Geoff Hollett, Karen Dionesotes, Joshua M Cohen, Noel Deep, Jennie B Jarrett
{"title":"The Misplaced Push to Restrict Access to Gabapentin.","authors":"Geoff Hollett, Karen Dionesotes, Joshua M Cohen, Noel Deep, Jennie B Jarrett","doi":"10.7326/ANNALS-24-00940","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00940","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.7326/ANNALS-24-02230-JC
Christine F McDonald
Source citation: Thomas D, McDonald VM, Stevens S, et al. Effect of azithromycin on asthma remission in adults with persistent uncontrolled asthma: a secondary analysis of a randomized, double-anonymized, placebo-controlled trial. Chest. 2024;166:262-270. 38431051.
来源引用:Thomas D、McDonald VM、Stevens S 等:阿奇霉素对哮喘持续失控成人患者哮喘缓解的影响:随机、双匿名、安慰剂对照试验的二次分析。Chest.2024;166:262-270.38431051.
{"title":"In persistent uncontrolled asthma, adding azithromycin to standard therapy increased clinical remission rates at 1 y.","authors":"Christine F McDonald","doi":"10.7326/ANNALS-24-02230-JC","DOIUrl":"10.7326/ANNALS-24-02230-JC","url":null,"abstract":"<p><strong>Source citation: </strong>Thomas D, McDonald VM, Stevens S, et al. <b>Effect of azithromycin on asthma remission in adults with persistent uncontrolled asthma: a secondary analysis of a randomized, double-anonymized, placebo-controlled trial.</b> Chest. 2024;166:262-270. 38431051.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-10-08DOI: 10.7326/ANNALS-24-01868
Cynthia H Chuang, Sarah Horvath
Induced abortion is safe, is common, and reduces pregnancy-related maternal morbidity and mortality. Internal medicine physicians are uniquely positioned to counsel patients on their pregnancy options, assess medical risks of pregnancy in the context of comorbidities, refer for abortion care when the patient desires it, or provide abortion care themselves. Clinicians can also provide anticipatory guidance about what patients should expect if they seek abortion care.
{"title":"Abortion.","authors":"Cynthia H Chuang, Sarah Horvath","doi":"10.7326/ANNALS-24-01868","DOIUrl":"10.7326/ANNALS-24-01868","url":null,"abstract":"<p><p>Induced abortion is safe, is common, and reduces pregnancy-related maternal morbidity and mortality. Internal medicine physicians are uniquely positioned to counsel patients on their pregnancy options, assess medical risks of pregnancy in the context of comorbidities, refer for abortion care when the patient desires it, or provide abortion care themselves. Clinicians can also provide anticipatory guidance about what patients should expect if they seek abortion care.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.7326/ANNALS-24-02090-JC
Jacob Korula
Source citation: van Kleef LA, Francque SM, Prieto-Ortiz JE, et al. Metabolic Dysfunction-Associated Fibrosis 5 (MAF-5) score predicts liver fibrosis risk and outcome in the general population with metabolic dysfunction. Gastroenterology. 2024;167:357-367.e9. 38513745.
资料来源:van Kleef LA、Francque SM、Prieto-Ortiz JE 等。 代谢功能障碍相关纤维化 5(MAF-5)评分可预测代谢功能障碍普通人群的肝纤维化风险和结局。胃肠病学》。2024;167:357-367.e9.38513745.
{"title":"In adults with metabolic dysfunction, the MAF-5 score predicted risk for liver fibrosis (AUC range, 0.73 to 0.81).","authors":"Jacob Korula","doi":"10.7326/ANNALS-24-02090-JC","DOIUrl":"10.7326/ANNALS-24-02090-JC","url":null,"abstract":"<p><strong>Source citation: </strong>van Kleef LA, Francque SM, Prieto-Ortiz JE, et al. <b>Metabolic Dysfunction-Associated Fibrosis 5 (MAF-5) score predicts liver fibrosis risk and outcome in the general population with metabolic dysfunction.</b> Gastroenterology. 2024;167:357-367.e9. 38513745.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.7326/ANNALS-24-02174-JC
Lawrence J Cheskin, Selvi Rajagopal
Source citation: Malhotra A, Grunstein RR, Fietze I, et al; SURMOUNT-OSA Investigators. Tirzepatide for the treatment of obstructive sleep apnea and obesity. N Engl J Med. 21 Jun 2024. [Epub ahead of print.] 38912654.
