Fatal Firearm Violence and Previous Interactions With the Pediatric Health Care System

Describe the interactions of young people killed by firearms with the pediatric health care system, with a focus on emergency department care. Characterize victims' risk factors for firearm violence as documented in the medical record.

Subjects were identified by querying the Gun Violence Archive (GVA) for individuals aged 13 to 30 who were fatally shot in Washington, D.C. between January 1, 2018 and December 31, 2022. GVA victims were matched to medical records within our pediatric hospital system. Records were analyzed for demographics, violence risk factors, and health care utilization.

A total of 352 patients met inclusion criteria. The most common risk factors ascertained from medical record review were accidental injury (70.5%), violent injury (45.4%), and involvement with the juvenile justice system (32.9%). Individuals with greater than 5 risk factors comprised only 9.4% of our population but accounted for more than a quarter of the total risk factors documented, including 46.8% of child abuse cases, 31.2% of firearm injuries, 25% of juvenile justice cases, and the majority of mental and behavioral health risk factors (89.4% of behavioral issues, 55.2% of mood problems, and 54.1% of ADHD cases). Conversely, thirty-eight subjects (10.8%) had no documented risk factors. Subjects visited our ED multiple times (mean 5.74 visits) and the majority (70.1%) visited an outpatient clinic.

Young victims of firearms had a range of risk factors for firearm violence and multiple interactions with our pediatric hospital system before death. Each interaction represents an opportunity to screen and intervene. This work also points to the opportunity to change the inequitable systems responsible for these risk factors. Further work must be done to evaluate which risk factors are most predictive and how they develop over time.