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

> **NIH NIH R01** · OREGON HEALTH & SCIENCE UNIVERSITY · 2021 · $1,991,980

## Abstract

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.

## Key facts

- **NIH application ID:** 10399358
- **Project number:** 1R01HD108017-01
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** Craig D. Newgard
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $1,991,980
- **Award type:** 1
- **Project period:** 2021-09-17 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10399358

## Citation

> US National Institutes of Health, RePORTER application 10399358, Risk prediction and optimizing outcomes to 1-year after firearm injury among children using emergency services in the US (1R01HD108017-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10399358. Licensed CC0.

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