来源引用:Malhotra A, Grunstein RR, Fietze I, et al; SURMOUNT-OSA Investigators.用于治疗阻塞性睡眠呼吸暂停和肥胖症的 Tirzepatide。N Engl J Med.21 Jun 2024.[Epub ahead of print.] 38912654.
{"title":"In adults with moderate-to-severe OSA and obesity, tirzepatide reduced apnea-hypopnea events vs. placebo.","authors":"Lawrence J Cheskin, Selvi Rajagopal","doi":"10.7326/ANNALS-24-02174-JC","DOIUrl":"10.7326/ANNALS-24-02174-JC","url":null,"abstract":"<p><strong>Source citation: </strong>Malhotra A, Grunstein RR, Fietze I, et al; SURMOUNT-OSA Investigators. <b>Tirzepatide for the treatment of obstructive sleep apnea and obesity.</b> N Engl J Med. 21 Jun 2024. [Epub ahead of print.] 38912654.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-10-08DOI: 10.7326/ANNALS-24-01740
Risa B Burns, Melanie R Jay, Anne N Thorndike, Zahir Kanjee
In 2022, 1 in 8 people in the world were living with obesity, and lifestyle interventions that include diet, exercise, and behavioral modification have been the foundation for management of obesity. Recently, pharmacologic therapies have been developed for management of obesity, the newest of these being glucagon-like peptide 1 receptor agonists. With the development of new pharmacologic options, the American Gastroenterological Association developed a guideline in 2022 to provide evidence-based recommendations for the pharmacologic management of obesity in adults and recommended, for adults with obesity or overweight with weight-related complications who have had an inadequate response to lifestyle interventions, adding pharmacologic agents to lifestyle interventions over continuing lifestyle interventions alone. In this article, 2 experts review the available evidence to answer the following questions: How effective are lifestyle interventions for the treatment of obesity? How effective are pharmacologic interventions for the treatment of obesity? Given these options, how do you engage in a shared decision-making discussion to develop a mutually agreed-on treatment plan?
{"title":"How Would You Manage This Patient With Obesity? Grand Rounds Discussion From Beth Israel Deaconess Medical Center.","authors":"Risa B Burns, Melanie R Jay, Anne N Thorndike, Zahir Kanjee","doi":"10.7326/ANNALS-24-01740","DOIUrl":"10.7326/ANNALS-24-01740","url":null,"abstract":"<p><p>In 2022, 1 in 8 people in the world were living with obesity, and lifestyle interventions that include diet, exercise, and behavioral modification have been the foundation for management of obesity. Recently, pharmacologic therapies have been developed for management of obesity, the newest of these being glucagon-like peptide 1 receptor agonists. With the development of new pharmacologic options, the American Gastroenterological Association developed a guideline in 2022 to provide evidence-based recommendations for the pharmacologic management of obesity in adults and recommended, for adults with obesity or overweight with weight-related complications who have had an inadequate response to lifestyle interventions, adding pharmacologic agents to lifestyle interventions over continuing lifestyle interventions alone. In this article, 2 experts review the available evidence to answer the following questions: How effective are lifestyle interventions for the treatment of obesity? How effective are pharmacologic interventions for the treatment of obesity? Given these options, how do you engage in a shared decision-making discussion to develop a mutually agreed-on treatment plan?</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The standard salvage technique used for difficult bile duct cannulation is precut sphincterotomy, whereas endoscopic ultrasound-guided rendezvous technique (EUS-RV) is a relatively newer method. Prospective comparative data between these 2 techniques as salvage for biliary access in patients with benign biliary disease and difficult bile duct cannulation is lacking.
Objective: To compare EUS-RV and precut sphincterotomy as salvage technique for difficult bile duct cannulation in benign biliary obstruction.
Setting: Tertiary care academic institute from July 2020 to May 2021.
Participants: All patients with benign biliary disease and difficult bile duct cannulation requiring salvage strategy.
