Cohort Definition Name: “Firearm Accidents (FA)”
Contributor name: Jill Hardin
Contributor OrcId: 0000-0003-2682-2187
Logic Description: All events of firearm accidents with an emergency room or inpatient visit on index.
Recommended study application: outcome
Assertion statement: This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.
Submitted cohort definition:
FirearmAccident.txt (9.3 KB)
Target Clinical Description
Overview:
Firearm accidents, also known as unintentional firearm injuries, occur when a firearm is discharged accidentally, leading to injury or death. These incidents often result from mishandling, improper storage, or lack of firearm safety knowledge. Firearm accidents can cause a range of injuries, from minor wounds to severe trauma, and pose a significant public health concern. From 2010 to 2019, there were an estimated 391, 592 emergency department (ED) visits in the United States among children and youth 0 to 24 years of age for firearm injuries. An in-depth analysis of 178 299 firearm injuries among youth 0 to 21 years of age in the Nationwide Emergency Department Sample demonstrated a male majority (89.0%), a mean age of 17.9 years, and 43% enrolled in public insurance. The intent of the shooting was unintentional in 39.4%, assault in 37.7%, and self-harm in 1.7%.
Presentation:
Clinical presentation of firearm accidents may include:
Gunshot wounds are characterized by entrance and exit wounds, bleeding, and tissue damage. Bone fractures may occur due to the impact of the bullet. Damage may occur to muscles, tendons, and nerves. There may be bleeding and vascular compromise. Injury may occur to vital organs, leading to life-threatening complications.
Diagnostics Evaluation:
Assessment of firearm accidents involves obtaining a detailed history of the circumstances surrounding the accident. A thorough examination of the wound and affected area is conducted. X-rays or other imaging studies are done to assess for fractures, foreign bodies, and internal injuries. Blood tests may be done to assess for blood loss, infection, and systemic effects.
Treatment Plan:
The treatment plan for firearm accidents involves immediate first aid to control bleeding, stabilize the patient, and provide basic life support if needed. Cleaning and debridement of the wound is performed under sterile conditions. Bone fractures are splinted or surgically fixed, as needed. Soft tissue injuries are sutured, or wounds closed. Surgical intervention may be required to control bleeding or to repair internal organs or structures.
Prognosis:
The short-term prognosis for firearm accident victims depends on the severity of injuries and the effectiveness of early medical intervention. Long-term outcomes can vary based on the extent of injuries. Some patients may experience chronic pain, disabilities, or functional impairments that require ongoing management and rehabilitation.
Exclusions:
Conditions or treatments to rule out:
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Intentional gunshot wounds (homicide or suicide)
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Other traumatic injuries
#Ambiguity:
Intentional Firearm Injuries: Intentional firearm injuries, including suicide or homicide, represent a different clinical context and should not be confused with unintentional firearm accidents.
Subtypes:
There are no specific subtypes of firearm accidents for this report.
References:
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Hardy MS, et al. Unintentional firearm injuries in children: a review, case series, and a framework for prevention. Am J Lifestyle Med. 2017;11(5):390-405.
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Rivara FP, et al. Youth firearm suicide: an opportunity for comprehensive regional injury prevention. Pediatrics. 2017;139(3):e20162643.
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Grossman DC, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA. 2005;293(6):707-714.
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Shenoi RP, et al. A population-based study of unintentional firearm injury: factors influencing severity. JAMA Surg. 2013;148(8):838-844.
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Sasser SM, et al. Epidemiology of firearm and other injuries treated at the trauma center of children’s hospital in Seattle. Pediatr Emerg Care. 1998;14(6):377-382.
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Zaleski RT, et al. Hospital-based emergency department visits involving unintentional discharges of firearms. Ann Emerg Med. 2006;48(6):720-725.
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Avraham JB, et al. Pediatric gunshot wounds: a scar to bear for a lifetime. Pediatr Ann. 2017;46(6):e213-e218.
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Rowhani-Rahbar A, et al. Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration: a cohort study. Ann Intern Med. 2015;162(7):492-500.
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Coben JH, et al. Hospitalizations for firearm-related injuries: a population-based study of patients aged 0–19 years. JAMA. 1999;282(5):447-454.
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Dahlberg LL, et al. Firearm injuries in the United States. Prev Med. 2004;38(1):9-16.
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Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System (WISQARS). Available at: WISQARS (Web-based Injury Statistics Query and Reporting System) | Injury Center | CDC. Accessed May 3, 2022
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Patel SJ, Badolato GM, Parikh K, Iqbal SF, Goyal MK. Sociodemographic factors and outcomes by intent of firearm injury. Pediatrics .2021;147(4):e2020011957.
Phevaluator results overview:
Phevaluator results shows the highest PPV results for the phenotype requiring a second code within 180 days of the first code. This definition decreases the sensitivity compared to the phenotype definition which requires only 1 code. The numbers of subjects identified in the two code phenotype is reduced by ~30-40% compared to the one code definition. There is a high degree of overlap between the two definitions.
We recommend use of cohort that requires a single FA code and ER visit on index. The group level characteristics around index is consistent with expected with high prevalence of injury, pain codes along with presence of diagnostic work ups (such as CT-scan and other imaging) and pain killers (such as acetaminophen and others) on index. There is unlikely to be an index event misclassification, given that over 90% of patients had an ER visit on index. It is hard to estimate the sensitivity of the definition, given that phevaluator results are subject to the limitation of the prediction model.
The Phevaluator results interpretation shows that although FA causes severe injuries they may appear similar to other injuries eg - industrial accidents, etc. which causes the results to be lower than hoped for, specifically reasonable PPV but lower sensitivity. Those without the FA code have some sort of severe wound that could have been caused by just about anything.