Database Linkage Providing Hospital-based Information About Children and Teen Firearm Injuries

Abstract

Firearm-related injuries are a leading cause of morbidity and mortality among children and adolescents. Research examining child and adolescent firearm injury prevention is constrained by the availability of high-quality data on non-fatal firearm injuries across the spectrum of hospital care. This project aims to address this challenge by linking existing clinical electronic health record and administrative databases to produce a rich patient-centric hospital-based database of pediatric firearm injuries across the care continuum. The study will use linkage methodology to produce a database related to firearm injuries (e.g., emergency care, hospital care, long-term health outcomes) and allow for preliminary exploration of the epidemiology of pediatric firearm injuries that are not immediately fatal at the time of the injury. The resulting database will help facilitate future studies focused on pediatric firearm care and prevention.

This proposal capitalizes on the strengths of Pediatric Emergency Care Applied Research Network (PECARN), the Children’s Hospital Association (CHA), and the Firearm Safety Among Children and Teens (FACTS) Consortium to address the dire issue of firearm injuries in pediatric emergency medicine. The resultant database will have the potential for pediatric firearm injury health services research at a pivotal time of funding opportunities.

By leveraging advances in health information technology to access patient-centric clinical data, researchers have opportunities to investigate risk factors for disease processes, along with the relationship between diagnostic and therapeutic interventions and outcomes in heterogeneous patient populations in real-world settings. This project proposes to capitalize on the strengths of two existing databases encompassing emergency department (ED) and hospital based (inpatient and outpatient clinic) medical care that may be linked to create a novel data bank facilitating the exploration of care to children with firearm-related injury. Each database would bring unique attributes to the final linked repository including deep clinical data, narrative free-text, and health care utilization outcomes that will allow the project team to gather contextual data on firearm injuries among children by intent and by injury. The databases proposed for linkage are the PECARN Registry, and the Children’s Hospital Association Pediatric Health Information Systems database (CHA-PHIS).

This project intends to create a linked database to allow health services research about firearm related emergency care, as well as to follow firearm-related injury patients across care settings (ED, inpatient, outpatient clinic) and also longitudinally across years. Strengths of the proposed work include the continuum of care sites (ED, inpatient, outpatient), the pooled volume of injuries (allowing more sophisticated analyses), and the depth of clinical data available, especially for non-fatal pediatric firearm injuries. In concert, these databases provide a unique opportunity to study the potential of prevention interventions and to identify optimal measurement and treatment of pediatric firearm injuries. Specific aims:

Aim 1: The linkage of two existing databases, a subset of the PECARN Registry with subset of the Children’s Hospital Association Pediatric Health Information Systems database (CHA-PHIS)

Aim 2: Pediatric firearm injury health services pilot study to validate International Classification of Disease (IDC) codes related to identification of pediatric firearm injury and documentation of intentionality and method of injury