At Home and at Risk: A Study on Pediatric Unintentional Firearm Injuries in the USA

Abstract

Aim of the study: Firearm injury is the leading cause of death among pediatric patients in the United States. Unintentional firearm injury remains underexplored compared to intentional firearm injury. This study aims to characterize risk factors and demographics associated with pediatric unintentional firearm injury.

Methods: Retrospective analysis of pediatric patients (≤18 years) with firearm injuries from 2017-2022 using the ACS National Trauma Databank. Firearm injuries were identified via ICD-10 codes, classified by intent, and place of injury. Analysis involved univariate, multivariate, and regression models to identify factors associated with unintentional injury.

Results: Of the 42,152 pediatric firearm injuries, 17.6% (n = 8043) were unintentional. Predominantly occurring at home (56.2%), these injuries mostly involved Black (45.7%) or White (42.0%) males (82.3%) aged 12-18 (74.1%). Children aged 2-5 experienced a higher number of unintentional injuries than intentional (1,064 vs. 770). Unintentional injuries were less severe (ISS >16: 10.9% vs. 17.3%, p<0.001) and less fatal (6.7% vs. 12.6%, p<0.001) compared to intentional injuries. Children aged 2-5 had higher odds of unintentional injury (OR 1.98, p<0.001), while adolescents aged 12-18 had lower odds (OR 0.32, p<0.001). Injuries at home were associated with higher odds of being unintentional (OR 1.61, p<0.001), while those on streets or roads were more likely intentional (OR 0.34, p<0.001).

Conclusions: Unintentional firearm injuries, while less severe and fatal, represent a substantial proportion of pediatric firearm trauma in the U.S. These injuries pose significant risks to younger children, often in domestic settings.

Levels of evidence: III.

Keywords: Firearm storage; Gun safety; Pediatric firearm injury; Trauma; Unintentional firearm injury.