120 - Firearm Screening Practices at an Academic Pediatric Primary Care Clinic

Poster Number: 120
Publication Number: 120.329

Erica Sheline, University of Colorado School of Medicine, Denver, CO, United States; Eric J. Sigel, University of Colorado School of Medicine, Denver, CO, United States; Maya E. Bunik, University of Colorado School of Medicine, Aurora, CO, United States; Jan Leonard, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Maya Haasz, Children's Hospital Colorado, Aurora, CO, United States

Background: In 2019, 3,390 children in the United States were killed by firearms (FAs). Despite American Academy of Pediatrics (AAP) recommendations that pediatricians should counsel on the dangers of FAs in the home, counseling rates remain low.

Objective: The goal of this retrospective chart review was to (1) compare rates of FA discussion during well child visits by provider type; and (2) compare proportion of patients receiving FA-related counseling during their well-child visit compared to other recommended anticipatory guidance (AG).

Design/Methods: This was a retrospective chart review at a hospital-associated primary care clinic in Aurora, Colorado from January 1, 2019 – December 31, 2019. Patients aged 1-18 were eligible if presenting for a well-child visit. Of 7474 visits, 10% were selected for chart review using random-sequence generation. The primary outcome was documentation of any discussion related to FAs. Secondary outcomes included provider type who wrote the main visit note and documentation of AG related to FAs compared to other AAP-recommended child safety topics. We compared patient demographics and visit characteristics using chi-square and Fisher’s exact tests.

Results: We reviewed 743 patient visits, of which 9% included documentation of FAs (table 1). Significant differences in FA documentation were observed by primary provider (p < 0.001), with medical students documenting most frequently (15% compared to residents at 10%, advanced practice providers at 11%, and attending physicians at 1%). Patient charts were more likely to contain documentation of FA discussion in older age groups (30% for 15-18yo; p < 0.001), and providers were significantly more likely to provide FA-related AG above age 11 (p < 0.001). Documentation rates of FAs did not change based on mental health history or PHQ-9 score. Three families reported FAs in their home with FA safety counseling documented in one of these encounters. At least one AG topic was reviewed in 98% of charts, most commonly motor vehicles in 21% compared to only 4% of patients who received FA-related AG.Conclusion(s): FA counseling rates were low across all levels of training compared to other common injury-prevention AG guidance recommended by the AAP. Providers early in their training were more likely to discuss FAs with patients and families, which may represent increased awareness and education surrounding FA safety in new trainees. The large burden of FA morbidity and mortality contrasted with low FA screening and AG rates highlights the need for research identifying optimal interventions to increase FA discussions in pediatric clinic visits.
Erica Sheline CVEricaCV_jan22.pdf