Surgical and Critical Care Resource Utilization After Firearm Injury: An Age-Based Analysis.

INTRODUCTION

Firearm injuries affect all ages and may require urgent stabilization and surgical care at the nearest hospital. Hospitals vary in their readiness to deliver surgical and critical care resources, especially for younger children. This study investigated resource utilization in a broad statewide cohort of firearm injuries and compared utilization by age group.

METHODS

Patients admitted to hospitals with a firearm injury between 2015 and 2021 from the Florida statewide Agency for Healthcare Administration database were reviewed and categorized by age in years: children (0-13), young adolescents (14-15), older adolescents (16-17), adults (18-64), and elderly (65+). Rates of surgical procedures and critical care interventions were compared between age groups. Multivariable logistic regression modeling was used to evaluate the independent effect of age on resource utilization.

RESULTS

Of 16,263 hospitalized firearm injuries, 72% required a surgical procedure and 36% required a critical care intervention (endotracheal intubation, tube thoracostomy, or blood transfusion). Surgical procedures on the central nervous system (CNS) were highest for children (8%), but similar for older adolescents (4%), adults (3%), and elderly (3%). Intubation, tube thoracostomy, and blood transfusion were required for 24%, 12%, and 15%, respectively. On logistic regression adjusted for sex, race/ethnicity, insurance, transfer status, shooting intent, firearm type, hospital type, and injury severity score, CNS procedures (odds ratio 2.24, 95% confidence interval: 1.41-3.57) and blood transfusions (odds ratio: 1.44, 95% confidence interval: 1.06-1.94) were more likely among children compared to adults.

CONCLUSIONS

Firearm injuries carried a high risk of surgical procedures and critical care interventions. The odds of CNS surgical procedures in younger children were over twofold higher than that of adults, highlighting the importance of appropriate pediatric neurosurgical care. Hospitals must maintain readiness to provide immediate stabilizing care, including blood transfusion and endotracheal intubation, to firearm injury victims of all ages.