Intervention: Patients were randomly assigned by computer-generated randomized blocks sequence in 1:1 fashion to either EUS-RV or precut sphincterotomy. Patients with failure in EUS-RV were crossed over to precut sphincterotomy and vice versa.
Measurements: The primary outcome measure was technical success. The other outcome measures included procedure time, radiation dose, and adverse events.
Results: In total, 100 patients were randomly assigned to EUS-RV (n = 50) and precut sphincterotomy (n = 50). The technical success rate (92% vs. 90%; P = 1.00; relative risk, 1.02 [95% CI, 0.90 to 1.16]), median procedure time (10.1 vs. 9.75 minutes), and overall complication rate (12% vs. 10%; relative risk, 1.20 [CI, 0.39 to 3.68]) were similar between the 2 groups. Five patients (10%) in the EUS-RV group and 5 patients (10%) in the precut sphincterotomy group had developed post-endoscopic retrograde cholangiopancreatography pancreatitis. All failed cases in either salvage group could be successfully cannulated when crossed over to the other group.
Limitation: Single center study done by experts.
Conclusion: Endoscopic ultrasound-guided rendezvous technique and precut sphincterotomy have similar success rates as salvage techniques in the technically challenging cohort of difficult bile duct cannulation for benign biliary disease, with acceptable complications rates.
{"title":"Endoscopic Ultrasound-Guided Rendezvous Technique Versus Precut Sphincterotomy as Salvage Technique in Patients With Benign Biliary Disease and Difficult Biliary Cannulation : A Randomized Controlled Trial.","authors":"Arup Choudhury, Jayanta Samanta, Gaurav Muktesh, Jahnvi Dhar, Antriksh Kumar, Jimil Shah, Marco Spadaccini, Pankaj Gupta, Alessandro Fugazza, Vikas Gupta, Thakur Deen Yadav, Rakesh Kochhar, Cesare Hassan, Alessandro Repici, Antonio Facciorusso","doi":"10.7326/M24-0092","DOIUrl":"10.7326/M24-0092","url":null,"abstract":"<p><strong>Background: </strong>The standard salvage technique used for difficult bile duct cannulation is precut sphincterotomy, whereas endoscopic ultrasound-guided rendezvous technique (EUS-RV) is a relatively newer method. Prospective comparative data between these 2 techniques as salvage for biliary access in patients with benign biliary disease and difficult bile duct cannulation is lacking.</p><p><strong>Objective: </strong>To compare EUS-RV and precut sphincterotomy as salvage technique for difficult bile duct cannulation in benign biliary obstruction.</p><p><strong>Design: </strong>Participant-masked, parallel-group, superiority, randomized controlled trial. (Clinical Trials Registry of India: CTRI/2020/07/026613).</p><p><strong>Setting: </strong>Tertiary care academic institute from July 2020 to May 2021.</p><p><strong>Participants: </strong>All patients with benign biliary disease and difficult bile duct cannulation requiring salvage strategy.</p><p><strong>Intervention: </strong>Patients were randomly assigned by computer-generated randomized blocks sequence in 1:1 fashion to either EUS-RV or precut sphincterotomy. Patients with failure in EUS-RV were crossed over to precut sphincterotomy and vice versa.</p><p><strong>Measurements: </strong>The primary outcome measure was technical success. The other outcome measures included procedure time, radiation dose, and adverse events.</p><p><strong>Results: </strong>In total, 100 patients were randomly assigned to EUS-RV (<i>n</i> = 50) and precut sphincterotomy (<i>n</i> = 50). The technical success rate (92% vs. 90%; <i>P</i> = 1.00; relative risk, 1.02 [95% CI, 0.90 to 1.16]), median procedure time (10.1 vs. 9.75 minutes), and overall complication rate (12% vs. 10%; relative risk, 1.20 [CI, 0.39 to 3.68]) were similar between the 2 groups. Five patients (10%) in the EUS-RV group and 5 patients (10%) in the precut sphincterotomy group had developed post-endoscopic retrograde cholangiopancreatography pancreatitis. All failed cases in either salvage group could be successfully cannulated when crossed over to the other group.</p><p><strong>Limitation: </strong>Single center study done by experts.</p><p><strong>Conclusion: </strong>Endoscopic ultrasound-guided rendezvous technique and precut sphincterotomy have similar success rates as salvage techniques in the technically challenging cohort of difficult bile duct cannulation for benign biliary disease, with acceptable complications rates.</p><p><strong>Primary funding source: </strong>None.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Long-term effects of individualized acupuncture in persons with chronic neck pain (CNP) remain unknown.
