Trends in Pediatric Orthopaedic Firearm Injuries: A 28-Year National Representative Database Review

Firearm-related morbidity and mortality remain a major public health issue in the United States, contributing substantially to preventable pediatric deaths and nonfatal orthopaedic injuries. The aim of this paper is to investigate trends and characteristics of orthopaedic firearm injuries for fatal and nonfatal cases.

The Firearm Injury Surveillance Study (FISS), a publicly available and nationally representative database composed of 102 emergency departments (EDs), was queried retrospectively for patients 0-18 years of age who sustained orthopaedic injuries involving firearm use between 1993 and 2021. The database yielded a national estimate of 15,426 total cases from 1993 to 2021. Demographics, injury characteristics, perpetrator, intent, and ED disposition were collected and analyzed. Simple linear regressions were utilized to assess trends in the number of orthopaedic injuries and fatalities over time.

Orthopaedic injuries resulting from firearm use had an overall declining trend (β = -6.15) from 1993 to 2021, with notable spikes in 2012 and 2020. The average annual incidence was 29.7 injuries per 100,000 children. Most of these injuries were sustained by males (81%) and the 15- to 18-year-old age group (80%). Over half of these injuries were self-inflicted (59.5%). Additionally, 69% of all injuries were unintentional. Fractures and strains/sprains were the most common, comprising 72% and 17% of cases, respectively. Injuries were most frequently sustained to the finger (26%), hand (11%), and foot (9%). Over 30% of injuries resulted in a fatality, and nearly 10% of cases involved a crime. Fatal cases had a decreasing trend from 1993 to 2021 (β = -4.39), with a spike in 2012. Males (62%), Caucasians (60%), and adolescents (age: 14.0-18.9 years) (100%) accounted for the greatest proportions of fatalities. In total, 88.2% of fatalities were unintentional.

Pediatric orthopaedic injuries from firearm use have seen a decline from 1993 to 2021, with a disproportionate representation by adolescent males. Despite the decline, the frequency of unintentional and self-inflicted injury persists and highlights the need for greater awareness of firearm safety and education.

(1)Analysis for a nationally representative database reveals that there was an overall decline in pediatric orthopaedic injuries sustained by firearms from 1993 to 2021, but there were spikes in prevalence in 2012 and 2020.(2)Males 15-18 years of age accounted for the greatest proportion of firearm injuries.(3)Most firearm-related injuries were fractures involving the upper extremity and mostly to the male and adolescent population.(4)Firearm injuries were frequently self-inflicted and unintentional, underscoring the need for greater firearm safety and education.

III.