Pediatric firearm injuries: Anatomy of an epidemic

Abstract

Pediatric firearm injuries: Anatomy of an epidemic Gun violence is the second the leading cause of mortality in pediatric trauma, with only motor vehicle collisions responsible for more pediatric deaths. 1e3 Despite increasing rates of vehicle miles traveled each year, increased safety efforts have substantially decreased deaths attributable to motor vehicle accidents. In contrast, the number of pediatric firearm injuries has continued to increase (Fig 1). 3,4 In 2019, firearms resulted in the deaths of more than 1,300 infants and children, alongside thousands more surviving with devastating and serious life-altering injuries. 1,2 These injuries continue to be a very worrisome public health issue because they are more fatal than any other injury presenting to trauma centers (Fig 2). Pediatric firearm deaths are tragedies that should certainly be preventable, although effective solutions remain elusive. Contributing to the failure to decrease firearmrelated mortality are fundamental gaps in existing information, which prevent an accurate description of this problem. Literature SearchResearch describing the pattern of firearm injury in the pediatric population is rare. Recently, there have been several adult studies examining injury patterns, using autopsy analyses from victims of combat scenarios or civilian, public mass shootings (CPMS). 5e8 Epidemiologic studies describing pediatric firearm injuries have also been published. 2,9,10 However, the variations in anatomic patterns of pediatric firearm injury, which are key to improving care and prevention, have yet to be described. Here we present selected data characterizing firearm injury in the pediatric US population during the past 7 years from which we hypothesize that the firearm injury and mortality risk differs among infants, adolescents, and adults. We offer several observations that may provide guidance for future research and action.The National Trauma Data Bank provides encounter-specific information from more than 900 trauma centers in the United States and includes both pediatric and adult patients. Throughout a 7-year time frame (2010e2016), we extracted data after approval by the institutional review board of the University of Pennsylvania (Philadelphia, PA) for all patients aged 0 to 19 years with firearm-related injuries. These data included the following 5 mechanisms of firearm injury: assaults, unintentional injuries, suicides, legal intervention (ie, firearm injury incurred from a law enforcement officer in the line of duty), and undetermined use, all classified by diagnosis codes of external injury (Internation Classification of Disease, Clinical Modification, 9th and 10th revisions). We then used the Abbreviated Injury Scale to identify body region and severity of injury. There were 36,581 encounters for pediatric firearm injuries in 7 years, including 4,017 deaths, corresponding to a case fatality rate of 11.0%. Assaults accounted for the majority of cases (n ¼ 29,036, 79.4%). Fewer encounters occurred in children 14 years of age (12.8%), an...

Pediatric suicide by violent means: a cry for help and a call for action

“…html). Self-inflicted firearm injuries have the highest mortality (Swendiman et al 2020). Additionally, there are discrepancies between institutional case fatality rates among pediatric victims of firearm violence and epidemiologic data which has the benefit of including on-scene fatalities; this discrepancy highlights a hidden mortality of pediatric firearm violence (Theodorou et al 2022).…”

The hidden mortality of pediatric firearm violence

“…[1]. Data from the National Trauma Data Bank underscore the magnitude of this disparity, with a case fatality rate (CFR) for gunshot wounds (GSWs) nearly four times that of motor vehicle collisions (MVCs) [2,3]. Pediatric GSWs are resource intensive with high rates of operative intervention and significant costs to the healthcare system, [4].…”

Burden of unintentional pediatric firearm injury: An examination of the Nationwide Readmission Database

“…3 Unintentional firearm injury accounts for almost half of all firearm injuries for those younger than 14 years. 4,5 For pediatric survivors of firearm injury, recovery includes numerous additional stressors for both the child (physical and psychological rehabilitation) and their caregivers (financial and psychologic stress). [6][7][8] This recovery may include multiple hospitalizations that have been shown to lead to decreased emotional and psychological well-being in children.…”

“…Increasing rates of pediatric firearm injury and death over the past two decades persist despite childhood access prevention laws enacted by many states 3 . Unintentional firearm injury accounts for almost half of all firearm injuries for those younger than 14 years 4,5 . For pediatric survivors of firearm injury, recovery includes numerous additional stressors for both the child (physical and psychological rehabilitation) and their caregivers (financial and psychologic stress) 6–8 .…”