Related Experiment Videos
The hidden mortality of pediatric firearm violence
Christina M Theodorou1, Carl A Beyer1, Melissa A Vanover1
1Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA.
Insights
Pediatric firearm injuries are significantly more lethal than motor vehicle collisions (MVCs), with a higher mortality rate and increased resource utilization. The case fatality rate for child gunshot wounds is rising, necessitating focused prevention efforts.
Area of Science:
- Pediatric Trauma Surgery
- Injury Epidemiology
- Public Health
Background:
- Firearm injuries and motor vehicle collisions (MVCs) are leading causes of mortality in children.
- Previous research suggests disparities in outcomes, but direct comparison of pediatric firearm injuries and MVCs is needed.
Purpose of the Study:
- To compare the mortality and resource utilization of pediatric firearm injuries versus MVCs.
- To analyze trends in case fatality rates (CFRs) for both injury types in children.
Main Methods:
- A retrospective analysis of pediatric trauma patients (<18 years) treated for gunshot wounds (GSW) or MVCs at a Level 1 pediatric trauma center (2009-2019).
- Comparison of mortality, need for immediate surgery, and resource utilization.
- Statewide analysis of CFRs and GSW intent using the California Department of Public Health's Overall Injury Surveillance tool (2006-2015).
- Prognosis study, Level II evidence.
Main Results:
- GSWs had a significantly higher mortality rate (7.5% vs. 0.8% for MVCs, p<0.0001) and required immediate surgery more often (34.4% vs. 11.2%, p<0.0001).
- On multivariable analysis, pediatric GSW patients were 7.8 times more likely to die than MVC patients (p<0.0001).
- Statewide, pediatric GSW CFR was 14.7% compared to 0.3% for MVCs (p<0.0001). The GSW CFR increased from 13.4% to 16.5% (p=0.05), while the MVC CFR decreased from 0.5% to 0.2% (p<0.0001) between 2006 and 2015.
Conclusions:
- Pediatric firearm violence is substantially more lethal and resource-intensive than MVCs.
- The rising case fatality rate for pediatric firearm injuries highlights an urgent public health concern.
- Increased resources and targeted interventions are crucial for preventing pediatric firearm injuries.
Introduction:
Firearms and motor vehicle collisions (MVC) are leading causes of mortality in children. We hypothesized that firearm injuries would have a higher mortality than MVCs in children and a higher level of resource utilization METHODS: Trauma patients <18 years old at a Level 1 pediatric trauma center sustaining gunshot wounds (GSW) or MVCs 2009-2019 were included. The primary outcome was mortality. The secondary outcome was immediate surgery. The California Department of Public Health's Overall Injury Surveillance tool was queried for patients <18 with GSW or MVC 2006-2015 to compare statewide case fatality rates (CFRs), and analyze proportions of GSWs by intent: assault, self-inflicted, and unintentional.
Results:
Of 13,840 pediatric trauma patients at our institution, 295 GSWs (2.1%) and 4467 MVCs (32.3%) were included. Mortality was higher for GSWs (7.5% vs. 0.8%, p<0.0001). GSW patients were more likely to require immediate surgery (34.4% vs. 11.2%, p<0.0001). On multivariable analysis, GSW patients were 7.8-times more likely to die than MVC patients (OR 7.83, 95% CI 3.68-16.66, p<0.0001), adjusted for age, sex, and injury severity. Statewide, there were 10,790 pediatric GSWs with 1586 deaths (CFR 14.7%) vs. 710 deaths in 261,363 children in MVCs (CFR 0.3%, p<0.0001). The GSW CFR rose (13.4% to 16.5%, p = 0.05) while the MVC CFR decreased (0.5% to 0.2%, p<0.0001) in 2015 vs. 2006.
Conclusion:
Firearm violence in pediatric patients is significantly more lethal than MVCs and is resource intensive. The case fatality rate for pediatric firearm violence is rising. Resources must be directed at preventing pediatric firearm injuries.
Level Of Evidence:
Prognosis study, Level II.