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Pediatric firearm mortality in the United States, 2010 to 2016: A National Trauma Data Bank analysis
Justin S Hatchimonji1, Robert A Swendiman, Matthew A Goldshore
1From the Department of Surgery (J.S.H., R.A.S., M.A.G.), Perelman School of Medicine, University of Pennsylvania; and Division of Pediatric General, Thoracic and Fetal Surgery (T.A.B., M.L.N., M.A., G.W.N.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Pediatric firearm deaths are rising, especially from self-inflicted injuries. Prioritizing prevention and treatment for these children is crucial for reducing child mortality.
Area of Science:
- Public Health
- Trauma Surgery
- Epidemiology
Background:
- Pediatric firearm injury is a significant cause of mortality in U.S. children.
- Characterizing children who die from firearm injuries is essential for targeted interventions.
Purpose of the Study:
- To analyze trends and characteristics of pediatric firearm injuries and associated mortality.
- To identify factors influencing mortality in pediatric firearm injury cases.
Main Methods:
- Utilized the National Trauma Data Bank (2010-2016) for patients aged 0-19 years.
- Classified injuries by intent using ICD codes and analyzed differences using statistical tests.
- Employed multivariable logistic regression to assess factors associated with mortality.
Main Results:
- Over 45,000 pediatric firearm injuries occurred, with a 12% mortality rate.
- Mortality was linked to younger age, white race, increased injury severity, shock, and polytrauma.
- Self-inflicted injuries showed an increasing trend and higher mortality, rising from 35.3% to 47.8% between 2010 and 2016.
- Treatment at a pediatric trauma center was found to be protective against mortality.
Conclusions:
- The proportion of self-inflicted pediatric firearm injuries and their associated mortality increased from 2010 to 2016.
- Given the high mortality in this subgroup, focused prevention and treatment efforts are urgently needed for firearm-injured children.
- Pediatric trauma center care is associated with reduced mortality in pediatric firearm injuries.
Background:
Pediatric firearm injury is a leading cause of death for U.S. children. We sought to further characterize children who die from these injuries using a validated national database.
Methods:
The National Trauma Data Bank 2010 to 2016 was queried for patients aged 0 to 19 years old. International Classification of Diseases external cause of injury codes were used to classify patients by intent. Differences between groups were analyzed using χ or Mann-Whitney U tests. Patterns over time were analyzed using nonparametric tests for trend. Multivariable logistic regression was used to investigate associations between the above factors and mortality.
Results:
There were a total of 45,288 children with firearm injuries, 12.0% (n = 5,412) of whom died. Those who died were younger and more often white than survivors. Mortality was associated with increased injury severity, shock on presentation, and polytrauma (p < 0.001 for all). There was an increasing trend in the proportion of self-inflicted injuries over the study period (p < 0.001), and mortality from these self-inflicted injuries increased concordantly (35.3% in 2010 to 47.8% in 2016, p = 0.001). Location of severe injuries had significant different mortality rates, ranging from 51.3% of head injuries to 3.9% in the extremities. In the multivariable model, treatment at a pediatric trauma center was protective against mortality, with odds ratios of 2.10 (confidence interval, 1.64-2.68) and 1.80 (confidence interval, 1.39-2.32) for death at adult and dual-designated trauma centers, respectively. This finding was confirmed in age-stratified cohorts.
Conclusion:
Proportions of self-inflicted pediatric firearm injury in the National Trauma Data Bank increased from 2010 to 2016, as did mortality from self-inflicted injury. Because mortality is highest in this subpopulation, prevention and treatment efforts should be prioritized in this group of firearm-injured children.
Level Of Evidence:
Epidemiological study, level V.
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