WHAT'S KNOWN ON THIS SUBJECT: Gunshot injuries are an important cause of preventable injury and mortality in children, with emergency services often providing the initial care for patients. However, there is little recent population-based research to guide public health, injury prevention, and health policy efforts. WHAT THIS STUDY ADDS:Gunshot injuries are uncommon in children, but cause greater injury severity, need for major surgery, mortality, and costs compared with other injury mechanisms. There is also large variation in the populationadjusted incidence of pediatric gunshot injuries between regions. abstract OBJECTIVE: To describe the incidence, injury severity, resource use, mortality, and costs for children with gunshot injuries, compared with other injury mechanisms. METHODS:This was a population-based, retrospective cohort study (January 1, 2006-December 31, 2008 including all injured children age #19 years with a 9-1-1 response from 47 emergency medical services agencies transporting to 93 hospitals in 5 regions of the western United States. Outcomes included population-adjusted incidence, injury severity score $16, major surgery, blood transfusion, mortality, and average per-patient acute care costs. RESULTS:A total of 49 983 injured children had a 9-1-1 emergency medical services response, including 505 (1.0%) with gunshot injuries (83.2% age 15-19 years, 84.5% male). The population-adjusted annual incidence of gunshot injuries was 7.5 cases/100 000 children, which varied 16-fold between regions. Compared with children who had other mechanisms of injury, those injured by gunshot had the highest proportion of serious injuries (23%, 95% confidence interval [CI] 17.6-28.4), major surgery (32%, 95% CI 26.1-38.5), in-hospital mortality (8.0%, 95% CI 4.7-11.4), and costs ($28 510 per patient, . CONCLUSIONS:Despite being less common than other injury mechanisms, gunshot injuries cause a disproportionate burden of adverse outcomes in children, particularly among older adolescent males. Public health, injury prevention, and health policy solutions are needed to reduce gunshot injuries in children. Pediatric gunshot-related injury and death has been the subject of several population-based epidemiologic studies from the mid-1980s through 2002. [2][3][4][5][6][7][8] Other studies during this time period grouped gunshot injuries with other forms of intentional injury. 9,10 More recent population-based research has been limited and focused exclusively on mortality 11,12 or was restricted to hospital-based samples. [13][14][15] Data from the National Violent Death Reporting System provide insight into the problem, 16 although only include fatalities. Thus, there remains a lack of recent population-based research on gunshotrelated injuries in children, with almost no studies evaluating or integrating the important role of emergency medical services (EMS) in the care of these patients.To address these important research gaps, we conducted a population-based study of injured children served by EMS agencies in 5 regi...

OBJECTIVE To describe the incidence, injury severity, resource use, mortality, and costs for children with gunshot injuries, compared with other injury mechanisms. METHODS This was a population-based, retrospective cohort study (January 1, 2006–December 31, 2008) including all injured children age ≤19 years with a 9-1-1 response from 47 emergency medical services agencies transporting to 93 hospitals in 5 regions of the western United States. Outcomes included population-adjusted incidence, injury severity score ≥16, major surgery, blood transfusion, mortality, and average per-patient acute care costs. RESULTS A total of 49 983 injured children had a 9-1-1 emergency medical services response, including 505 (1.0%) with gunshot injuries (83.2% age 15–19 years, 84.5% male). The population-adjusted annual incidence of gunshot injuries was 7.5 cases/100 000 children, which varied 16-fold between regions. Compared with children who had other mechanisms of injury, those injured by gunshot had the highest proportion of serious injuries (23%, 95% confidence interval [CI] 17.6–28.4), major surgery (32%, 95% CI 26.1–38.5), in-hospital mortality (8.0%, 95% CI 4.7–11.4), and costs ($28 510 per patient, 95% CI 22 193–34 827). CONCLUSIONS Despite being less common than other injury mechanisms, gunshot injuries cause a disproportionate burden of adverse outcomes in children, particularly among older adolescent males. Public health, injury prevention, and health policy solutions are needed to reduce gunshot injuries in children.

Epidemiologic study, level III.