Section of Pediatric Surgery CS Mott Children's Hospital University of Michigan, Ann Arbor, MI.
Department of Surgery and Pediatrics, University of Vermont Medical Center and Children's Hospital, Larner College of Medicine at the University of Vermont, Burlington, VT.
Ann Surg. 2022 Sep 1;276(3):463-471. doi: 10.1097/SLA.0000000000005557. Epub 2022 Jun 28.
To compare new mental health diagnoses (NMHD) in children after a firearm injury versus following a motor vehicle collision (MVC).
A knowledge gap exists regarding childhood mental health diagnoses following firearm injuries, notably in comparison to other forms of traumatic injury.
We utilized Medicaid MarketScan claims (2010-2016) to conduct a matched case-control study of children ages 3 to 17 years. Children with firearm injuries were matched with up to 3 children with MVC injuries. Severity was determined by injury severity score and emergency department disposition. We used multivariable logistic regression to measure the association of acquiring a NMHD diagnosis in the year postinjury after firearm and MVC mechanisms.
We matched 1450 children with firearm injuries to 3691 children with MVC injuries. Compared to MVC injuries, children with firearm injuries were more likely to be black, have higher injury severity score, and receive hospital admission from the emergency department ( P <0.001). The adjusted odds ratio (aOR) of NMHD diagnosis was 1.55 [95% confidence interval (95% CI): 1.33-1.80] greater after firearm injuries compared to MVC injuries. The odds of a NMHD were higher among children admitted to the hospital compared to those discharged. The increased odds of NMHD after firearm injuries was driven by increases in substance-related and addictive disorders (aOR: 2.08; 95% CI: 1.63-2.64) and trauma and stressor-related disorders (aOR: 2.07; 95% CI: 1.55-2.76).
Children were found to have 50% increased odds of having a NMHD in the year following a firearm injury as compared to MVC. Programmatic interventions are needed to address children's mental health following firearm injuries.
比较儿童 firearm 伤后和机动车碰撞（MVC）后新的心理健康诊断（NMHD）。
儿童 firearm 伤后心理健康诊断方面存在知识空白，尤其是与其他形式的创伤性损伤相比。
我们利用 Medicaid MarketScan 理赔数据（2010-2016 年），对 3 至 17 岁儿童进行了 firearm 伤和 MVC 伤的病例对照匹配研究。将 firearm 伤患儿与最多 3 名 MVC 伤患儿进行匹配。严重程度由损伤严重程度评分和急诊科处置决定。我们使用多变量逻辑回归来衡量 firearm 和 MVC 机制受伤后次年获得 NMHD 诊断的关联。
我们将 1450 名 firearm 伤患儿与 3691 名 MVC 伤患儿进行了匹配。与 MVC 伤相比，firearm 伤患儿更可能为黑人，损伤严重程度评分更高，且从急诊科收治入院的比例更高（P <0.001）。与 MVC 伤相比，firearm 伤患儿 NMHD 诊断的调整后比值比（aOR）高出 1.55 [95%置信区间（95%CI）：1.33-1.80]。与出院患儿相比，住院患儿 NMHD 的可能性更高。firearm 伤后 NMHD 风险增加归因于物质相关和成瘾障碍（aOR：2.08；95% CI：1.63-2.64）和创伤和应激相关障碍（aOR：2.07；95% CI：1.55-2.76）的增加。
与 MVC 伤相比，firearm 伤患儿在伤后 1 年 NMHD 的发生几率增加了 50%。需要采取计划干预措施来解决 firearm 伤后儿童的心理健康问题。
