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Mental Health Consequences Following Firearm and Motor Vehicle Related Injuries: Impacting our Treatment Strategies
Peter F. Ehrlich1, Heidi De Souza2, Annie Andrews3, Bonnie Zima4, Sophia Chaudhary5, Matt Hall2, Jennifer A. Hoffmann6, Joel Fein5, Eric Fleegler7, Christian D. Pulcini8, Kristyn Jefferies9, Monica Goyal10, Elizabeth . Alpern6, Stephen Hargarten11
1Surgery, University of Michigan, Ann Arbor, Michigan, United States, 2Statistics, Childrens Hospital Association, Lenexa, Kansas, United States, 3Pediatrics, Medical Collage of South Carolina, Charleston, South Carolina, United States, 4Psychiatry, UCLA, Los Angeles, California, United States, 5Emergency Medicine, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania, United States, 6Pediatrics, Lurie Childrens Hospital, Chicago, Illinois, United States, 7Emergency Medicine, Boston Childrens Hopsital, Boston, Massachusetts, United States, 8Emergency Medicine, UNIVERSITY OF VERMONT, Burlington, Vermont, United States, 9Pediatrics, Childrens Mercy Hospital, Kansas City, Missouri, United States, 10Emergency Medicine, Childrens National Medical Center, Washington, District of Columbia, United States, 11Emergency Medicine, Medical Collage of Wisconsin, Milwaukee, Wisconsin, United States

Objective Trauma exposure is a well-established risk factor for child mental health concerns. A critical knowledge gap exists regarding mental healthcare following firearm injuries. The purpose of this study is to compare newly detected mental health diagnoses (NMHD) and resource among children and adolescents who receive follow-up care after a firearm injury compared to those who suffer a MVC injury. Methods Using Medicaid MarketScan claims data (2010-2016) we conducted a longitudinal propensity score retrospective study with one year follow up for children aged 3- 17. Each child with a firearm injury was matched with up to 3 children with a MVC injury using age (in years), sex, and the season in which the injury occurred. Children Injury severity was determined by injury severity score (ISS) and ED disposition (home, admit to floor or ICU). Complex chronic condition (CCC) status was determined by diagnosis and procedure codes through a previously validated scheme had Medicaid enrollment one year prior to and after injury date. A multivariable logistic regression model for the primary outcome of acquiring a NMHD diagnosis post injury was used to compare firearm injuries to MVC injuries. Odds ratio (OR) for NMHD post injury was adjusted for race, complex chronic conditions (CCC), and severity of injury. Results A total of 1459 children and adolescents were included in the firearm injury cohort with 3691 included as matched controls in the MVC injury cohort. Compared to children with MVC injuries those with firearm injuries were more likely to be Black (64.7%, 37.0 p<0.001), had higher median ISS (4.0, 1.0 p<0.001), less likely to have a prior CCC (5.2%, 7.8% p=0.001), and less likely to be discharged from the emergency department (ED) (71.7%, 93.4% p<0.001). Children with firearm injuries were more likely to have a NMHD post injury compared to after MVC aOR (1.55 [1.33, 1.80]). Hospital admission/severity of injury increased the odds of a new mental health diagnosis compared to discharged from ED: floor (aOR 1.80 [1.47, 2.22]) and ICU (aOR1.78 [1.22, 2.59]) The increased risk of new mental health diagnoses was driven by increases in substance-related and addictive disorders (aOR 2.077 [1.635, 2.639]) and trauma and stressor-related disorders (aOR 2.071 [1.551, 2.764]) (figure1) Conclusions Children in the year following a firearm injury were 1.5 times more likely to have a new NMHD as compared to a MVC. Trauma center future research is needed to develop strategies to detect and treat for the risk of MH sequela as well as examine the extent of undetected need for MH care among children at risk for exposure to firearm injuries


Figure one Adjusted Odds ratio of a New Mental Health Diagnosis Following a Firearm Injury


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