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Few ED physicians counsel families on firearm injury prevention
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CHICAGO — Although most pediatric emergency medicine providers believe that proper counseling could prevent firearm injuries sustained by children, only about 35% provide occasional or frequent guidance on the topic to families, according to survey data presented at the AAP 2017 National Conference & Exhibition.
The researchers note that many physicians are hesitant to provide this education to the families they treat because of political ideologies and not having extensive education in this topic.
“I think it is part of our job as pediatricians to educate,” Sheryl E. Yanger, MD, FAAP, from Ann & Robert H. Lurie Children’s Hospital of Chicago, said in an interview with Infectious Diseases in Children. “There isn’t just one way to provide this screening and counseling, so physicians should find something that works for them and for their department.”
To assess pediatric emergency medicine providers’ knowledge, beliefs and ways in which firearm safety counseling and assessments are performed within the ED, the researchers conducted a prospective cross-sectional survey that included pediatric emergency providers. These providers were reached through the AAP Section of Emergency Medicine Pediatric Emergency Medicine Collaborative Research Committee listserve.
Of the 185 respondents (40% response rate), 90% were attending physicians who had completed a pediatric emergency medicine fellowship (83%). These respondents also were likely to practice in an academic university-based (78%), urban (87.9%) or free-standing children’s hospital (69.4%). Of all respondents, 66.8% were Democrats, and 11.6% owned a firearm or had one in the home.
Most physicians believed that the information provided to families have the ability to limit the number of general injuries sustained by children (90%), including the promotion of helmet use and child passenger safety, and 70% believed that this information may prevent firearm-related injuries. Although a significant number of physicians believe that this information can be helpful, they were much less likely to sometimes or frequently counsel families on firearm injuries compared with general injuries.
The main reasons reported by physicians for not providing firearm injury prevention information include political restraints, lack of awareness and legal constraints where there were obstacles to providing topics on general injury prevention. Approximately one-third of physicians were also uneducated on state law permitting or hindering firearm discussions.
Beliefs held by those who were likely to provide counsel on firearm injury prevention were revealed through logistic regression. These beliefs included confidence that the information provided would be helpful in reducing pediatric injuries (AOR 2.19, P =.04), feeling as though they are able to provide this information effectively (AOR 4.05, P = .002) and having a sense of responsibility regarding the need to counsel families on firearm safety (AOR 5.13, P < .001). Physicians were also more likely to counsel families if they were aged older than 45 years (AOR 3.37, P = .002).
“We are hoping that through identifying barriers, we can provide education and information that will hopefully increase the use of screening and counseling,” Yanger said. “The way to decrease gun violence is primary prevention in children and decreasing their access to firearms.” – by Katherine Bortz
Reference:
Yanger S, et al. Firearm safety: A survey on practice patterns, knowledge and opinions of pediatric emergency medicine providers. Presented at: The 2017 AAP National Conference & Exhibition; Sept. 16-19; Chicago.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Daniel M. Fein, MD
We, as pediatricians — and, in particular, pediatric emergency medicine physicians — need to do a better job of screening for a child’s risk of firearm injury, even when the reason for the visit is not firearm-related.
There may be some bias with this study as not every emergency department (ED) is at a level 1 trauma center where providers are likely to see firearm-related injuries, as opposed to counseling on safe sleep habits in which all ED providers, regardless of the type of ED, will see infants where this is directly relevant.
This study highlights that firearm-related injuries need to be on pediatricians’ and pediatric emergency medicine physicians’ minds, even in non-level 1 trauma centers, and it is our responsibility to know how to appropriately counsel parents and caregivers on firearm safety.
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