Tag Archive for: Legislation

ambulance bay at Children's National Hospital

AAP names Children’s National gun violence study one of the most influential articles ever published

ambulance bay at Children's National Hospital

The American Academy of Pediatrics (AAP) has named a 2019 study led by clinician-researchers at Children’s National Hospital one of the 12 most influential Pediatric Emergency Medicine articles ever published in the journal Pediatrics.

The American Academy of Pediatrics (AAP) has named a 2019 study led by clinician-researchers at Children’s National Hospital one of the 12 most influential Pediatric Emergency Medicine articles ever published in the journal Pediatrics.

The findings showed that states with stricter gun laws and laws requiring universal background checks for gun purchases had lower firearm-related pediatric mortality rates but that more investigation was needed to better understand the impact of firearm legislation on pediatric mortality.

The study, State Gun Laws and Pediatric Firearm-Related Mortality, was led by Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine, along with Gia M. Badolato, M.P.H., coauthor; Shilpa J. Patel, M.D., MPH, coauthor and emergency medicine specialist; and Kavita Parikh, M.D., MSHS, coauthor and hospitalist, all of Children’s National.

The big picture

In 2019, firearm injuries were the second-leading cause of death for U.S. children. Presently, they are the leading cause of death.

“We have learned that interventions to tackle gun violence are not a ‘one size fits all’ and we need to start developing and scaling tailored interventions that embrace and center community voices and partnerships,” Dr. Goyal said. “The good news is that over the last 5-7 years, there has been a groundswell of energy to address the firearm epidemic in our nation that has led to the growth of investigators, funding and advocacy efforts dedicated to developing and disseminating evidence-based interventions and policies for gun violence prevention. But we need more dedicated funding to support these efforts and continue to invest in those who wish to dedicate their careers to this work.”

About the recognition

The AAP Section on Emergency Medicine (SOEM), founded in 1981, is among the AAP’s largest sections, providing a forum for advocacy, education and research on patient care in pediatric emergency medicine (PEM). The AAP Committee on PEM (COPEM), a national committee founded in 1985, is the principal author of PEM-related AAP policies.

Members of the SOEM’s executive committee and COPEM reviewed every issue from the 75-year history of Pediatrics and selected 15 landmark papers in total, which names the study led by Dr. Goyal and her team.

What they’re saying

“This paper was the result of years of hard work and the beginning of many other collaborations as a research team. I am thankful to work with this team as we continue to add to this important area of research,” said Dr. Patel.

“I was honored to have our article chosen as one of the most influential Pediatric Emergency Medicine articles. I feel encouraged by this recognition that PEM physicians and researchers can be the bridge to the community and work together to make a difference for children,” added Badolato.

Led by their determination to change the status quo and improve the quality of life for children, the clinician-research team established Safer Through Advocacy, Firearm Education and Research (SAFER). It’s a group that works to fill the gaps in hopes of stimulating the change needed to help move the national landscape towards policies that make it safer for children and communities.

“We have created collaborations with pediatricians and researchers throughout the country and continue to work to fill the gaps,” Dr. Parikh said.

Other authors of the study include: Robert McCarter Jr., ScD, co-author; and Sabah F. Iqbal, M.D., PM Pediatrics, co-author.

Gavel in front of a pistol

Saving children’s lives with stricter gun laws

Gavel in front of a pistol

A new study led by clinician-researchers at Children’s National finds states with stricter gun laws had lower firearm-related deaths among children and adolescents.

A new study led by clinician-researchers at Children’s National in Washington, D.C., shows an apparent benefit to stricter laws regulating firearm access: They can save children’s lives.

The study published online July 15, 2019, in Pediatrics shows that states with stricter gun laws had lower firearm-related deaths among children and adolescents. In addition, state laws that had been in place for more than five years requiring universal background checks for firearm purchases were associated with a 35% lower firearm-related death rate among children.

The authors say the findings underscore the need for robust research to understand the interplay between legislation type and pediatric deaths due to firearm injuries.

The cross-sectional study examined 2011 to 2015 firearm fatality data from the Web-based Injury Statistics Query and Reporting System (WISQARS), de-identified data collected by the Centers for Disease Control and Prevention about fatal injuries in the U.S. The team used the Brady Campaign to Prevent Gun Violence’s gun law scorecards which measure the strength or weakness of state laws, with higher scores designating states with consistently strong firearm laws.

Some 21,241 children aged 21 years and younger died from firearm-related injuries over the five-year study period, or about 4,250 deaths per year.

