- •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.
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.
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.
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.
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.
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Fatal injury and violence data | WISQARS | injury center | CDC. Published February 10, 2022. Accessed May 15, 2022. https://www.cdc.gov/injury/wisqars/fatal.html.
- Shooting at elementary school devastates community in south texas.The New York Times. 2022; (Published May 24Accessed June 2, 2022)
10 people killed and 3 wounded in shooting at a buffalo supermarket - the new York times. Accessed June 2, 2022. https://www.nytimes.com/live/2022/05/14/nyregion/buffalo-shooting.
- Changes in US mass shooting deaths associated with the 1994-2004 federal assault weapons ban: Analysis of open-source data.J Trauma Acute Care Surg. 2019; 86: 11-19https://doi.org/10.1097/TA.0000000000002060
- Current causes of death in children and adolescents in the United States.N Engl J Med. 2022; 386: 1955-1956https://doi.org/10.1056/NEJMc2201761
- The major causes of death in children and adolescents in the United States.N Engl J Med. 2018; 379: 2468-2475https://doi.org/10.1056/NEJMsr1804754
- Violent death rates: the US compared with other high-income OECD countries, 2010.Am J Med. 2016; 129: 266-273https://doi.org/10.1016/j.amjmed.2015.10.025
- Childhood firearm injuries in the United States.Pediatrics. 2017; 140 (Pediatrics. 2017;140(4):e20172298)e20163486https://doi.org/10.1542/peds.2017-2298
- Fatal wounding pattern and causes of potentially preventable death following the pulse night club shooting event.Prehospital Emerg Care Off J Natl Assoc EMS Phys Natl Assoc State EMS Dir. 2018; 22: 662-668https://doi.org/10.1080/10903127.2018.1459980
- Eliminating preventable death on the battlefield.Arch Surg Chic Ill 1960. 2011; 146: 1350-1358https://doi.org/10.1001/archsurg.2011.213
- Died of wounds on the battlefield: causation and implications for improving combat casualty care.J Trauma. 2011; 71: S4-S8https://doi.org/10.1097/TA.0b013e318221147b
- Patterns of anatomic injury in critically injured combat casualties: a network analysis.Sci Rep. 2019; 9: 13767https://doi.org/10.1038/s41598-019-50272-3
- Wounding patterns based on firearm type in civilian public mass shootings in the United States.J Am Coll Surg. 2019; 228: 228-234https://doi.org/10.1016/j.jamcollsurg.2018.11.014
- Injury characteristics of the Pulse Nightclub shooting: lessons for mass casualty incident preparation.J Trauma Acute Care Surg. 2020; 88: 372-378https://doi.org/10.1097/TA.0000000000002574
- Incidence and cause of potentially preventable death after civilian public mass shooting in the US.J Am Coll Surg. 2019; 229: 244-251https://doi.org/10.1016/j.jamcollsurg.2019.04.016
- The profile of wounding in civilian public mass shooting fatalities.J Trauma Acute Care Surg. 2016; 81: 86-92https://doi.org/10.1097/TA.0000000000001031
- Preventable death and interpersonal violence in the United States: who can be saved?.J Trauma Acute Care Surg. 2019; 87: 200-204https://doi.org/10.1097/TA.0000000000002336
- A profile of combat injury.J Trauma. 2003; 54: S13-S19https://doi.org/10.1097/01.ta.0000057151.02906.27
- An analysis of prehospital deaths: who can we save?.J Trauma Acute Care Surg. 2014; 77: 213-218https://doi.org/10.1097/TA.0000000000000292
- Comparison of the causes of death and wounding patterns in urban firearm-related violence and civilian public mass shooting events.J Trauma Acute Care Surg. 2020; 88: 310-313https://doi.org/10.1097/TA.0000000000002470
- Pediatric firearm injuries: Anatomy of an epidemic.Surgery. 2020; 168: 381-384https://doi.org/10.1016/j.surg.2020.02.023
- Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association.Ann Intern Med. 2015; 162: 513-516https://doi.org/10.7326/M15-0337
- APSA board of governors. Firearm injuries and children: position statement of the American Pediatric Surgical Association.Pediatrics. 2019; 144https://doi.org/10.1542/peds.2018-3058
- International network for epidemiology in policy (Formerly known as IJPC-SE). The role of epidemiology in firearm violence prevention: a Policy Brief.Int J Epidemiol. 2018; 47: 1015-1019https://doi.org/10.1093/ije/dyy059
- Pediatric firearm mortality in the United States, 2010 to 2016: a National Trauma Data Bank analysis.J Trauma Acute Care Surg. 2020; 88: 402-407https://doi.org/10.1097/TA.0000000000002573
- Civilian gunshot wounds to the head: prognostic factors affecting mortality: meta-analysis of 1774 patients.J Neurotrauma. 2018; 35: 2605-2614https://doi.org/10.1089/neu.2018.5682
- Who are the owners of firearms used in adolescent suicides?.Suicide Life Threat Behav. 2010; 40: 609-611https://doi.org/10.1521/suli.2010.40.6.609
- Characteristics of infant homicides: findings from a U.S. multisite reporting system.Pediatrics. 2009; 124: e210-e217https://doi.org/10.1542/peds.2008-3675
- The role of intimate partner violence in homicides of children aged 2-14 years.Am J Prev Med. 2019; 56: 38-46https://doi.org/10.1016/j.amepre.2018.08.028
- Sociodemographic factors and outcomes by intent of firearm injury.Pediatrics. 2021; 147e2020011957https://doi.org/10.1542/peds.2020-011957
- The disturbing findings of pediatric firearm injuries from the national trauma data bank: 2010-2016.J Surg Res. 2021; 259: 224-229https://doi.org/10.1016/j.jss.2020.05.096
- Parental misperceptions about children and firearms.Arch Pediatr Adolesc Med. 2006; 160: 542-547https://doi.org/10.1001/archpedi.160.5.542
- Adapting safety check as a universal suicide prevention strategy in pediatric primary care.Acad Pediatr. 2021; 21: 1161-1170https://doi.org/10.1016/j.acap.2021.04.012
- Quantifying the need for pediatric REBOA: a gap analysis.J Pediatr Surg. 2021; 56: 1395-1400https://doi.org/10.1016/j.jpedsurg.2020.09.011
Published online: December 03, 2022
Accepted: November 30, 2022
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