Objective: To evaluate the efficacy and safety of pressure pain, sensory-based individualized acupuncture for relieving CNP.
Design: A 24-week multicenter randomized controlled clinical trial. (ChiCTR1800016371).
Setting: Outpatient settings at 4 clinical centers in China from May 2018 to March 2020.
Participants: 716 participants with CNP.
Intervention: Participants were randomly assigned to a waiting list (WL) group or to 1 of 3 interventions, which consisted of 10 sessions over 4 weeks: higher sensitive acupoints (HSA), lower sensitive acupoints (LSA), and sham acupoints (SA) acupuncture groups.
Measurements: The primary outcome was the change in the visual analogue scale (VAS) score for neck pain (range, 0 to 100) from baseline to 4 weeks, with a difference of 10 points considered the minimum clinically important threshold. The VAS was also assessed every 4 weeks through 24 weeks.
Results: The modified intention-to-treat population included 683 participants. The mean baseline VAS was 50.36, 50.10, 49.24, and 49.16 for HSA, LSA, SA, and WL, respectively. Compared with a mean baseline to week 4 change of -12.16 in the HSA group, the mean changes were -10.19 in the LSA group (net difference [ND], -1.97 [95% CI, -5.03 to 1.09]), -6.11 in the SA group (ND, -6.05 [CI, -9.10 to -3.00]), and -2.24 in the WL group (ND, -9.93 [CI, -12.95 to -6.90]). The intervention effects persisted at 24-week follow-up.
Limitation: Lack of complete blinding and limited generalizability.
Conclusion: Individualized acupuncture interventions using high- or low-sensitivity acupuncture points were more effective in reducing CNP than SA and WL control groups sustained through 24 weeks, but the magnitude of relative improvement did not reach a minimal clinically important difference.
Primary funding source: National Natural Science Foundation of China.
{"title":"Long-Term Effects of Individualized Acupuncture for Chronic Neck Pain : A Randomized Controlled Trial.","authors":"Ling Zhao, Mingsheng Sun, Zihan Yin, Jin Cui, Ruihui Wang, Laixi Ji, Guoyan Geng, Jiao Chen, Dingjun Cai, Qi Liu, Hui Zheng, Fanrong Liang","doi":"10.7326/M23-2425","DOIUrl":"10.7326/M23-2425","url":null,"abstract":"<p><strong>Background: </strong>Long-term effects of individualized acupuncture in persons with chronic neck pain (CNP) remain unknown.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of pressure pain, sensory-based individualized acupuncture for relieving CNP.</p><p><strong>Design: </strong>A 24-week multicenter randomized controlled clinical trial. (ChiCTR1800016371).</p><p><strong>Setting: </strong>Outpatient settings at 4 clinical centers in China from May 2018 to March 2020.</p><p><strong>Participants: </strong>716 participants with CNP.</p><p><strong>Intervention: </strong>Participants were randomly assigned to a waiting list (WL) group or to 1 of 3 interventions, which consisted of 10 sessions over 4 weeks: higher sensitive acupoints (HSA), lower sensitive acupoints (LSA), and sham acupoints (SA) acupuncture groups.</p><p><strong>Measurements: </strong>The primary outcome was the change in the visual analogue scale (VAS) score for neck pain (range, 0 to 100) from baseline to 4 weeks, with a difference of 10 points considered the minimum clinically important threshold. The VAS was also assessed every 4 weeks through 24 weeks.</p><p><strong>Results: </strong>The modified intention-to-treat population included 683 participants. The mean baseline VAS was 50.36, 50.10, 49.24, and 49.16 for HSA, LSA, SA, and WL, respectively. Compared with a mean baseline to week 4 change of -12.16 in the HSA group, the mean changes were -10.19 in the LSA group (net difference [ND], -1.97 [95% CI, -5.03 to 1.09]), -6.11 in the SA group (ND, -6.05 [CI, -9.10 to -3.00]), and -2.24 in the WL group (ND, -9.93 [CI, -12.95 to -6.90]). The intervention effects persisted at 24-week follow-up.</p><p><strong>Limitation: </strong>Lack of complete blinding and limited generalizability.</p><p><strong>Conclusion: </strong>Individualized acupuncture interventions using high- or low-sensitivity acupuncture points were more effective in reducing CNP than SA and WL control groups sustained through 24 weeks, but the magnitude of relative improvement did not reach a minimal clinically important difference.</p><p><strong>Primary funding source: </strong>National Natural Science Foundation of China.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-09-17DOI: 10.7326/M24-0430
Zoe M Miller, Benjamin P Cooper, Daphne Lew, Rachel M Ancona, Vicki Moran, Christopher Behr, Marguerite W Spruce, Lindsay M Kranker, Michael A Mancini, Matt Vogel, Doug J E Schuerer, Lindsay Clukies, Megan L Ranney, Randi E Foraker, Kristen L Mueller
Background: Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States.