“Firearm injuries represent the second-leading cause of death for U.S. children. That’s about 10 funerals a day for kids whose untimely deaths could have been prevented,” says Monika K. Goyal, M.D., MSCE, director of research in the Division of Emergency Medicine and Trauma Services at Children’s National and the study’s lead author. “For every 10-point increase in the strictness of firearm legislation, there was a 4% drop in firearm-related mortality rates among children and youth.”

States that had laws in effect for five years or longer requiring universal background checks for firearm purchase had 35% lower rates of death due to firearms in children.

“Our findings demonstrate a powerful association between the strength of firearm legislation and pediatric firearm-related mortality, Dr. Goyal adds. “This association remains strong even after we adjust for rates of firearm ownership and other population variables, such as education level, race/ethnicity and household income.”

Just as a combination of evidence-based public health approaches – including legislation mandating seatbelt use – reduced mortality from motor vehicle crashes (6.1 deaths per 100,000 children in 2015 compared with 9.8 deaths per 100,000 in 2007), the authors contend that a similar strategy could help to inform decision-making to reduce childhood injuries and deaths due to firearms.

In addition to Dr. Goyal, additional study authors include Gia M. Badolato, MPH, coauthor, Shilpa J. Patel, M.D., MPH, coauthor and emergency medicine specialist, Kavita Parikh, M.D., MSHS, coauthor and hospitalist, and Robert McCarter Jr., ScD, coauthor and research section head, design and biostatistics, all of Children’s National; and Sabah F. Iqbal, M.D., PM Pediatrics, coauthor.

Neonatal Baby

Treating the smallest opioid epidemic victims

Neonatal Baby

The Virginia Commissioner of Health recently declared the opioid epidemic a public health crisis. A little-known facet of the ongoing crisis is the effects it can have on babies born to opioid-addicted mothers. In fact, according to the New England Journal of Medicine, substance-exposed babies make up as many as 27 out of every 1,000 deliveries across the country.

Neonatal Abstinence Syndrome (NAS) is a condition that affects infants who are born to mothers who are chronic users of some form of opiate during pregnancy. While heroin certainly falls into this category, in recent years the dramatic increase in prescriptions of other opioids as a therapy for chronic pain has led to a correlated increase in the number of infants who withdraw from substances like OxyContin, Percocet, and Morphine.

Infants with NAS can experience tremors, sleep problems, excessive high-pitched crying (often inconsolable), irritability, difficulty feeding and seizures. Unfortunately, these symptoms may present while the infant is in the care of parents who are withdrawing from an opioid addiction themselves, and tragically, cases of non-accidental trauma have been recorded.

In an effort to draw increased attention to this troubling aspect of the ongoing opioid crisis in Virginia and across the country, and with hopes of breaking down barriers to effective treatment for newborns, Children’s National neonatologists and pediatricians are working with lawmakers in Virginia to standardize a streamlined protocol for all newborns born to opioid-addicted mothers in the Commonwealth based on best practices.

In each of the three hospitals in Virginia where Children’s National physicians operate, the established NAS protocol has been implemented to identify at-risk infants, monitor their treatment and attempt to reduce length of stay and rate of readmission. The goals are to standardize the protocol and have it put into practice in all newborn units in Virginia and eventually extend it throughout the region. The protocol includes the following:

  • Universal risk assessment of newborns
  • Appropriate observation period
  • NAS scoring to assess severity of condition
  • Prioritize non-pharmacologic interventions vs. pharmacologic therapy
  • Discharge criteria

Children’s National staff based in Mary Washington Hospital in Fredericksburg, Va., first brought to light the importance of the issue and pointed out that better coordination and government involvement could work together to significantly improve care for these infants. Since then, leaders from the Division of Neonatology at Children’s National have been working closely with Virginia legislation to develop and pass several bills that as a package help address the issue in the following ways:

  • Adding NAS to the list of diseases which must be reported to the state Department of Health
  • Directing the Department of Health and Human Resources to look at NAS in collaboration with other related stakeholders to study the issue at large and specifically collect pertinent information to help address it
  • Removing language that states for the purposes of defining a substance-affected infant that the substance must be illicit

This protocol and these bills are important steps forward in both providing the effective treatment needed for and the collection of data related to NAS cases, but they are only a first step. Children’s National and state leaders continue to work together to bring Virginia’s hospitals together in an attempt to foster a collaborative approach to addressing NAS. By sharing expertise and techniques, Virginia’s health care providers can ensure that the tiniest victims of the opioid crisis do not go untreated.