Defining the Full Spectrum of Pediatric Firearm Injury and Death in the United States: It's Even Worse Than We Think.

OBJECTIVE: The objective of this study is to characterize the full spectrum of pediatric firearm injury in the United States (U.S.) by describing fatal and nonfatal injury data epidemiology, vulnerable populations, and temporal trends.

SUMMARY BACKGROUND DATA: Firearm injury is the leading cause of death in children and adolescents in the U.S.. Nonfatal injury is critical to fully define the problem, yet accurate data at the national level is lacking.

METHODS: Cross-sectional study combining national firearm injury data from the Centers for Disease Control (fatal) and the National Trauma Data Bank (nonfatal) between 2008 - 2019 for ages 0 to17 years. Data was analyzed using descriptive and chi square comparisons and linear regression.

RESULTS: Approximately 5,000 children and adolescents are injured or killed by firearms each year. Non-fatal injuries are twice as common as fatal injuries. Assault accounts for the majority of injuries and deaths (67%), unintentional 15%, and self-harm 14%. Black youth suffer disproportionally higher injuries overall (crude rate 49.43/million vs. White, non-Hispanic 15.76/million), but self-harm is highest in White youth. Children <12y are most affected by nonfatal unintentional injuries, 12-14y by suicide, and 15-17y by assault. Nonfatal unintentional and assault injuries, homicides and suicides have all increased significantly (P<0.05).

CONCLUSIONS: This study adds critical and contemporary data regarding the full spectrum and recent trends of pediatric firearm injury in the U.S. and identifies vulnerable populations to inform injury prevention intervention and policy. Reliable national surveillance for nonfatal pediatric firearm injury is vital to accurately define and tackle this growing public health crisis.