AEM Early Access

AEM Early Access 21: Long-term Mortality in Pediatric Firearm Assault Survivors

Welcome to the twenty-first episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

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DISCUSSING (CLICK ON LINK FOR FULL TEXT, OPEN ACCESS THROUGH DECEMBER 31):

Long-term mortality in pediatric firearm assault survivors: a multi-center, retrospective, comparative cohort study. Ashkon Shaahinfar, MD, MPH, Irene H. Yen, PhD, MPH, Harrison J. Alter, MD, MS, Ginny Gildengorin, PhD, Sun-Ming J. Pan, James M. Betts, MD and Jahan Fahimi, MD, MPH.

listen now: first author interview with ashkon shaahinfar md mph

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Ashkon Shaahinfar, MD, MPH

Attending Physician and Emergency Ultrasound Director

Division of Emergency Medicine

UCSF Benioff Children’s Hospital Oakland

ABSTRACT

Objectives: The objective was to determine whether children surviving to hospital discharge after firearm assault (FA) and nonfirearm assault (NFA) are at increased risk of mortality relative to survivors of unintentional trauma (UT). Secondarily, the objective was to elucidate the factors associated with long-term mortality after pediatric trauma.

Methods: This was a multicenter, retrospective cohort study of pediatric patients aged 0 to 16 years who presented to the three trauma centers in San Francisco and Alameda counties, California, between January 2000 and December 2009 after 1) FA, 2) NFA, and 3) UT. The Social Security Death Master File and the California Department of Public Health Vital Statistics (2000–2014) were queried through December 31, 2014, to identify those who died after surviving their initial hospitalization and to delineate cause of death. Multivariate Cox proportional hazards regression was performed to determine associations between exposure to assault and long-term mortality.

Results: We analyzed 413 FA, 405 NFA, and 7,062 UT patients who survived their index hospital visit. A total of 75 deaths occurred, including 3.9, 3.2, and 0.7% of each cohort, respectively. Two-thirds of all long-term deaths were due to homicide. After multivariate adjustment, adolescent age, male sex, black race/ethnicity, and public insurance were independent risk factors for long-term mortality. FA (adjusted hazard ratio [AHR] = 1.8, 95% confidence interval [CI] = 0.82–4.0) and NFA (AHR = 1.9, 95% CI = 0.93–3.9) did not convey a statistically significant difference in risk of long-term mortality compared to UT. Being assaulted by any means (with or without a firearm), however, was an independent risk factor for long-term mortality in the full study population (AHR = 1.9, 95% CI = 1.01–3.4) and among adolescents (AHR = 1.9, 95% CI = 1.01–3.6).

Conclusion: Children and adolescents who survive assault, including by firearm, have increased long-term mortality compared to those who survive unintentional, nonviolent trauma.

AEM Early Access 20: Tracking Assault-Injured, Drug-Using Youth in Longitudinal Research

Welcome to the twentieth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

DISCUSSING (click on link for full text, open access through november 30):

Tracking Assault-Injured, Drug-Using Youth in Longitudinal Research: Follow Up Methods. Jessica S. Roche, MPH, Michael J. Clery, MD, MPP, Patrick M. Carter, MD, Aaron Dora-Laskey, MD, MS, Maureen A. Walton, MPH, PhD, Quyen M. Ngo, PhD, and Rebecca M. Cunningham, MD.

LISTEN NOW: FIRST AUTHOR INTERVIEW WITH JESSICA ROCHE, MPH

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Jessica Roche, MPH

Managing Director

University of Michigan Injury Prevention Center

Abstract

Objectives: Violence is one of the leading causes of death among youth ages 14-24. Hospital and ED-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, though little literature exists regarding optimizing follow-up methods for violently-injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants.

Methods: The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drug-using youth recruited in an urban ED, and a comparison population of drug using youth seeking medical or non-violence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, 24 months). Follow-up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and follow-up interview completion at 18 24 months.

Results: 599 patients (ages 14-24) were recruited from the ED (mean age=20.1 years, 41.2% female, 58.2% African American), with follow-up rates at 6, 12, 18, and 24 months of 85.3%, 83.7%, 84.2%, and 85.3%, respectively. Participant contact efforts ranged from 2 to 53 times per follow-up timeframe to complete a follow-up appointment, and more than 20% of appointments were completed off-site at community locations (e.g., participants' homes, jail/prison).Participants who were younger (p<.05) and female (p<.01) were more likely to complete their 24-month follow-up interview. Participants who sought care in the ED for assault injury (p<.05) and had a substance use disorder (p<.01) at baseline required fewer contact attempts to complete their 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p<.01) required more intensive contact efforts.

Conclusions: The FYI study demonstrated that achieving high follow-up rates for a difficult-to track, violently-injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for follow-up strategies planned as part of other violence prevention studies.

AEM Education and Training 08: Factors Important to Top Clinical Performance in EM Residency

Welcome to the eighth episode of AEM Education and Training, a podcast collaboration between the Academic Emergency Medicine E&T Journal and Brown Emergency Medicine. Each quarter, we'll give you digital open access to AEM E&T Articles or Articles in Press, with an author interview podcast and links to curated supportive educational materials for EM learners and medical educators.

Find this podcast series on iTunes here.

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DISCUSSING (click on title to access):

Factors Important to Top Clinical Performance in Emergency Medicine Residency: Results of an Ideation Survey and Delphi Panel. Jesse M. Pines MD, MBA, MSCE Sukayna Alfaraj MD Sonal Batra MD, MST Caitlin Carter MPH Nisha Manikoth EdD Colleen N. Roche MD James Scott MD Ellen F. Goldman Ed

LISTEN NOW: AUTHOR INTERVIEW WITH JESSE PINES MD, MBA, MSCE

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Jesse Pines MD, MBA, MSCE

National Director of Clinical Innovation, US Acute Care Solutions

ABSTRACT:

Objectives

We explore attributes, traits, background, skills, and behavioral factors important to top clinical performance in emergency medicine (EM) residency.

Methods

We used a two‐step process—an ideation survey with the Council of Emergency Medicine Residency Directors and a modified Delphi technique—to identify: 1) factors important to top performance, 2) preresidency factors that predict it, and 3) the best ways to measure it. In the Delphi, six expert educators in emergency care assessed the presence of the factors from the ideation survey results in their top clinical performers. Consensus on important factors that were exemplified in >60% of top performers were retained in three Delphi rounds as well as predictors and measures of top performance.

Results

The ideation survey generated 81 responses with ideas for each factor. These were combined into 89 separate factors in seven categories: attributes, personal traits, emergency department (ED)‐specific skills and behaviors, general skill set, background, preresidency predictors, and ways to measure top performance. After three Delphi rounds, the panel achieved consensus on 20 factors important to top clinical performance. This included two attributes, seven traits, one general skill set, and 10 ED‐specific skills and behaviors. Interview performance was considered the sole important preresidency predictor and clinical competency committee results the sole important measure of top performance.

Conclusion

Our expert panel identified 20 factors important to top clinical performance in EM residency. Future work is needed to further explore how individuals learn and develop these factors.