How Often Are Physicians Screening for Firearms in the Home During Inpatient Pediatric Admissions for Common Diagnoses?

Title How often are physicians screening for firearms in the home during inpatient pediatric admissions for common diagnoses? Purpose/Objective Firearm-related injuries remain a top cause of death in American children and adolescents. The 2012 American Academy of Pediatrics Gun Violence Policy Recommendations recommend that pediatricians incorporate questions about the presence and availability of firearms into their patient history taking and urge parents who possess guns to prevent access to these guns by children. No studies have measured rates of screening for firearms in the inpatient setting. Our study aims to evaluate the frequency of screening for firearms in an academic tertiary children’s hospital. Design/Methods This IRB exempt retrospective chart review examined patients with the top seven pediatric diagnoses admitted to an academic tertiary children’s hospital from 2000-2015. Patients with an admitting or primary diagnosis of asthma, acute kidney failure, jaundice, single liveborn infant, pneumonia, bronchiolitis, or any mood disorder were included in the study. The data analysts then electronically searched the admission H&P for patients who met these inclusion criteria for documentation of the following keywords associated with firearm screening: “firearm,” “pistol,” “gun,” “handgun,” “bullet,” “ammunition,” or “rifle.” Study authors will hand review admission H&Ps for patients identified in the electronic search to assess the frequency of documentation of four firearm and ammunition storage practices: 1) keeping guns locked 2) keeping guns unloaded 3) keeping ammunition locked 4) keeping ammunition in a separate location from guns. They will also assess the frequency and type of documentation of any firearm-related guidance provided in these admission H&Ps. Results Evidence of screening was found in 977 of the 10,981 charts included for study (8.9%). Rates of screening were highest for patients with an admitting diagnosis of mood disorder: 867/3807 (22.8%) compared to a range of 0-3.6% for the other diagnoses. Likewise, rates of screening were highest when the admitting service was child psychiatry: 821/3355 (24.5%) compared to a range of 1.0-2.1% for all general pediatric, ICU, and other pediatric subspecialty services. Results of the hand review of identified charts are pending at the time of abstract submission. Conclusions/Discussion Firearm screening occurred infrequently in this inpatient setting, especially for non-psychiatric patients. The inpatient setting provides a unique opportunity for screening and education on firearms. The benefits of inpatient screening include fewer time constraints, access to hospital resources, exposure to a greater number of providers, and the presence of more family members or caregivers. The admission process may provide an opportunity for screening that is currently being missed. Further studies are warranted to explore barriers to firearm screening in inpatient pediatrics and best practices for improvement.