Objective: To examine the factors associated with recurrent firearm injury among children who presented with acute (index) nonfatal firearm injury in the St. Louis region.
Design: Multicenter, observational, cohort study.
Setting: 2 adult and 2 pediatric level I trauma hospitals in St. Louis, Missouri.
Participants: Pediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019.
Measurements: From the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository, we collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. The Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the cumulative incidence of experiencing a recurrent firearm injury.
Results: During the 10-year study period, 1340 children presented with an index firearm injury. Most patients were Black (87%), non-Hispanic (99%), male (84%), and between the ages of 15 and 17 years (67%). The estimated risk for firearm reinjury was 6% at 1 year and 14% at 5 years after initial injury. Male children and those seen at an adult hospital were at increased risk for reinjury.
Limitation: Our data set does not account for injuries occurring outside of the study period and for reinjuries presenting to nonstudy hospitals.
Conclusion: Children who experience an initial firearm injury are at high risk for experiencing a recurrent firearm injury. Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children.
Primary funding source: National Institutes of Health.
{"title":"Factors Associated With Recurrent Pediatric Firearm Injury : A 10-Year Retrospective Cohort Analysis.","authors":"Zoe M Miller, Benjamin P Cooper, Daphne Lew, Rachel M Ancona, Vicki Moran, Christopher Behr, Marguerite W Spruce, Lindsay M Kranker, Michael A Mancini, Matt Vogel, Doug J E Schuerer, Lindsay Clukies, Megan L Ranney, Randi E Foraker, Kristen L Mueller","doi":"10.7326/M24-0430","DOIUrl":"10.7326/M24-0430","url":null,"abstract":"<p><strong>Background: </strong>Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States.</p><p><strong>Objective: </strong>To examine the factors associated with recurrent firearm injury among children who presented with acute (index) nonfatal firearm injury in the St. Louis region.</p><p><strong>Design: </strong>Multicenter, observational, cohort study.</p><p><strong>Setting: </strong>2 adult and 2 pediatric level I trauma hospitals in St. Louis, Missouri.</p><p><strong>Participants: </strong>Pediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019.</p><p><strong>Measurements: </strong>From the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository, we collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. The Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the cumulative incidence of experiencing a recurrent firearm injury.</p><p><strong>Results: </strong>During the 10-year study period, 1340 children presented with an index firearm injury. Most patients were Black (87%), non-Hispanic (99%), male (84%), and between the ages of 15 and 17 years (67%). The estimated risk for firearm reinjury was 6% at 1 year and 14% at 5 years after initial injury. Male children and those seen at an adult hospital were at increased risk for reinjury.</p><p><strong>Limitation: </strong>Our data set does not account for injuries occurring outside of the study period and for reinjuries presenting to nonstudy hospitals.</p><p><strong>Conclusion: </strong>Children who experience an initial firearm injury are at high risk for experiencing a recurrent firearm injury. Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children.</p><p><strong>Primary funding source: </strong>National Institutes of Health.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}