Trends and Disparities in Reconstruction for 39,476 Firearm Injuries in the Pediatric Population
Austin D. Chen1, Klaas Ultee1, Masoud Malyar1, Alexandra Bucknor1, Anmol S. Chattha1, Anna Rose Johnson1, Qing Zhao Ruan1, Salim Afshar2, Bernard T. Lee, MD1, Samuel J. Lin1
1Beth Israel Deaconess Medical Center, Boston, MA, USA; 2Boston Children's Hospital, Boston, MA, USA
Background: The aim of our study was to investigate national and regional trends, and sociodemographic disparities of firearm injuries and flap reconstruction in the pediatric population.
Methods: Data for patients ≤20 years admitted with firearm injuries were retrieved from the Healthcare Cost and Utilization Project Kids' Inpatient Database for years 2000-2012. National and regional trends in firearm injury incidence and flap reconstruction over time, patient characteristics, injuries, and outcomes were analyzed for flap reconstruction (FR) and non-flap reconstruction (NFR) patients.
Results: There were 39,476 pediatric patients admitted for firearm injuries over the study period. There was no change in annual gunshot incidence (111 per million to 92 per million) but an increase in FR (2.57% to 3.34%, p=0.003). Northeast and West regions showed an increase in FR from 1.90% to 3.10% (p=0.034 and p=0.004, respectively). There were more male FR vs. NFR patients (92.3% vs. 89.9%, p=0.009). NFR vs. FR patients were more often African American (55.6% vs. 51.2%) or Hispanic (22.5% vs. 15.4%), in the first quartile of income (47.8% vs. 44.0%), or self-pay (21.3% vs. 16.3%) or no charge (1.5% vs. 0.6%), and admitted at small (6.1% vs. 3.6%) or medium (22.2% vs. 19.5%), rural (2.8% vs. 2.1%) or urban non-teaching (15.3% vs. 10.2%) centers in the Northeast (16.4% vs. 14.6%) or West (26.8% vs. 20.6%).
Conclusion: There are geographical and patient-level disparities in the receipt of flap reconstruction and further research may aim to understand the reasons for these trends.
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