O3215: Mental and Behavioral Health Characteristics and Service Utilization in Firearm-injured Children

Background: Firearms are a leading cause of injury-related death in children in the US and are associated with increased morbidity. There is a bidirectional relationship between mental and behavioral health (MBH) and risk for traumatic injury. Elucidating the prevalence and timeline of MBH diagnoses, predisposing psychosocial factors, and MBH service utilization in firearm-injured children, is important for understanding how to effectively provide services and improve recovery. The objective of this study was to describe MBH diagnoses identified before, during, and within 6 months after injury in firearm-injured children compared to a matched population of motor vehicle cash (MVC)-injured children. Our secondary objective was to describe pre-injury adverse childhood experiences (ACEs) that may moderate the relationship between MBH and injury, and MBH services utilized before, during, and after injury.

Methods: This was a single-institution, retrospective study at a Level 1 Pediatric Trauma Center. The trauma registry was queried to identify firearm-injured children 5-17 years old from 1/1/2016-03/31/2021 with a length of stay >= 48 hours. These children were matched 1:1 by age, sex, season, and injury severity to MVC-injured children. Demographic characteristics, including the Area Deprivation Index (ADI, a marker of socioeconomic status), were compared between firearm-injured and MVC-injured children. Review of the electronic medical record (EMR) was used to capture MBH diagnoses through notes and pharmacy records for the following time periods: before, during, and up to 6 months after the index injury admission. Additionally, MBH services and pre-injury ACEs were described.

Results: There were 98 firearm-injured children that met inclusion criteria. After matching, firearm-injured children were more likely to be Black (75.5% vs. 37.8%, p< 0.001), have public insurance (84.7% vs. 60.2%, p< 0.001), and live in areas of higher deprivation (median ADI 10.0 [IQR 8.0-10.0] vs. 9.0 [IQR 5.0-10.0, p=0.008) than MVC-injured children. Attention deficit/hyperactivity disorder was most the most common MBH diagnosis, identified in 18.4% of children pre-injury. However, MBH diagnoses were rarely identified during or after admission, and there were no significant differences in type nor quantity of MBH diagnoses at any time period between cohorts. Among ACEs documented, firearm-injured children were more likely to experience neglect (10.2% vs. 1.0%, p=0.01), financial problems (20.4% vs. 9.2%, p=0.04), family conflict (31.6% vs. 14.3%, p=0.007), and family separation (41.8% vs. 22.4%, p=0.006) (Table 1). There were no significant differences in Psychiatry and Psychology service utilization between cohorts before, during, and after index injury admission (Table 2).

Conclusion: This study showed little variation in MBH diagnoses and MBH services utilized between firearm-injured and MVC-injured children before, during, and after admission. Despite the low prevalence of MBH diagnoses documented, the inpatient MBH service teams treat the majority of patients irrespective of mechanism, demonstrating commitment to the needs of all injured children at our institution.