Trends in Pediatric Firearm Injuries: 2016-2023

Firearm injuries (FIs) are the leading cause of death for children and adolescents in the United States. Prior studies noted increases in pediatric FI emergency department (ED) visits early in the pandemic, but long-term trends are unclear.

We conducted a retrospective observational study using the Pediatric Health Information System including patients aged younger than 18 years with an FI-related ED visit from 2016 to 2023. Encounters were identified by International Classification of Diseases, Tenth Revision discharge diagnosis codes for FI. Time series analysis with segmented Poisson regression with hospital-level clustering was used to identify change points and estimate annualized trends in FI encounters (ED visits, hospitalizations, and mortality).

A total of 6358 pediatric FI ED visits were identified. Most patients were male (79.0%), aged 12 through 17 (69.8%), Black (60.4%), and publicly insured (76%). FI ED visits increased from an average of 44.1 per month in 2016 to 83.3 in 2023. Change points in March and June 2020 marked an early pandemic surge, with ED visits rising at an annualized rate of 496% before before demonstrating no statistically significant linear change thereafter, although volumes remained higher than pre-pandemic levels. Hospitalizations and in-hospital death encounters rose in number, but the proportions remained stable (50.7%-55.5% hospitalized; 5.7%-8.1% mortality).

Pediatric FI ED visits rose early in the COVID-19 pandemic and have remained elevated through 2023, establishing a concerning new baseline. The stable proportions of hospitalizations and in-hospital mortality suggest that increases in absolute counts were driven primarily by rising injury incidence not accompanied by increased severity. Findings underscore the need for sustained prevention and cross-sector collaboration to reduce pediatric FI burden.