Absolute versus relative socioeconomic disadvantage and homicide: a spatial ecological case–control study of US zip codes

Background Homicide is a major cause of death and contributes to health disparities in the United States. This burden overwhelmingly affects people from racial and ethnic minority populations as homicide occurs more often in neighborhoods with high proportions of racial and ethnic minority residents. Research has identified that environmental factors contribute to variation in homicide rates between neighborhoods; however, it is not clear why some neighborhoods with high concentrations of racial and ethnic minority residents have high homicide rates while neighborhoods with similar demographic compositions do not. The aim of this study was to assess whether relative socioeconomic disadvantage, (i.e., income inequality), or absolute socioeconomic disadvantage (i.e., income) measured at the ZIP code- and state-levels, is associated with high homicide rates in US ZIP codes, independent of racial and ethnic composition. Methods This ecological case–control study compared median household income and income inequality in 250 ZIP codes with the highest homicide rate in our sample in 2017 (cases) to 250 ZIP codes that did not experience any homicide deaths in 2017 (controls). Cases were matched to controls 1:1 based on demographic composition. Variables were measured at both the ZIP code- and state-levels. Results Lower median household income at the ZIP code-level contributed most substantially to the homicide rate. Income inequality at the state-level, however, was additionally significant when controlling for both ZIP code- and state-level factors. Conclusions Area-based interventions that improve absolute measures of ZIP code socioeconomic disadvantage may reduce gaps in homicide rates

A Multicenter Evaluation of Pediatric Emergency Department Injury Visits during the COVID-19 Pandemic

BACKGROUND: Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child\u27s environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic. METHODS: This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children \u3c 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020. RESULTS: The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p \u3c 0.001), non-Hispanic (72% vs 69%, p \u3c 0.001) and had private insurance (35% vs 32%, p \u3c 0.001). Injury hospitalizations increased 2.2% (p \u3c 0.001) and deaths increased 0.03% (p \u3c 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p \u3c 0.001) between 2019 and 2020. Injuries declined for struck by/against (- 4.9%) and overexertion (- 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019. CONCLUSIONS: The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives

Advocacy training tool for pediatric residents to strengthen firearm safety laws

Firearm injury is the leading cause of death in children and adolescents in the US, surpassing motor vehicle crashes. There is a need for greater legislative advocacy around firearm injury prevention, specifically around safer storage of firearms. A national medical trainee-based program convened in 2021 with the goal of increasing advocacy efforts around common causes of pediatric injury. A focus was to create a set of advocacy training tools that could be utilized by a wide variety of stakeholders. The subgroup sought to design policy-based training tools; one focused on general firearm injury prevention principles and another specifically focused on Child Access Prevention (CAP) laws. We explicate the utility of these documents and the need for greater advocacy around pediatric firearm injuries</jats:p

Firearm injury prevention advocacy: Lessons learned and future directions

Injuries and deaths due to firearms in children and young adults is a public health crisis in the United States. Pediatric clinicians are powerful advocates to reduce harm due to firearms. By forming coalitions with legislators on a bipartisan basis, working with government relations teams in the hospitals, and partnering with community allies and stakeholders, pediatric clinicians can work to enact legislation and influence policies at the individual, state, and national levels. This can include advocacy for strengthening Child Access Prevention Laws and firearm safer storage campaigns

United States Emergency Department Screening for Drug Use Among Assault-Injured Individuals: A Systematic Review

Introduction: The clinical model of screening, providing a brief psychosocial and/or pharmacological intervention, and directly referring patients to treatment (SBIRT) is a compelling model to address drug use among assault-injured individuals in the busy emergency department (ED) setting. Our objective in this study was to examine the current literature and determine ED-based strategies that have been reported that screen, directly refer to drug mis-use/addiction specialized treatment services, or initiate addiction treatment among individuals injured by non-partner assault in the United States.&nbsp;Methods: We conducted a systematic review of ED-based studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. OVID, MEDLINE, OVID Embase, OVID AMED, Web of Science-Core Collection, Cochrane CENTRAL, and CINAHL were systematically searched using keywords and Medical Subject Heading terms. Studies were excluded if they only involved intimate partner assault-injury, tobacco, or alcohol use. We categorized ED-based strategies as screening, direct referral, or treatment initiation.Results: Of the 2,076 non-duplicated studies identified, we included 26 full-text articles in the final analysis. Fourteen studies were cross-sectional, 11 were cohort, and one was case-control in design. The most common drug use screening instrument used was the National Institute on Drug Abuse Quick Screen Question. Cannabis was the most common drug detected upon screening.Conclusion: Drug use, while highly prevalent, is a modifiable risk factor for non-partner assault-injury. The paucity of scientific studies is evidence for the need to intentionally address this area that remains a major challenge for the public’s health. Future research is needed to evaluate ED-based interventions for drug use in this population

Trauma-Informed Acute Care of Patients With Violence-Related Injury

Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs. </jats:p