Presenter Profile
Lindsay D. Clukies, MD, FAAP
Associate Trauma Medical Director
Co-Director, Emergency Medical Services
Division of Pediatric Emergency Medicine
St. Louis Children's Hospital
Washington University in St. Louis
lindsayedavidson@wustl.edu
Dr. Clukies is a pediatric emergency medicine physician at St. Louis Children's Hospital. She completed her undergraduate degree at McGill University in Montreal, Canada and medical school at New York Medical College. She went on the pediatrics residency and pediatric emergency medicine fellowship at Washington University in St. Louis/St. Louis Children's Hospital where she stayed on as faculty. She is the associate trauma medical director and has particular interests in injury prevention, clinical guidelines, firearm injuries and pre-hospital care. When she is not working she is keeping busy with her 3 sons and 3 rescue dogs.
Presentations
Guardian Receptivity to Physician-Led Firearm-safety Education in a Pediatric Emergency Department (ED): Psychometric Evaluation of a New Measure
Lindsay D. Clukies, MD, FAAP
G. Hoganson, MD;
N. Agostin, BA, EMT;
S. Wiltrakis, MD; MS;
K. Mueller, MD;
S. Morand MD;
D. Jeffe, PhD
Firearm injuries are the leading cause of death among U.S. children and adolescents, yet little is known about guardians’ receipt of physician-led firearm-safety education. We aimed to assess guardians’ exposure to and attitudes toward firearm-safety education and evaluate the underlying structure of a brief attitudinal questionnaire to guide development of a physician-led educational initiative.
An anonymous electronic survey was administered to guardians of patients being treated in the ED of a Level 1 pediatric trauma center. The survey assessed firearm ownership, prior education about and attitudes toward receiving physician-led firearm-safety education. Ten items measured respondents’ attitudes regarding the importance of and receptivity to such education using a 5-point Likert scale from Strongly Disagree (1) to Strongly Agree (5). Principal component analysis (PCA) was conducted for data reduction and to examine the underlying structure of these items. Cronbach’s alpha measured the internal-consistency reliability of items loading on resulting components. Analyses of variance (ANOVA) tested between-groups differences in receptivity to physician-led firearm-safety education. Chi-square tests examined associations among guardian characteristics and exposure to firearm-safety education.
Of 591/765 (77%) guardians who completed the 10 items assessing receptivity to physician-led firearm-safety education, PCA yielded a single-component solution. All items loaded highly on the component (range: .74-.93), and internal-consistency reliability was high (Cronbach’s ? =.96). Mean (SD) receptivity scores were higher among guardians with (vs. without) a 4-yr college degree (3.5 [1.0] vs. 3.2 [1.0]; p <.001) and who never (vs. ever) received firearm-safety education (3.5 [1.0] vs. 3.1 [1.0]; p < .001), but scores did not differ significantly by firearm ownership (p =.18). A lower percentage of guardians with a 4-yr college degree knew someone injured or killed by a firearm (33.2% vs. 53.5%; p <.001); but a higher percentage reported firearm ownership (45.4% vs. 35.6%; p <.02) and no prior firearm-safety education (57.2% vs. 47.6%; p =.02).
Guardians receptivity to physician-led firearm-safety education differed by educational attainment and exposure to firearm-safety education, but not by firearm ownership. The receptivity measure demonstrated strong internal-consistency reliability, supporting its use in future interventions. These findings can inform development of tailored educational initiatives aimed at reducing pediatric firearm injuries.
1. Describe guardian attitudes toward physician-led firearm-safety education in a pediatric emergency department setting, including how these attitudes vary by education level and prior exposure to firearm-safety education.
2. Interpret the psychometric properties of a newly developed receptivity scale, including its internal-consistency reliability and results of principal component analysis.
3. Apply findings to inform the design of targeted physician-led firearm-safety education initiatives aimed at reducing pediatric firearm injuries.
Assessing Pediatric Resident Comfort and Preparedness in Firearm-Injury Prevention Education: A Foundation for Curriculum Development
Lindsay Clukies, MD
G Hoganson, MD
N Agostin, BA, EMT
S Wiltrakis, MD
K Mueller, MD
S Morand, MD
D Jeffe, PhD
Firearm injuries are the leading cause of death among children and adolescents in the U.S. Despite this public health crisis, firearm-injury prevention education remains infrequent in pediatric care. Pediatric residents are uniquely positioned to provide such education to families but may lack the training, confidence, or comfort to do so. This study aimed to assess pediatric resident comfort discussing firearm safety and evaluate the underlying structure of a brief attitudinal questionnaire to guide development of a physician-led curriculum.
An anonymous electronic survey was administered to 112 pediatric residents at an urban, Level 1 trauma center in January 2024. The survey included six items about residents’ comfort discussing firearm access, secure storage, local resources, and firearm laws with families as well as interest in further training on these topics. Responses were scored on a 5-point scale from “Not at all” (1) to “Very much” (5); higher scores indicate greater comfort and greater interest. Principal component analysis (PCA) was conducted for data reduction and to examine the underlying structure of these items. Cronbach’s ? measured the internal-consistency reliability of items loading on resulting components.
Sixty-three (56% of 112) residents completed the survey, 58 (92.1%) of whom reported having cared for a patient with a firearm injury; yet only 31 (49.2%) reported being trained to discuss secure firearm storage. PCA yielded a 2-component solution, with five items each loading >.600 on the first component; the item about interest in further training loaded on its own component and was analyzed separately. The 5-item component measuring residents’ comfort discussing firearm-safety/injury-prevention had high internal-consistency reliability (Cronbach’s ? = 0.845), with a mean (SD) score of 2.4 (0.8) indicating low levels of comfort. Notably, residents’ mean interest in firearm-safety/injury-prevention training was 4.1 (0.9). Barriers to discussing firearm safety with families included having little comfort with the topic (25 [35.7%]) and knowledge about available resources (24 [38.1%]).
Despite extensive clinical exposure to firearm-related injuries, pediatric residents reported low levels of comfort discussing firearm-injury prevention with families. The strong internal-consistency reliability of the 5-item scale measuring comfort discussing firearm-safety with families and the barriers to having such family discussions provide preliminary evidence of the validity of this measure. Findings underscore the need for a structured curriculum to build residents’ competence and confidence in initiating firearm-safety discussions with families.
1. Describe the current comfort levels and training gaps among pediatric residents in discussing firearm-injury prevention with families.
2. Interpret the findings of a principal component analysis (PCA) used to evaluate a 6-item attitudinal survey measuring residents’ comfort and training interest in firearm safety counseling.
3. Identify key barriers to firearm safety counseling in pediatric care and explain how these findings can inform the development of a structured, physician-led curriculum.