Cumulative Incidence and Risk Factors for Pediatric Firearm Reinjury: A Two-Center Cohort Study

Pediatric patients who experience firearm injury may be at risk for subsequent reinjury, yet the timing and predictors of recurrence remain poorly defined. Characterizing reinjury patterns at both individual and system levels is essential for informing targeted prevention strategies.

We performed a retrospective review (2010-2024) of patients aged 0-18 years presenting with non-self-inflicted firearm injuries to two Level I pediatric and adult trauma centers. Cross-institutional database linkage was used to identify reinjury events. Cumulative incidence functions estimated reinjury risk over time, accounting for death as a competing risk. Univariate and multivariate Cox proportional hazards models evaluated independent predictors of reinjury.

Among 834 patients (84.9% male, 79% Black; median age 17 years [IQR 15-18]), 67 died from their index injury and 75 sustained a subsequent firearm injury at a median of 22 months (IQR 12-61). No reinjury events occurred among children younger than 11 years. Cumulative reinjury incidence at one, three, and five years was 2.5% (1.4-3.6), 5.9% (4.2-7.5), and 7.8% (5.8-9.7), respectively. Assault-related index injury (aHR 2.18, 95% CI 1.10-4.35), lower injury severity (aHR 0.59, 95% CI 0.36-0.97), and treatment at an adult trauma center (aHR 3.43, 95% CI 1.46-8.06) were independently associated with increased reinjury risk.

Firearm reinjury among pediatric patients is concentrated in adolescence and often occurs years after the initial event. Reinjured youth were more likely to have been assaulted, uninsured, and initially treated for relatively minor injuries-factors that may limit engagement with supportive services. These findings underscore the need for developmentally tailored violence-prevention and resource-linkage interventions initiated at the time of first injury.