Increasing Firearm Screening in Resident Pediatric Well-Child Checks

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Tiffany Chen, MD; William Butler, MD; Tatiana Campuzano, MD; Aashna Patel, MD, MPH; �Archana Sivanandam, MD; Colleen Kraft, MD, MBA; Jeffrey Birnbaum, MD

Disclosures

• None

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Content Warning

• This presentation contains information about firearms and guns, including images of weapons and ammunition

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Background

EveryStat for Gun Safety

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Background

World Population Review

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Background

World Population Review

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Objectives

1. Increase the rate of firearm screening in pediatric resident WCCs at two clinics to 80% over an 8-month period
2. Explore associations between demographics and firearm presence in our clinic population
3. To promote open conversations about firearm safety with families

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Methods

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WCC Screening Question

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Didactic Sessions

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Per AAP:

1. Firearm unloaded
2. Firearm locked
3. Ammunition separate from firearm
4. Ammunition locked

Cable Gun Locks

In partnership with LA Department of Public Health / Office of Violence Prevention

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Chart Review

• Patients 0-17yo who presented for WCC with pediatric residents at 2 clinics
• Randomly selected 100 charts per month 7/1/2024-3/31/2025

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Results

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Patient Characteristics

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Demographics by Firearm Screening

* statistically significant association

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Demographics by Firearm Presence

• 10 patients of 512 reported firearm present
• 1 patient answered "N/A"
• Positive screening rate of 1.1%

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Discussion

• Largest increase in firearm screening after introduction of firearm screening question to template
• Significant associations between age and firearm screening documentation AND language and firearm screening documentation may suggest bias

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Discussion

• Positive screening rate of 1.1% vs �13% in Los Angeles households with child <18yo
• No association between demographic and firearm presence
• Ages ranged 5mo – 15yo
• 9 of 10 are English-speaking
• 6 explicitly documented storage in locked safes
• 2 mentioned that they had a family member in law enforcement �(e.g. in the police or in the army)

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Limitations

• Assumption that reviewed charts accurately reflect our clinic patient population
• May have missed firearm screening if verbally asked but not documented
• No standardized documentation of firearm storage method

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Conclusion / Future Directions

• In 8 months, rate of firearm screening documentation increased from 2% to average of 65%
• Reported firearm prevalence among clinic population is less than expected
• Collect more data to determine significant trends and sustainability of interventions
• Explore firearm storage methods
• Target high-risk populations for community-based interventions

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References 

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3. Miller M, Azrael D. Firearm Storage in US Households With Children: Findings From the 2021 National Firearm Survey. JAMA Network Open. 2022;5(2):e2148823-e2148823.
4. Lee LK, Fleegler EW, Goyal MK, et al. Firearm-Related Injuries and Deaths in Children and Youth: Injury Prevention and Harm Reduction. Pediatrics. 2022;150(6).
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6. Naureckas Li C, Sacks CA, Cummings BM, Samuels-Kalow M, Masiakos PT, Flaherty MR. Improving Pediatric Residents' Screening for Access to Firearms in High-Risk Patients Presenting to the Emergency Department. Acad Pediatr. 2021;21(4):710-715.
7. Hollon H, Thacker L, Wolf E, et al. A Resident-Led Firearm Curriculum for Pediatrics Residents Improves Safe Storage Counseling. J Pediatr. 2023;263:113680.
8. Lennon T, Ruddy J, Badesch B, Krueger C, Solomon B, Hoops K. Pediatric Residents' Outpatient Firearm Screening and Safety Counseling Practices (Or Lack Thereof): A Retrospective Chart Review. Health Promot Pract. 2024;25(1):29-32.
9. Byrne AK, Thompson LA, Hagen M. Improving Firearm Screening and Anticipatory Guidance During Well-child Checks: A Resident-led Quality Improvement Project. Pediatrics. 2022;149(1 Meeting Abstracts February 2022):157-157.
10. Los Angeles County Department of Health Services Public Health. L.A. Health at a Glance. Health Assessment Unit, Office of Health and Epidemiology, Los Angeles County Department of Health Services- Public Health. 2002.

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