TY  - JOUR
PY  - 2022//
TI  - Population density and triage of pediatric firearm injuries in a rural trauma system
JO  - American surgeon
A1  - Shaw, Taylor B.
A1  - Cockrell, Hannah C.
A1  - Carter, Kristen T.
A1  - Mijalis, Eleni M.
A1  - Buti, Yusef
A1  - Sawaya, David
A1  - Berch, Barry R.
A1  - Kutcher, Matthew E.
A1  - Morris, Michael W. Jr
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: Rural pediatric firearm injuries require regional pediatric and trauma expertise. We evaluated county-level population density associations with transport, hospital interventions, and patient outcomes at a Level I pediatric trauma center serving a rural, statewide catchment area. MATERIAL AND METHODS: The trauma registry of the only in-state pediatric trauma center was reviewed for firearm injuries in patients < 18 between 1/2013 and 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. <br><br>RESULTS: 364 patients were identified, including 7 patients who were re-injured. Mean age was 11.3 ± 4.5 y and patients were 79.4% male. 59.3% were transferred from a referring hospital. Median injury severity score was 5 (IQR 1-10); 88.0% required trauma center admission, and 48.2% required operative intervention. 7.4% were injured in a rural county, 46.4% in a micropolitan county, and 46.2% in a metropolitan county. Patients from rural counties were more likely to be unintentionally injured (72.0%) than those from micropolitan (54.4%) or metropolitan counties (44.0%, P =.04). While need for inpatient admission and length of stay were similar, those transported from rural counties had significantly longer transport times (P <.01) and less frequent need for operative intervention (P =.03), as well as trends toward lower injury severity (P =.08) and mortality (P =.06). <br><br>CONCLUSION: Management of pediatric firearm injury is a unique challenge with significant regional variability. Opportunities exist for outreach, telehealth, and decision support to ensure equitable distribution of resources in rural trauma systems. LEVEL OF EVIDENCE: Epidemiological, Level III.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-1348
UR  - http://dx.doi.org/10.1177/00031348221121554
ID  - ref1
ER  -