We Ask Everyone? Utilization of Universal Screening for Firearm Injury Risk Among Pediatric Trauma Patients

Emma Cornell, MPH
Olivia Frank, MPH
Laura Harrison, MPH
Sandeep Kapoor, MD
Monica Shekher Kapoor, MD
Chethan Sathya, MD

As the leading cause of death for children and adolescents, firearm injury requires healthcare-led solutions to meaningfully address and reduce the epidemic of gun violence in the US. We implemented a universal Firearm Injury and Mortality Prevention (FIMP) screening program in three emergency departments (EDs) to identify and subsequently provide resources to patients who may be at risk for firearm injury based on violence risk or access to a firearm within or outside the home. Anecdotal reports from ED staff indicated high risk trauma patients including those with firearm-related injuries were not being screened in the ED. We retrospectively reviewed all pediatric patients with a trauma-related discharge diagnoses to determine the frequency of FIMP screening among this subpopulation.

Beginning in July 2021, universal screening for firearm injury risk for patients ?12 years was implemented across three health system hospitals including our pediatric level one trauma center. This screening includes a question about firearm access within or outside of the home, and the 4-question SaFETy score, a validated tool shown to predict future firearm violence risk. Data for all pediatric patients were extracted from the electronic medical record (EMR) and REDCap. Following data extraction, chief complaint and primary diagnosis were reviewed and coded as “trauma,” or “medical, according to ICD-10 CM diagnoses; patients coded as “trauma” were included. Standard descriptive statistical analyses were performed using SPSS (Statistical Package for Social Sciences).

From implementation in July 2021 through March 31, 2024, 42,492 patients ages 12-17 were seen in the pediatric ED, including 7,144 trauma patients (16.8% of total patients). Among trauma patients, 18.4% (n=1,311) received FIMP screening in the ED among which 4.3% (n=57) screened positive for either access to a firearm or risk for future firearm violence. Youth aged 15 and 14 accounted for the greatest percentage of trauma patients screened (20.7% and 17.5% respectively), and males accounted for 65.7% (n=861) of these patients. White and African American/Black children accounted for the largest percentage of trauma patients receiving the screening (30.6% and 27.6% respectively). There were 309 patients with a violent injury listed as their primary diagnosis following discharge (stab wound, gunshot wound, assault, child abuse, and self-injury), 30.1% of whom (n=93) received FIMP screening.

The majority of high-risk trauma patients including those with violent mechanisms of injury are not receiving FIMP screening while in the ED. Factors that may be associated with reduced screening include severity of injury and patient acuity for trauma patients, many of whom enter the ED as a trauma activation and may go directly to the OR from the trauma bay, thus preventing a comprehensive evaluation. Future steps should evaluate the feasibility of delivery of FIMP Screening and intervention in the inpatient setting for patients with severe traumatic injuries who require hospitalization and complex care.

1. Attendees will be able to describe trends observed in the implementation of firearm injury and mortality prevention screenings.
2. Attendees will be able to identify opportunities to integrate firearm injury and mortality prevention screening among trauma patients.
3. Attendees will be able to potential barriers and facilitators to firearm injury and mortality prevention screening among high risk populations.