Trends in Intentional and Unintentional Firearm Injuries in Pediatric Trauma Patients: An 11-Year Retrospective Study

Abstract

Introduction

In 2020, firearm injuries became the leading cause of death in children and adolescents and have continued to increase despite injury prevention strategies. The information obtained about these injuries is often limited to the demographic and clinical data required for trauma registries, which often lack granularity regarding the circumstances leading to the use of a firearm. The purpose of this study is to analyze admissions for firearm injuries according to intention and social vulnerability to enable the creation of targeted prevention strategies.

Methods

This is a retrospective cohort study using trauma registry data from a single institution from 2012 to 2022. Patients were stratified by a mechanism into unintentional, intentional, and self-inflicted firearm injuries based on chart review. Demographics were compared between groups and the overall trauma population. Social Vulnerability Index data were obtained from the Centers for Disease Control and Prevention registry.

Results

Of the 13,197 trauma patients admitted from January 2012 to December 2022, 153 were related to firearm injuries (1.2%). Relative to the overall trauma population, patients with firearm injuries were predominantly older (9.7 versus 7.4 y, P < 0.001), male (74% versus 61%, P < 0.001), Black (43% versus 17%, P < 0.001), and insured via Medicaid or another government subsidized program (62% versus 48%, P < 0.001). Injuries were classified as intentional (53%), unintentional (44%), and self-harm (1%). Unintentional injuries more frequently resulted in death (17.6% versus 8.6%), although this difference was not enough to reach the statistical significance. The proportion of intentional injuries increased significantly in the 2020-2022 period relative to previous years (P = 0.032).

Conclusions

Vulnerable populations have experienced a disproportionate increase in firearm violence starting in 2020. Unintentional injuries are a significant source of mortality in the pediatric population and represent a vital target for future injury prevention strategies.