Variation in Acute Pain Management of Youth with Non-Fatal Firearm Injuries

Christian D Pulcini; Mark Zamani; Elizabeth R Alpern; Sofia Chaudhary; Peter F Ehrlich; Joel A Fein; Monika Goyal; Matt Hall; Stephen Hargarten; Jennifer A Hoffmann; Rachel Myers; Karen M Sheehan; Bonnie T Zima; Eric W Fleegler; CHARGE Group

doi:10.1016/j.acap.2025.102877

Variation in Acute Pain Management of Youth with Non-Fatal Firearm Injuries

Acad Pediatr. 2025 Jul 2:102877. doi: 10.1016/j.acap.2025.102877. Online ahead of print.

Authors

Affiliations

¹ Departments of Emergency Medicine & Pediatrics, University of Vermont Medical Center and Children's Hospital, Larner College of Medicine at the University of Vermont, Burlington, VT, USA. Electronic address: Christian.pulcini@uvm.edu.
² Children's Hospital Association, Washington, DC, USA.
³ Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁴ Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
⁵ Section of Pediatric Surgery, CS Mott Children's Hospital University of Michigan Ann Arbor, Michigan, USA.
⁶ Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Pediatrics, Children's National Hospital, George Washington University, Washington, DC, USA.
⁸ Children's Hospital Association, Lenexa, KS, USA.
⁹ Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁰ UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA.
¹¹ Departments of Pediatrics and Emergency Medicine, Harvard Medical School; Department of Emergency Medicine, Massachusetts General Hospital; MGH Gun Violence Prevention Center, Boston, MA, USA.

PMID: 40614961
DOI: 10.1016/j.acap.2025.102877

Abstract

Objective: Firearm injuries are a leading cause of morbidity among youth, yet acute pain management practices have not been well characterized. Our objective was to evaluate acute pain medication administration by key sociodemographic characteristics and injury severity after non-fatal firearm injuries.

Methods: We performed a retrospective cross-sectional analysis utilizing Pediatric Health Information System at 40 US children's hospitals from 2016-2021. We included inpatient and ED only encounters for patients 0-21 years old with a firearm injury diagnosis. The main outcome was administration of analgesic medications: none, non-opioid only, or at least one opioid. We included sociodemographic and injury severity score. Multivariable logistic regression was utilized to determine characteristics associated with the outcome.

Results: We included 4,924 patients with non-fatal firearm injuries. By ED discharge vs. admission, 39.0% vs. 3.5% received no analgesia. For the 2,522 patients discharged from the ED, younger children were more likely to receive no analgesia. Non-Hispanic White and Hispanic patients were more likely to receive no analgesia compared to non-Hispanic Black patients (aOR 1.67 [95% CI 1.31, 2.31]; aOR 1.53 [1.18, 1.98], respectively). Receipt of opioids was lower among 5-9-year-old patients (aOR 0.40 [0.29, 0.54]), females (aOR 0.77 [0.62, 0.97]), and non-Hispanic White (aOR 0.59 [0.62, 0.75) and Hispanic patients (aOR 0.52 [0.40, 0.67]).

Conclusion: Among youth with non-fatal firearm injuries, analgesia administration varied greatest in the ED discharged population. This suggests a need for further investigation into pain management practices focused on differences and potential undertreatment of pain in youth with non-fatal firearm injury.

Keywords: Emergency Department; Firearm Injury; Inpatient; Pain Management.