O3240: Profiles of Prior Healthcare Contact among Pediatric and Young Adult Patients Presenting for Gunshot Wound

Background: Firearms are the leading cause of death in the United States among individuals 1-24 years and the incidence is rising. This study aims to identify risk factors associated with presentation for a gunshot wound (GSW) using information from electronic health records of prior visits.

Methods: We included GSW encounters for patients < 25 years at a level 1 pediatric and adult trauma center from 01/2018-12/2022. For patients with prior visits to the same institution as the GSW (termed “prior contact”), we coded information on prior visit types, injuries, mental health diagnoses and referrals to identify patterns of contact among these individuals. Latent class analysis (LCA) was conducted to identify profiles for these patients with prior contact before their GSW. Logistic regression was used to associate profile membership with patient and GSW encounter characteristics.

Results: 899 GSW encounters occurred during our study period. 567 (63%) of these were seen for prior contact. Using LCA, we identify 5 profiles for prior contact patients: Class 1 with high prior trauma exposure (10.2%), Class 2 with high prior nonviolent and nontraumatic injury exposure (27.5%), Class 3 with low prior contacts and limited risk factors (40.7%), Class 4 with high psychiatric exposure, including inpatient care (13.8%), and Class 5 with high socio-economic resource needs and few prior injuries (7.8%). Using logistic regression, Class 1 are more likely to be male, older, and have more prior contacts on average. Class 2 have more prior contacts but are otherwise undistinguished by patient or prior encounter characteristics. Class 3 are younger, more likely female, and are more likely to have arrived via air transport. Class 4 have higher prior contacts, a higher likelihood of trauma team activation at the ED and are more likely to have a self-inflicted GSW. Class 5 are not significantly different on key patient characteristics from other classes but are more likely to experience GSW injury inflicted by others and demonstrate a pattern of missed appointments and child services involvement.

Conclusion: This study has identified 5 profiles of prior healthcare visits, documented mental health and socio-economic risk factors, and prior injuries among pediatric and young adult patients presenting for GSW, a diverse population in high need of tailored prevention strategies in clinical and community settings. Only one group, the high trauma exposure (Class 1), had substantial documentation of firearm related risk factors, suggesting that other risk factors and patterns of prior injury could be better utilized to identify risk for a future GSW encounter. Classes 1, 2, 4, and 5 (representing 60% of the study population) had, on average, 5 prior contacts with the same healthcare system where they later received care for an initial GSW encounter.