Wounding Patterns in Fatal and Nonfatal Pediatric Firearm Injuries

Gunshot wounds (GSWs) are the leading cause of death in children. This study defines pediatric firearm wound patterns and fatal organ injury to identify salvageability of injuries.

Survivor data were collected from an urban Level I pediatric trauma center and nonsurvivor data were collected from the medical examiner. All GSW patients aged 14 years and younger from 2011 to 2021 were included. Both survivors and nonsurvivors were analyzed for body area wounds. For nonsurvivors, trauma surgeons and medical examiners determined fatal organ injury. Wound patterns and fatal organ injury were compared with existing data on adult wound patterns and fatal organ injury.

A total of 165 patients were analyzed, including 148 (90%) survivors. Nonsurvivors were younger (8 ± 4 vs. 10 ± 4 years old, P =0.04). Only 5% of survivors had a tourniquet placed, but none required operative control of hemorrhage. All nonsurvivors suffered head wounds, chest wounds, or both. Nonsurvivors had significantly more head wounds (71%) compared with survivors (9%) ( P <0.001). Survivors had significantly more extremity wounds than nonsurvivors (68% vs. 12%, P <0.001). Nonsurvivors had significantly more brain (71% vs. 3%, P <0.001) and heart injuries (24% vs. 1%, P <0.001). No deaths were caused by exsanguination from peripheral vascular injury.

Pediatric firearm deaths are largely due to nonsurvivable brain injury. The best opportunity to lower pediatric firearm mortality is to prevent the injury itself, although this needs to be assessed in other cities and settings as well.