Critical care resource use, cost, and mortality associated with firearm-related injuries in US children's hospitals.

To assess trends and resource use attributable to firearm-related injuries in US pediatric intensive care units (PICUs). Retrospective data from Pediatric Health Information Systems (PHIS) database from 2004 to 2017. Of 5,984,938 admissions to 28 children's hospitals, 3707 were for firearm injuries. A total of 1088 of 3707 hospitalizations (29.9%) required PICU admission. Median PICU length of stay was 2 days (IQR, 1-6 days), and the median cost for PICU patients was $37,569.31 (IQR, $19,243.83-$77,856.32). Use of mechanical ventilation (674/1088 admissions [61.9%]), surgical procedures (744/1088 admissions [68.3%]), blood transfusions (429/1088 admissions [39.9%]), and intracranial pressure monitoring devices (30/1088 admissions [2.8%]) increased in PICU patients. Computed tomography showed an overall increase (197/287 [68.6%] to 138/177 [78%], P = .037) from 2004 to 2007 to 2016-2017. Mortality among PICU patients (140/1058 [13.23%]) attributable to firearm-related injuries increased insignificantly (34/285 (11.93%] to 25/172 [14.53%], P = .746). Using PHIS data, we found a significant increase in median cost per hospitalization and an increase in critical care resource use, including the frequency of invasive mechanical ventilatory assistance, neuromonitoring, operations performed, and transfusion of blood products. Further research is needed to continue to characterize the burden of pediatric critical firearm injury. Retrospective cohort study. Level III.

Kamat PP ，Santore MT ，Hoops KEM ，Wetzel M ，McCracken C ，Sullivan D ，Hall M ，Grunwell JR ... -  《-》

Clinical characteristics of firearm-related injuries in children in Turkey.

Vatansever G ，Yılmaz HL ，Nalbant T ，Kanğin M ，Almış H ，Köker A ，Çeleğen M ，Tekşam Ö ，Bozlu G ，Havan M ，Arslanköylü AE ，Güleryüz OD ，Battal F ，Özkaya PY ，Yener N ，Yıldızdaş D ，Duran R ，Tekin D ，Ulukol B ，Kendirli T ，Turkish Pediatric Firearm Study Group ... -  《-》

Opioid-Related Critical Care Resource Use in US Children's Hospitals.

There has been a rapid increase in the rate of pediatric opioid-related hospitalizations. It is unknown how this increase has impacted the use of pediatric critical care. Our objective in this study was to assess the trends in pediatric hospitalization for opioid ingestions in a cohort of US children's hospitals and, specifically, to evaluate the impact on pediatric critical care resource use. A retrospective cohort study of the Pediatric Health Information System was performed to identify hospitalizations for opioid ingestions from 2004 to 2015. Admission to the PICU and the use of naloxone, vasopressors, and ventilation were assessed by using billing data. The primary outcome measure was the trend in the rate of PICU admission for opioid-related ingestion over time, assessed by using Poisson regression. There were 3647 opioid-related hospitalizations in 31 hospitals; 42.9% required PICU care. The overall mortality was 1.6%, with annual deaths decreasing from 2.8% to 1.3% (P < .001). The number of opioid-related hospitalizations requiring PICU care doubled between 2004 and 2015. The rate of PICU admission for opioid-related hospitalization increased significantly, from 24.9 to 35.9 per 10 000 PICU admissions (P < .001). Among PICU admissions, 37.0% required mechanical ventilator support, and 20.3% required vasopressors. The US opioid crisis is negatively impacting children, and the rate of hospitalization and PICU admission for pediatric opioid ingestions is increasing. Current efforts to reduce adult opioid use have not curtailed the incidence of pediatric opioid ingestions, and additional efforts are needed to reduce preventable opioid exposure in children.

Kane JM ，Colvin JD ，Bartlett AH ，Hall M ... -  《-》

Outcomes of Children With Firearm Injuries Admitted to the PICU in the United States.

Firearm-related injury is the second leading cause of injury and death for children 1-18 years old in United States. The objective of our study was to analyze the outcomes of children admitted to the PICU with firearm injuries. Retrospective study. PICUs in United States contributing data to Virtual Pediatric Systems, LLC, from January 2009 to December 2017. Children age 1 month to 18 years old admitted to the PICU with firearm injury, identified by external cause of injury E-codes and International Classification of Diseases, 9th Edition, and International Classification of Diseases, 10th Edition, codes were identified. None. There were 1,447 cases identified of which 175 (12%) died in the PICU. Unintentional firearm injury (67.7%) and assault with a firearm injury (20%) comprised 90% of the cases. Males comprised 78% of the cohort (1,122) and race distribution included 45% Black (646), 27% White (390), and 12% Hispanic (178). Among the children who died in the PICU, 55% were 13-18 years old. Children attempting suicide with a firearm were more likely to die in the PICU as compared to the other causes of firearm injury. Based on their Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores at discharge, there is high morbidity in children with firearm injuries. Mortality rate of children with firearm injury admitted to the PICU is high. Children admitted to the PICU with suicide attempt with a firearm carried the highest mortality. Further studies may help further define the epidemiology of firearm injuries in children and plan interventions to minimize these unnecessary deaths.

Bagdure D ，Foster CB ，Garber N ，Holloway A ，Day J ，Lee J ，Soto-Campos G ，Brundage N ，Bhutta A ，Graciano AL ... -  《Pediatric Critical Care Medicine》

Financial burden of pediatric firearm-related injury admissions in the United States.

Taylor JS ，Madhavan S ，Han RW ，Chandler JM ，Tenakoon L ，Chao S ... -  《PLoS One》