About

Joel A Fein, MD, MPH, is a Professor of Pediatrics (Emergency Medicine) at the Children's Hospital of Philadelphia and a Senior Fellow at the Center for Public Health Initiatives at the University of Pennsylvania School of Medicine. His clinical expertise is in Pediatric Emergency Medicine, and his research focuses on emergency department-based violence prevention, mental health evaluation, and procedural pain management. Dr. Fein has contributed to understanding violence and trauma in youth, including the persistence of post-traumatic stress in violently injured adolescents and the impact of domestic violence screening in pediatric emergency settings. His work emphasizes violence prevention, mental health assessment, and injury research, making significant contributions to pediatric emergency medicine and public health.

Research topics

• Demography
• Family medicine
• Medical emergency
• Medicine
• Psychiatry
• Gerontology

Selected publications

• Comparing Patient-Centered Approaches to Social Care in the Emergency Department: A Mixed-Method Randomized Controlled Trial

  Annals of Emergency Medicine · 2026-02-01 · 1 citations

  article
  PublisherDOI

• Characteristics of Adolescents With Elevated Suicide Risk Presenting to the <scp>ED</scp> With Physical Health Complaints

  Academic Emergency Medicine · 2026-04-01

  articleOpen access
  PublisherDOI

• Performance of Risk Classification Algorithms for Adolescent Suicide Attempt at the Intersection of Race and Sex

  Biological Psychiatry · 2025-04-09

  article
  PublisherDOI

• A Unique Case of Ureaplasma Parvum Causing Disseminated Infection and Hyperammonemia in an Immunocompetent Patient

  American Journal of Respiratory and Critical Care Medicine · 2025-05-01

  articleSenior author

  Abstract Ureaplasma parvum is a an often-overlooked organism found as part of the normal urogenital tract microbiome. It is frequently missed on cultures as it does not grow in routine bacteriological cultures. It produces urease which hydrolyzes urea and generates ammonia as a byproduct. While this has no harm when it occurs in the urine, systemic infections pose a severe threat and can lead to hyperammonemia that can result in coma and death. While this infection is known amongst the transplant community, it is rarely seen in an adult who is not immunosuppressed. A 48-year-old female with borderline personality disorder, multiple sclerosis, methamphetamine use, and type two diabetes presented with osteomyelitis of the left temporomandibular joint. She was started on ampicillin-sulbactam and subsequently developed septic arthritis of the right elbow, cellulitis of the left forearm, and a loculated left pleural effusion. She underwent several washouts of her infected joints with purulent material found, but no growth on cultures. For her empyema she underwent multiple chest tube placements as well as lytic therapy, again with purulent fluid, but no growth on cultures. Following surgery, she had a rapid response called for encephalopathy and hypoxia. She was emergently intubated and became comatose without clear cause. Lumbar puncture (LP) was without target on standard polymerase chain reaction (PCR) panel or culture. An ammonia level was checked and was found to be elevated at 365, despite normal liver and kidney function. She then developed new onset seizures with worsening edema on head imaging. PCR of her urine was sent and resulted with Ureaplasma parvum. Her antibiotics were switched to doxycycline and her fever and white blood cell count improved. Repeat samples from her pleural fluid, left elbow joint, and bronchoscopy were sent that confirmed Ureaplasma parvum present. A repeat LP was performed, but did not have Ureaplasma present. She ultimately required a tracheostomy and had slow improvement in her mentation over several weeks but continues to have seizures. Her case is unique because she did not have a history of transplant or significant immunosuppression. While she had multiple sclerosis, she had not received ocrelizumab in over 6 months prior to onset of her symptoms. This case emphasizes the limitations of our standard cultures and the importance of listening to the history.

  PublisherDOI

• Exploring programme implementation of a US paediatric hospital-based violence intervention programme by injury mechanism

  Injury Prevention · 2025-05-24 · 1 citations

  article

  Background Hospital-based violence intervention programmes (HVIPs) support recovery following interpersonal violence, with most patients participating following firearm injuries. There remains insufficient understanding of who HVIPs serve and how programmes are implemented, especially among paediatric patients. We sought to describe the implementation of a paediatric HVIP and examine relationships between HVIP implementation metrics and mechanism of injury (firearm vs non-firearm). Methods We conducted a retrospective cohort study using HVIP records from 2018 to 2023, identifying 2021 patients (8–18 years) treated at our urban paediatric trauma centre in the northeastern USA, 416 of whom enrolled in our HVIP. We conducted bivariate and multivariate regression analyses examining differences in patient-level characteristics and HVIP implementation by injury mechanism. Results Most patients (94%) experienced non-firearm injuries. Firearm-injured patients were more likely to enrol in our HVIP (adjusted OR=4.01, 95% CI 2.64 to 6.14) than non-firearm-injured patients, though non-firearm-injured patients represented 85% of HVIP participants. In comparison to non-firearm-injured patients, firearm-injured patients had longer programme duration (adj_ B =43.73, 95% CI 4.84 to 82.63 days), more documented encounters (adj_ B =16.30, 95%CI 3.44 to 29.16) and more recovery goals (adj_ B =3.37, 95%CI 1.21 to 5.52). HVIP goal resolution and graduation rates did not significantly differ by mechanism. Conclusion Our study identified metrics to describe HVIP implementation among paediatric patients with diverse injury types and documented consistent HVIP engagement, retention and outputs for those with firearm and non-firearm injuries alike. Our work suggests the relevance, and acceptability of HVIPs for paediatric patients with diverse injuries and offers a framework for process measurement in future implementation, outcome and impact evaluations.

