721 - Child Opportunity Index as a Predictor of Firearm-related Disorders of Consciousness

The Child Opportunity Index (COI) is a publicly available index that measures neighborhood resources, and has been widely used to study pediatric health outcomes. Prior research shows that children with lower COI are disproportionately impacted by firearms. There are additional studies demonstrating that patients with penetrating brain injuries are less likely to emerge than blunt injuries, however, this data is limited in the pediatric population. This study aimed to determine whether COI predicts firearm-related brain injury as the cause of a DoC compared to other etiologies. A secondary aim was to assess whether children with firearm-related DoC were less likely to emerge from DoC compared to those with injuries from other traumatic mechanisms, such as motor vehicle collisions. 

Design:

A single-center retrospective chart review was conducted at an inpatient rehabilitation facility which included 60 patients in Chicago from March 1, 2016 to December 3, 2024. We collected patient data including mechanisms of injury, zip code, age, and coma recovery scores. 

Results:

COI is a significant predictor of firearm injury as the mechanism of injury for DoC, with those with lower COI level being more likely to sustain their DoC from a firearm injury (χ2(4)=17.341, p=0.021). Additionally, mechanism of injury (firearm vs other traumatic) is not a significant predictor of odds of emergence from DoC (χ2(1)=3.562, p=0.059).

Conclusions:

Children with lower COI are more likely to sustain DoC from firearms when compared to children with higher COI. Additionally, when comparing children who sustained their injury from firearms as opposed to other trauma (ie, motor vehicle collisions), while there was a trend of lower emergence rate for the firearm group, this did not reach statistical significance. These findings underscore the importance of implementing meaningful programs and public policies that decrease firearm violence.