Assault-Related Versus Accidental Pediatric and Adolescent Firearm Injuries: Trends and Types of Extremity Trauma

Firearm injuries are the leading cause of death among U.S. children, with increasing rates of both fatal and nonfatal injuries. While prior studies have described general epidemiologic trends, few have explored how injury intent is related to patterns of extremity injury in pediatric patients.

We conducted a retrospective review of pediatric patients (18 y or younger) presenting with firearm-related extremity injuries at a pediatric level I trauma center from January 1, 2018, to December 31, 2023. Demographic data, injury characteristics, and clinical outcomes were compared between assault-related and accidental injuries. Statistical analysis included χ 2 , the Fisher exact tests, and the Grubb test for statistical outliers, with significance set at P <0.05.

A total of 230 patients were included, of whom 74.3% sustained assault-related injuries and 25.6% accidental injuries. Assault-related injuries primarily affected older African American males and were associated with higher injury severity scores, multisystem trauma, ICU admission, multiple gunshot wounds, and multiple extremity involvement. Accidental injuries were more common in younger patients and had higher rates of fractures (69.5% vs. 52.1%; P =0.02), orthopaedic consults (79.7% vs. 59.2%; P =0.0046), and surgical intervention (50.9% vs. 27.5%; P =0.001). A significant monthly spike in accidental injuries was noted in January ( P <0.05).

Injury intent is associated with patterns of extremity trauma following pediatric and adolescent firearm injury. While assault-related injuries are more systemically severe, accidental injuries often result in complex extremity trauma requiring operative care. The monthly spike of accidental injuries in January highlights an opportunity for targeted prevention efforts around firearm safety and storage.

Level III.