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Pediatric emergency department physicians wary of discussing firearm injury prevention

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CHICAGO – Many emergency departments provide education on childhood injury prevention. But new research shows many physicians are leaving out one important topic: firearm injury prevention.

The study abstract, "Firearm Safety: A Survey on Practice Patterns, Knowledge and Opinions of Pediatric Emergency Medicine Providers," will be presented Friday, Sept. 15 at the 2017 American Academy of Pediatrics National Conference & Exhibition in Chicago. The study found many physicians do not discuss firearm injury prevention when discussing overall injury prevention issues such as helmet use, child passenger safety or childproofing.

"The best solution for firearm injuries in children is primary prevention," said lead researcher Sheryl Yanger, MD, FAAP, an attending physician in pediatric emergency medicine at Ann & Robert H. Lurie Children's Hospital of Chicago. "And we hope this study will lead to future efforts to increase pediatric injury prevention and firearm safety counseling in the emergency department."

Researchers conducted a prospective cross-sectional survey of pediatric emergency providers and received 185 responses. Approximately 35 percent of those who responded said they provide counseling on firearm injury prevention "sometimes" or "frequently" when compared with other injury prevention topics, such as helmet use and child passenger safety.

When asked about barriers to firearm safety counseling, respondents reported more political restraints, lack of awareness, and legal constraints as compared with barriers to general injury prevention counseling. About a third of respondents were unsure if the law in their state permitted them to have discussions about firearms.

Researchers suggest that future efforts to increase firearm safety screening and counseling by pediatric emergency department providers in the emergency department should focus on efforts to improve clinician confidence and increase the feeling of personal responsibility for providing this information. This, as well as continuing to analyze barriers to both general injury prevention and firearm safety in the emergency department, may lead to increased counseling among pediatric emergency department providers.

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Yanger will present the abstract, available below, on Friday, Sept.15, from 3:15 p.m. to 3:30 p.m. CT in McCormick Place West, Room S101. Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Abstract Title: Firearm Safety: A Survey on Practice Patterns, Knowledge and Opinions of Pediatric Emergency Medicine Providers

Background and Objectives: Firearm injuries continue to be one of the top three leading causes of death in American youth, and access to firearms remains an important focus for primary injury prevention efforts in children. Emergency departments (EDs) often serve as a center for screening and education on injury prevention as injuries are the most common reason for pediatric ED visits. Our study sought to examine the knowledge, opinions, and practice patterns of pediatric emergency medicine (PEM) providers in regard to firearm safety counseling and assessment in the ED. Methods: We conducted a prospective cross-sectional survey of pediatric emergency providers through the AAP Section on Emergency Medicine (SOEM) Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) list-serve. Results: A total of 465 members of the SOEM received an invitation to complete the survey. Results of 185 responses were available for analysis, giving an overall response rate of 40%. The majority of respondents were attending physicians (90%), had completed PEM fellowship (83%), and practice in academic university based (78%), urban (87.9%), free-standing children's hospitals (69.4%). Most clinicians self-identified as Democrat (66.8%) and only 11.6% reported owning or having a firearm in the home. Ninety percent of providers agreed that information they provide families can help reduce pediatric injuries in general and 70% agreed that information they provide may help prevent firearm injuries. However, only half as many clinicians reported providing counseling on firearm injury prevention "sometimes" or "frequently" when compared with other injury prevention topics, such as helmet use and child passenger safety. When asked about barriers to firearm safety counseling, more respondents reported political restraints, lack of physician awareness, and legal constraints compared with barriers to general injury prevention counseling. About a third of respondents were unsure if the law in their state permitted them to have discussions about firearms. The results of logistic regression analysis showed that the biggest predictors of clinicians providing firearm safety counseling were: 1) feeling that information they provide families helps to reduce pediatric injuries (AOR 2.19, p = 0.04), 2) confidence in their ability to provide firearm injury prevention information (AOR 4.05, p = 0.002), 3) feeling that it is their responsibility to counsel on firearm safety (AOR 5.13, p 45 yr (AOR 3.37, p = 0.002). Discussion: This survey, while of a select population of PEM providers, suggests that future efforts to increase firearm safety screening and counseling by PEM providers in the ED should focus on interventions that improve clinician confidence and increase the feeling of personal responsibility for providing this information. This, as well as analyzing barriers to both general injury prevention and firearm safety in the ED, may lead to increased counseling among PEM providers.

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Noreen Stewart
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