Risk prediction and optimizing outcomes to 1-year after firearm injury among children using emergency services in the US

美国使用紧急服务的儿童遭受枪伤后一年内的风险预测和优化结果

• 批准号: 10399358
• 负责人: Craig D. Newgard
• 金额: $ 199.2万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-17 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10399358
• 关键词: Accident and Emergency department; Accidental Injury; Acute; Address; Adult; Adverse event; Area; Caring; Cause of Death; Cessation of life; Characteristics; Child; Childhood; Childhood Injury; Consensus; County; Critical Care; Data; Data Science; Data Sources; Diagnosis; Disease; Electronic Health Record; Emergency Care; Emergency department visit; Emergency medical service; Event; Firearms; Goals; Grant; Guidelines; Gun injury; Health; Home; Hospitals; Individual; Infrastructure; Injury; Intervention; Investments; Life; Link; Location; Machine Learning; Measures; Methods; Modeling; Modernization; Monoclonal Antibody R24; Morbidity - disease rate; National Health Policy; National Institute of Child Health and Human Development; Natural History; Operative Surgical Procedures; Outcome; Outcome Measure; Participant; Patients; Pattern; Population; Predictive Factor; Prevention Research; Process; Public Health; Readiness; Research; Research Design; Research Infrastructure; Resources; Risk; Risk Factors; Severities; Site; Societies; Statistical Methods; Survivors; Time; Translations; Trauma; Triage; United States National Institutes of Health; Visit; adverse outcome; age group; analytical method; base; care costs; care systems; child services; cohort; cost; design; emergency settings; experience; health care service utilization; high risk; improved; indexing; injured; injury prevention; interest; mortality; neglect; novel; pediatric department; preventable death; public health priorities; recidivism; risk prediction; risk prediction model; tool; trauma centers

Proposed Approach: We will build three national cohorts of children requiring emergency services over a 10-year period to evaluate primary, secondary, and tertiary firearm injury prevention. We will use existing research infrastructure, data science methods, the ability to track children to one year, novel analytics, and an interdisciplinary team to address this critical public health need. Importance: Injury remains the leading cause of death in children, with firearms resulting in the highest mortality, surgical intervention, critical care, and cost compared to all other mechanisms of injury. However, there are many challenges to firearm injury prevention in children. Risk prediction tools are sparse, firearm injury recidivism and death are concerns among children who initially survive such an injury, and processes of care to optimize survival are under-investigated. There is a compelling need for research in these areas to facilitate targeted interventions to reduce firearm injury and mortality among at-risk children. Objectives: The proposal has 3 specific aims: Specific Aim 1: Using three national cohorts of children 0 to 17 years requiring emergency services, employ machine learning and geospatial analysis to develop and validate risk prediction models for firearm injury and short-term mortality using individual-, home-, incident-, and county-level factors. Specific Aim 2. Among children discharged alive following a firearm injury, measure injury recidivism, healthcare utilization, and mortality to 1-year and develop risk prediction models to identify children at-risk of adverse outcomes in the year after an index firearm event. Specific Aim 3: For children presenting to an ED after a firearm injury, identify ED and hospital characteristics independently associated with in-hospital, 30-day, and 1-year survival, and quantify the additional lives saved through feasible shifts in the location of initial emergency care. Study Design & Setting: We will build 3 cohorts of children using emergency services from 1/1/2012 to 12/31/2021 in 1,217 EDs in 8 states (ED cohort), 832 trauma centers in 50 states (Trauma Center cohort), and 5,461 EMS agencies in 28 states (EMS cohort). We will link six different data sources to the cohorts to capture longitudinal outcomes and 110 predictor variables at the patient-, incident-, home-, and county-level. Participants: Children 0–17 years using emergency services, including: 40.9 million in the ED cohort (n = 35,240 with firearm injuries), 620,007 in the Trauma Center cohort (n = 22,847 with firearm injuries), and 6.8 million in the EMS cohort (n = 14,314 with firearm injuries). Outcome measures: We will evaluate models for firearm injury, adverse events to 1-year among children initially surviving a firearm injury, and short- and long-term survival following a firearm injury.

建议的方法：我们将建立三个需要紧急服务的儿童国家队列 在10年的时间内，评估初级，二级和三级火器伤害预防。我们将 利用现有的研究基础设施，数据科学方法，跟踪儿童到一年的能力， 新颖的分析和跨学科团队来解决这一关键的公共卫生需求。 重要性：伤害仍然是儿童死亡的主要原因，枪支造成的死亡率最高。 死亡率、手术干预、重症监护和与所有其他损伤机制相比的成本。 然而，在预防儿童火器伤害方面存在许多挑战。风险预测工具包括 稀疏，火器伤害累犯和死亡是儿童谁最初生存这样一个问题， 伤害和护理过程，以优化生存的研究不足。迫切需要 在这些领域进行研究，以促进有针对性的干预措施，减少 高危儿童 目标：该提案有三个具体目标： 具体目标1：利用需要紧急服务的0至17岁儿童的三个国家群组， 机器学习和地理空间分析，以开发和验证火器伤害的风险预测模型， 短期死亡率使用个人，家庭，事件，县一级的因素。 具体目标2。在枪伤后被活着释放的儿童中，测量伤害再犯率， 医疗保健利用率和死亡率，并开发风险预测模型，以确定儿童的风险， 不良后果在一年后的指标火器事件。 具体目标3：对于火器伤后到艾德就诊的儿童，确定艾德和医院特征 与住院、30天和1年生存率独立相关，并量化挽救的额外生命 通过可行地改变最初的紧急护理地点。 研究设计和设置：我们将建立3个队列的儿童使用紧急服务，从1/1/2012至 2021年12月31日，8个州的1，217名ED（艾德队列），50个州的832家创伤中心（创伤中心队列），以及 28个州的5，461个EMS机构（EMS队列）。我们将把六个不同的数据源与队列联系起来， 捕获纵向结果和110个预测变量在病人，事件，家庭和县一级。 参与者：使用紧急服务的0-17岁儿童，包括：艾德队列中的4090万人 （n = 35，240例火器伤），620，007例创伤中心队列（n = 22，847例火器伤）， EMS队列中有680万例（n = 14，314例火器伤）。 结果测量：我们将评估火器伤模型，1年内不良事件， 最初从火器伤中幸存的儿童，以及火器伤后的短期和长期生存。