Pediatric Firearm Reinjury: A Retrospective Statewide Risk Factor Analysis

Pediatric firearm injuries are a significant public health concern in the United States. This study examines risk factors for firearm reinjury in Maryland's pediatric population.

Pediatric patients (age 0-19 y) who presented to any hospital in Maryland with a firearm injury between October 1, 2015, and December 31, 2019, were identified in the Maryland Health Services Cost Review Commission database and were followed for repeat firearm injuries through March 31, 2020. Logistic regression was used to analyze risk factors for reinjury. Geospatial analysis was used to identify communities with the highest prevalence of reinjury.

Of 1351 index presentations for firearm injuries, 102 (7.3%) were fatal. Among children with nonfatal injuries, 40 (3.1%) re-presented with a second firearm injury, 25% of which were fatal. The median interval to reinjury was 149 d [interquartile range: 73-617]. Reinjury was more common in children aged ≥15 y (90% versus 76%), males (100% versus 87%), of Black race (90% versus 69%) or publicly insured (90% versus 68%) (all P < 0.05). Most lived in highly deprived neighborhoods of Baltimore City. No single factor was significant in multivariable models.

Pediatric firearm reinjury is rare but highly morbid in Maryland. While prior studies have shown Black race to be independently associated with firearm reinjury, we found the effect of race was entirely attenuated after controlling for neighborhood deprivation. These findings underscore the urgent need for targeted interventions in areas identified as high risk in addition to policies to reduce youth firearm access.