Pediatric Trauma Trends Before and After Recreational Cannabis Legalization in Nevada: A Retrospective Repeated...

Background: Cannabis legalization has raised concerns regarding its potential influence on injury patterns, particularly among children. However, evidence on pediatric trauma remains limited. Objective: To examine trends in pediatric trauma incidence, injury mechanisms, healthcare utilization, and socioeconomic characteristics before and after recreational cannabis legalization in Nevada. Methods: A retrospective repeated cross-sectional study of trauma registry data was conducted using pediatric trauma activations recorded between 2013 and 2023. Incidence rates per 100,000 population were calculated using census data. Pre-legalization (2013-2016) and post-legalization (2017-2023) periods were compared using incidence rate ratios (IRRs) and bivariate tests. Socioeconomic status was assessed using the Distressed Communities Index (DCI). Results: Among 1772 pediatric trauma activations, overall incidence remained stable (21.6 vs. 21.4 per 100,000; IRR = 0.99, 95% CI: 0.90-1.09). Post-legalization, motor vehicle collision-related injuries increased (49.3% vs. 41.3%, p = 0.002), while pedestrian injuries declined (25.5% vs. 32.4%). ICU admissions decreased (19.5% vs. 27.3%, p < 0.001), although ICU length of stay increased (5.9 vs. 4.0 days, p = 0.005). A higher proportion of patients originated from less distressed communities post-legalization (p = 0.021), alongside shifts in insurance coverage (p < 0.001). Conclusions: Pediatric trauma incidence remained stable following cannabis legalization in Nevada; however, shifts in injury mechanisms, healthcare utilization, and socioeconomic patterns were observed. Because cannabis legalization was assessed at the population level and individual cannabis exposure was not directly measured, findings should be interpreted as temporal associations rather than causal effects. These findings highlight the need for ongoing surveillance and targeted, equity-focused injury prevention strategies.