Fractures in Children Due to Firearm Activity

Abstract

The purpose of this study was to investigate fracture patterns due to pediatric firearm injuries. The data used was from the US Firearm Injury Surveillance Study 1993-2019. Over these 27 years, there were 19,033 children with fractures due to firearm activity with an average age of 12.2 years; 85.2% were boys and the firearm was a powder type in 64.7%. The finger was the most common fracture location, while the tibia/fibula was the most common location for those admitted to the hospital. Children ≤ 5 years of age sustained more skull/face fractures; most spine fractures occurred in the 11-15-year age group. The injury was self-inflicted in 65.2% of the non-powder and 30.6% of the powder group. The injury intent was an assault in 50.0% of the powder and 3.7% of the non-powder firearm group. Powder firearms accounted for the majority of the fractures in the ≤5 and 11-15 year-olds, non-powder firearms accounted for the majority of the fractures in the 6-10 year-olds. Injuries occurring at home decreased with increasing age; there was an increase in hospital admissions over time. In conclusion, our findings support the need for safe storage of firearms in the home away from children. This data will be helpful to assess any changes in prevalence or demographics with future firearm legislation or other prevention programs. The increasing acuity of firearm-associated injuries seen in this study is detrimental to the child, impacts familial wellbeing, and results in significant financial costs to society.

Keywords: children; demographics; extremity; firearm; fracture; hospital admission; spine.

Figure 1

Fracture distribution by major anatomic location: (a) for those patients treated and released from the ED; (b) for those patients admitted to the hospital from the ED.

Figure 2

Differences between the four major fracture locations (spine, upper extremity, lower extremity, and skull/face: (a) by age group (p = 0.041); (b) by firearm type (p < 10⁻⁴); (c) by ED disposition (p = 0.0001); (d) by being shot or not (p < 10⁻⁴).

Figure 3

Differences between powder and non-powder firearms: (a) by race (p = 0.0005); (b) by perpetrator of the injury (p < 10⁻⁴); (c) by injury intent (p < 10⁻⁴); (d) by incident locale (p < 10⁻⁴); (e) by age group (p = 0.006).

Figure 4

Differences between being shot or not. (a) By incident locale (p < 10⁻⁴); (b) by disposition from the ED (p < 10⁻⁴).

Figure 5

Differences by disposition from the ED: (a) by race (p = 0.011); (b) by perpetrator of the injury (p = 0.0006); (c) by intent of the injury (p < 10⁻⁴); (d) by year time span (p = 0.004).

Figure 6

Differences in age group by incident locale (p = 0.037). Note the decreasing number of cases occurring at home with increasing age.

Figure 7

Temporal variability in the number of ED visits for fractures in children < 16 years old: (a) by day of the week. Note the increased number of ED visits on the weekend); (b) by month. Note that there is no apparent pattern. There was no change by month upon linear regression analysis: r² = 0.057, p = 0.45. Additionally, cosinor analysis [37,38] demonstrated no rhythmic pattern as seen in many other pediatric non-firearm injuries [39,40,41]; (c) by year from 1993 through 2019. There was no change over time upon linear regression analysis: r² = 0.05, p = 0.26.

Figure 7

Temporal variability in the number of ED visits for fractures in children < 16 years old: (a) by day of the week. Note the increased number of ED visits on the weekend); (b) by month. Note that there is no apparent pattern. There was no change by month upon linear regression analysis: r² = 0.057, p = 0.45. Additionally, cosinor analysis [37,38] demonstrated no rhythmic pattern as seen in many other pediatric non-firearm injuries [39,40,41]; (c) by year from 1993 through 2019. There was no change over time upon linear regression analysis: r² = 0.05, p = 0.26.