauma Registry (TR) was queried for all patients &lt18 years with gunshot wounds (GSW) from 1/1/2016 to 5/31/2021. The electronic medical record (EMR) was also queried for patients treated and released from the Emergency Department who did not qualify for the TR. Statewide vital statistics data captured out-of-hospital GSW fatalities from 1/1/2016 to 12/31/2020. Pearson chi2 was used to compare categorical variables and Wilcoxon rank-sum test was used to compare non-normally districted continuous variables.
RESULTS: 55,862 encounters for trauma met inclusion criteria (TR+EMR), with 380 (0.7%) GSW encounters during the study period. GSW encounters treated at CW and pediatric GSW fatalities increased state-wide over the study period (Figure 1). Among encounters for GSWs at CW, there were 206 (54%) admissions, 152 (40%) treated and released, 14 (23.7%) transfers to another facility or jail, 6 (1.6%) deaths, and 2 (0.5%) left against medical advice. There was no difference in sex, race, ethnicity, or insurance status between the two groups. A greater proportion of children with unintentional GSWs were sent home from the ED (68.4% vs 26.2% admitted) while a greater proportion of assault related GSWs were admitted (51.5% vs. 6.5%).
CONCLUSIONS: Fatal and nonfatal pediatric firearm injuries are increasing in Wisconsin, and a large proportion of injured children are discharged from the ED with unclear services in place to address mental, behavioral, and physical healthcare needs. With the rise in firearm violence, there is a commensurate need for healthcare systems to respond to those needs.


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