Highlights
- •Pediatric wounding patterns varied by age and intent of injury (suicide, homicide, unintentional injury).
- •Most pediatric suicide victims had injuries to the head and were dead on scene.
- •Children with homicide and unintentional deaths had more wounding pattern variation and far fewer died on scene.
- •Public health strategies for firearm injuries should be tailored to pediatrics based on age, intent of firearm use, and wounding pattern.
Abstract
Introduction
Pediatric firearm injury became the leading cause of death among U.S. children in
2020. Studies evaluating wounding patterns in military and mass casualty shootings
have provided insights into treatment and potential salvageability in adults, however,
similar studies in the pediatric population do not exist. Hence, our study aimed to
analyze wounding patterns of pediatric firearm fatalities and associated demographics
and characteristics, such as place of death, to better understand pediatric firearm
injuries, potential salvageability, and opportunities to reduce firearm deaths among
vulnerable pediatric populations.
Methods
A retrospective review of the National Violent Death Reporting System from 2005-2017
was performed on patients 18 and younger. Mortalities were stratified by patient age:
<12 years and 13-18 years and by intent— homicide, suicide, and unintentional. Comparative
and exploratory analyses of demographics, location of death and anatomic location
of wounds were performed.
Results
Of 8,527 pediatric firearm mortalities identified, 4,728 were homicides, 3,180 were
suicides and 619 were unintentional injuries. Suicide victims were most likely to
be dead on scene and >90% of suicide victims suffered head/neck injuries. For victims
of homicide, younger children were more likely to die on scene (61% vs 44% p < 0.001).
The pattern of injury in homicides differed for younger children compared to adolescents,
with younger children with more head/neck injuries and older children more thoracic,
thoracoabdominal, abdominal, and junctional injuries. In both age groups, children
with extremity, abdominal and thoracoabdominal injuries were more likely to die later
in the emergency department or inpatient setting.
Conclusions
Wounding patterns across pediatric firearm mortalities in the U.S. vary by age and
intent. The majority of pediatric firearm deaths were due to head/neck injuries. Children
with homicide and unintentional deaths had more wounding pattern variation, including
more injuries to the thorax and abdomen, and a much lower rate of dead-on scene than
suicide victims. Our study of wounding patterns among U.S. children killed by firearms
highlights the complexity of these injuries and offers opportunities for tailored
public health strategies across varying vulnerable pediatric populations.
Keywords
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Article info
Publication history
Published online: December 03, 2022
Accepted:
November 30,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
