Defining the Full Spectrum of Pediatric Firearm Injury and Death in the United States

Abstract

Objective: To characterize the full spectrum of pediatric firearm injury in the United States by describing fatal and nonfatal injury data epidemiology, vulnerable populations, and temporal trends. Background: Firearm injury is the leading cause of death in children and adolescents in the United States. Nonfatal injury is critical to fully define the problem, yet accurate data at the national level are lacking. Methods: A cross-sectional study combining national firearm injury data from the Centers for Disease Control (fatal) and the National Trauma Data Bank (nonfatal) between 2008 and 2019 for ages 0 to 17 years. Data were analyzed using descriptive and χ 2 comparisons and linear regression.Results: Approximately 5000 children and adolescents are injured or killed by firearms each year. Nonfatal injuries are twice as common as fatal injuries. Assault accounts for the majority of injuries and deaths (67%), unintentional 15%, and self-harm 14%. Black youth suffer disproportionally higher injuries overall (crude rate: 49.43/million vs White, non-Hispanic: 15.76/million), but self-harm is highest in White youth. Children <12 years are most affected by nonfatal unintentional injuries, 12 to 14 years by suicide, and 15 to 17 years by assault. Nonfatal unintentional and assault injuries, homicides, and suicides have all increased significantly (P < 0.05). Conclusions: This study adds critical and contemporary data regarding the full spectrum and recent trends of pediatric firearm injury in the United States and identifies vulnerable populations to inform injury prevention intervention and policy. Reliable national surveillance for nonfatal pediatric firearm injury is vital to accurately define and tackle this growing public health crisis.

Trends in pediatric firearm-related injuries and disparities in acute outcomes

“…Age groups were as follows; 0–6 years, 7–12 years, 13–15 years, and 16–20 years. We chose to separate the adolescent age group into younger (13–15 years) and older (16–20 years) categories due to the varying mechanisms of FRI that have been shown to impact these age groups within the literature ( 35 ). The sample did not have any patients aged 21 years, despite eligibility.…”

Pediatric Firearm Injury

“…To appropriately encapsulate the magnitude of this problem and begin advocacy for intervention and policy, a summary of the most comprehensive available data sources detailing fatal and nonfatal injuries is critical. Dr Naik-Mathuria et al3, in this issue of Annals of Surgery , have provided just this in their cross-sectional population-based study combining national firearm injury data in children and adolescents (2008-2019) from 2 reliable sources. Importantly, the manuscript not only provides a current comprehensive view of this problem but also confirms prior epidemiologic estimates, illuminates important temporal trends, and highlights continued disparities in vulnerable populations 1,2,4…”

“…Significant disparities continue to exist in firearm injuries: Black children are the most likely to suffer mortality or injury by assault, fatal assault in Hispanic children is second only to Blacks, the majority of self-harm injuries/fatalities occur in White, non-Hispanic children, and Native Americans, whereas non-Hispanic youth have the highest crude rate of suicide. Finally, attention to age trends is important: those children below 12 years old are most affected by nonfatal unintentional injuries, 12- to 14-year-olds by suicide, and 15- to 17-year-olds by assault 3. Despite the inherent limitations of the databases, these are the best estimates of the “full spectrum” of pediatric firearm injuries on which we should act.…”

“…Finally, attention to age trends is important: those children below 12 years old are most affected by nonfatal unintentional injuries, 12-to 14-year-olds by suicide, and 15-to 17-year-olds by assault. 3 Despite the inherent limitations of the databases, these are the best estimates of the "full spectrum" of pediatric firearm injuries on which we should act.A comprehensive public health approach to reduce firearm injuries and deaths among youth must include a multipronged approach to public education, clinical interventions, and legislative advocacy. Although different strategic approaches specific to firearms are needed, lessons should be learned from a successful approach to reduce pediatric mortalities related to motor vehicle collisions from 2001 to 2019.…”

“…Finally, attention to age trends is important: those children below 12 years old are most affected by nonfatal unintentional injuries, 12-to 14-year-olds by suicide, and 15-to 17-year-olds by assault. 3 Despite the inherent limitations of the databases, these are the best estimates of the "full spectrum" of pediatric firearm injuries on which we should act.…”