Pediatric firearm injuries: A Midwest experience

Abstract

Introduction: Firearm injuries remain a significant public health concern. As a Level 1 Pediatric Trauma Center with a wide and diverse catchment, we sought to define our own experience as well as identify the affected patient population.

Methods: A retrospective review was conducted utilizing our institution's trauma registry including all pediatric patients (age ≤ 17 years) who presented with a firearm injury between 2012 and 2017. Patients were stratified by age group as well as by geographic location. Outcomes as well as circumstances of the shooting were measured.

Results: A total of 236 patients were included. One hundred thirteen patients (47.9%) were ≤12 years while 123 (52.1%) were between the ages of 13 and 17 years. The younger group had a 52.2% operative intervention rate while the older group had a 37.2% operative intervention rate (p = 0.005) while there was no difference in mortality rate. Patients in the younger group tended to be injured by someone who was known to the patient (self: 22.1%, family/friend: 44.3%) as an accidental shooting (61.9%) while patients in the older group were usually injured by a stranger (58.5%) as an assault (61.8%). When stratified by location, the majority of patients were from large cities. However, after adjusting for population, the firearm injury rate was the highest in the small cities. The majority of the shootings in these small cities were accidental, even after stratifying by age (young group: 81.4% small cities vs 50% large cities, p = 0.0008%; older group: 62.5% small cities vs 25.2% large cities, p = 0.0005).

Conclusions: Although gun violence in the pediatric population is traditionally viewed as an "urban" problem among teens, our research shows that young children also suffer the consequences of firearm injuries and that rural areas are afflicted particularly by accidental firearm discharges. This may represent a new targeted audience for outreach.

Level of evidence: III.

Keywords: Firearm; Gun; Pediatric trauma.