Risk factors and clinical outcomes of pediatric versus adult intentional self-inflicted firearm injuries

Intentional self-inflicted firearm injuries represent a major public health concern in the United States, with alarming increases among pediatric populations. This study compares trends, risk factors, and outcomes of intentional self-inflicted firearm injuries between pediatric and adult patients. We hypothesized that pediatric patients would demonstrate better outcomes than adults, attributed to greater physiological resilience.

To compare demographics, risk factors, and clinical outcomes between pediatric (<18 years) and adult (≥18 years) patients with intentional self-inflicted firearm injuries.

We analyzed the 2022-2023 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database, identifying 8404 patients with intentional self-inflicted firearm injuries. Patients were grouped into Adult (≥18 years) and Pediatric (<18 years) cohorts. The primary outcome was mortality; secondary outcomes included length of stay and in-hospital complications. Inclusion was restricted to ICD-10-CM codes X72-X74 (intentional self-harm by firearm); accidental (W32-W34) and undetermined (Y22-Y24) injuries were excluded.

We identified 7847 adults and 557 pediatric patients. Both cohorts had a mean Injury Severity Score (ISS) of 21.4. A greater proportion of pediatric patients were Black compared with adults (21.72 % vs. 13.08 %; p < 0.001). Adults more frequently carried diagnoses of mental or personality disorders (16.40 % vs. 9.52 %; p < 0.001). No significant differences were observed between groups in mortality or hospital complications.

Adult and pediatric patients sustaining intentional self-inflicted firearm injuries experienced similarly poor outcomes, with mortality exceeding 50 % in both groups. These findings suggest that the presumed protective advantage of higher physiological reserves in pediatric patients may be diminished in the context of firearm trauma. Enhanced prevention, mental health support, and firearm safety measures remain critical.

Why is this topic important? Intentional self-inflicted firearm injuries are highly lethal and are rising among youth. What does this study attempt to show? Differences in demographics, risk factors, and outcomes between pediatric and adult patients with intentional self-inflicted firearm injuries. What are the key findings? Pediatric patients were more often Black and injured at home; adults had higher rates of alcohol, substance use, and mental/personality disorders; however, ISS, complications, and mortality were similar. How is patient care impacted? Supports counseling on secure firearm storage and routine screening for suicidality and mental-health needs in both pediatric and adult care settings. In pediatric populations, the predominance of home injuries emphasizes counseling caregivers on locked, unloaded firearm storage with separate ammunition.