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Observational Study
. 2023 Aug;58(8):1500-1505.
doi: 10.1016/j.jpedsurg.2022.10.007. Epub 2022 Oct 22.

COVID-19 Pandemic Effects on the Epidemiology and Mortality of Pediatric Firearm Injuries; A Single Center Study

Mary Elizabeth Bernardin  1 , Lindsay Clukies  2 , Hongjie Gu  3 , Connor Fairfax  4 , Martin S Keller  5
Affiliations
Observational Study

COVID-19 Pandemic Effects on the Epidemiology and Mortality of Pediatric Firearm Injuries; A Single Center Study

Mary Elizabeth Bernardin et al. J Pediatr Surg. 2023 Aug.

Abstract

Background: The COVID-19 pandemic has been associated with increased firearm injuries amongst adults, though the pandemic's effect on children is less clearly understood.

Methods: This cross-sectional study was performed at a Level 1 Pediatric Trauma Center and included youths 0-19 years. The trauma registry was retrospectively queried for firearm injuries occurring pre-COVID-19 pandemic (March 2015-February 2020). Baseline data was compared to prospectively collected data occurring during the COVID-19 pandemic (March 2020-March 2022). Fischer's exact, Pearson's Chi-square and/or correlation analysis was used to compare pre and post-COVID-19 firearm injury rates and intent, victim demographics and disposition. Temporal relationships between firearm injury rates and local COVID-19 death rates were also described.

Results: 413 pre-COVID-19 firearm injuries were compared to 259 pandemic firearm injuries. Victims were mostly Black males with a mean age of 13.4 years. Compared to the 5 years pre-pandemic, monthly firearm injury rates increased 51.5% (6.8 vs 10.3 shootings/month), including a significant increase (p = 0.04) in firearm assaults/homicides and a relative decrease in unintentional shootings. Deaths increased 29%, and there were significantly fewer ED discharges and more admissions to OR and/or PICU (p = 0.005). There was a significant increase in Black victims (p = 0.01) and those having Medicaid or self-pay (p<0.001). Firearm injury spikes were noted during or within the 3 months following surges in local COVID-19 death rates.

Conclusions: The COVID-19 pandemic was associated with an increase in the frequency and mortality of pediatric firearm injuries, particularly assaults amongst Black children following surges in COVID death rates. Increased violence-intervention services are needed, particularly amongst marginalized communities.

Level of evidence: This is a prognostic study, evaluating the effects of the COVID-19 pandemic on pediatric firearm injuries, including victim demographics, injury intent and mortality. This study is retrospective and observational, making it Oxford Level III evidence.

Keywords: COVID-19 pandemic; Firearm injury; Gun violence; Pediatric injury prevention.

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Conflict of interest statement

Declaration of Competing Interest All authors declare no conflict of interest related to this work.

Figures

Fig. 1:
Fig. 1
Average monthly pediatric firearm injuries by intent, March 2015-March 2022.
Fig. 2:
Fig. 2
Pediatric firearm assaults (FA) and COVID-19 deaths per month in St. Louis, MO (March 2020-March 2022).
See this image and copyright information in PMC

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