  PublisherDOI

• Prevalence of Suicidal Ideation and Suicide Attempts by Race and Gender in Three Large U.S. Adolescent Cohorts

  American Journal of Psychiatry · 2025-05-28 · 4 citations

  articleOpen access
  PublisherOA PDFDOI

• Firearm Violence and Health in Policymaker Discourse: Mixed Methods Social Media Analysis

  JMIR Formative Research · 2025-11-11

  articleOpen access

  Background: Since 2019, firearm violence has remained the leading cause of death for US children and adolescents aged 1-19 years. This crisis has spurred action from policymakers, health professionals, and advocates. However, political polarization has contributed to divergent views on the causes and appropriate responses to firearm violence. Communication by elected officials, especially on social media, plays a critical role in shaping public opinion and policy agendas. Understanding how state policymakers discuss firearm violence, including the use of causal blame, calls to action, and health-related narratives, can inform more effective public health strategies. Objective: This study aimed to examine how Pennsylvania state legislators discuss firearms and firearm violence on social media and assess the extent to which their messaging aligns with public health perspectives. Methods: We conducted a 2-phase mixed methods analysis of X (formerly known as Twitter; X Corp) posts by Pennsylvania state legislators from May 27, 2017, to July 26, 2022. Posts were grouped into 3 time periods surrounding the Tree of Life Synagogue mass shooting in Pittsburgh. Using a Boolean search strategy, we identified 4573 posts related to firearms and firearm violence. After removing reposts and non-English content, we randomly sampled 1491 (32.6%) original posts authored by 152 unique legislators. Posts were coded using a structured codebook based on the Multiple Streams Framework to capture rhetorical framing, causal blame, and policy content. Interrater reliability was high (Holsti coefficient >0.8). We used chi-square tests and multivariable logistic regression to assess associations between rhetorical elements and policy mentions, adjusting for time period. Results: Mass shootings were the most frequently referenced category of firearm violence, peaking after the Tree of Life shooting (22/43, 51% vs 91/118, 77.1% vs 140/220, 63.6%; P=.004), while firearm suicide was rarely discussed. Posts using advocacy frames were nearly 5 times more likely to mention policy (adjusted odds ratio [aOR] 4.67, 95% CI 3.55-6.16), whereas those referencing mass shootings (aOR 0.54, 95% CI 0.37-0.77) or emotional appeals (aOR 0.53, 95% CI 0.40-0.69) were significantly less likely to do so. Most posts used general advocacy (aOR 2.97, 95% CI 2.13-4.13) and vague blame (aOR 8.26, 95% CI 6.02-11.35), resulting in nonspecific policy suggestions. Posts that attributed blame to firearm access were strongly associated with specific policy proposals (aOR 6.37, 95% CI 4.29-9.47) and inversely associated with general policy mentions (aOR 0.26, 95% CI 0.17-0.42). Only 9.4% (133/1422) of posts used health frames; when present, they more often referenced physical consequences (58/133, 43.6% vs 216/1358, 15.9%; P<.001). Conclusions: Pennsylvania legislators primarily focused on mass shootings and relied on emotional or symbolic language without proposing specific policies. Health frames were rare and typically focused on consequences rather than prevention. Findings highlight an opportunity to support policymakers with health-informed messaging strategies to promote actionable firearm violence prevention policies, particularly those addressing prevention.

  PublisherDOI

• Child and Neighborhood-Level Factors and Violent Reinjury Among Children With Firearm Injuries

  JAMA Pediatrics · 2025-03-03 · 1 citations

  articleOpen access

  This cross-sectional study assesses the association between Child Opportunity Index and revisits for violent reinjury among children within 1 year of an index firearm-related injury.

  PublisherOA PDFDOI

• Neighborhood Firearm Violence, Psychosocial Risks, and Youth Firearm Perception

  American Journal of Preventive Medicine · 2025-06-03 · 1 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Interpersonal violence: a global issue demands consistent data collection and comprehensive solutions

  Pediatric Research · 2025-09-09

  article1st authorCorresponding
  PublisherDOI

Frequent coauthors

• Sofia Chaudhary

  Children's Healthcare of Atlanta

  62 shared

• Elizabeth R. Alpern

  Lurie Children's Hospital

  58 shared

• Eric W. Fleegler

  Boston Children's Hospital

  55 shared

• Monika K. Goyal

  George Washington University

  45 shared

• Cynthia J. Mollen

  University of Pennsylvania

  42 shared

• Rachel K. Myers

  University of Pennsylvania

  41 shared

• Nancy Kassam‐Adams

  Children's Hospital of Philadelphia

  41 shared

• Charles C. Branas

  University of Otago

  34 shared

Labs

• Fein LabPI

Education

• Master of Public Health

  University of Pennsylvania

  2005

• Fellow, Pediatric Emergency Medicine

  Children's Hospital of Philadelphia

  1993

• Resident, Pediatrics

  Children's Hospital of Philadelphia

  1991

• Doctor of Medicine (MD), Medicine

  New York University

  1988

• Bachelor of Arts, Biology & Psychology

  Wesleyan University

  1984