P3.L224: Pediatric Penetrating Trauma from 2010 through 2023: Sociodemographic and Clinical Characteristics of Firearm-Related Injuries

Background: Firearm-related trauma is the leading cause of death and traumatic brain injury (TBI)-related mortality in children and adolescents in the United States (US), and these proportions have been increasing. The authors sought to characterize the sociodemographic traits, injury context, and clinical features of victims of firearm-related trauma compared to other penetrating trauma at a large Level 1 pediatric trauma center in the Southeastern US.

Methods: Retrospective review of all pediatric trauma patients with penetrating injuries that caused a trauma activation 2010-2023. Sociodemographic, contextual, and clinical variables were extracted from a single-institution trauma registry. Childhood Opportunity Index (COI), Social Vulnerability Index (SVI), and Rurality were determined by patient home zip code using government census data. Associations between continuous variables were analyzed using Student’s T test. Categorical variables were analyzed using Chi-square tests and logistic regressions.

Results: There were 1211 pediatric penetrating trauma activations between January 2010 and September 2023. Of these, 616 (50.9%) were gunshot wounds (GSW). GSW patients were older (15.2 years vs. 12.7; P < 0.0001), more likely to be male (83.3% vs 77.6%; P = 0.01) and African American (58.6% vs 33.9% white; P < 0.0001). Fewer GSW patients were had private insurance (20.6% vs. 30.8%, P < 0.0001). GSW patients had twice the odds of residing in zip codes classified as “Moderate” or “Very Low” COI [OR 2 (1.2-3.4) and 2.2 (1.3-3.8), respectively] and were more likely to reside in zip codes with “Medium-High” SVI [OR 1.8 (1.1-2.9)]. GSW patients were also more likely to live in non-rural regions [OR 1.7 (1.4-2.2)]. When compared to other penetrating injuries, GSW patients had lower Glasgow Coma Scale (P < 0.0001), higher Injury Severity Scores (P = 0.0013), and an overall mortality rate of 15.6% compared to 6.7% for non-GSWs (P < 0.0001). Among GSWs, context of injury was most commonly assault (54.9%), followed by accident (31.7%), and then suicide attempt (5.7%). Context was unknown in 7.8% of cases. Most GSWs in which the type of gun was identified were inflicted with handguns (69.2%); of those, the majority were assaults (49.5%) or accidental firings (34.2%).

Conclusion: This study outlines the sociodemographic and clinical characteristics of pediatric GSW victims at a large level 1 trauma center, which differ significantly compared to other penetrating traumas. GSW victims tended to live in non-rural regions that score poorly on COI and SVI. They typically had higher acuity presentations, longer hospital stays, and greater mortality than their non-GSW penetrating trauma peers. Strikingly, two-thirds of GSWs in which the weapon was identified and a third of total GSWs were inflicted using handguns; of those, a third were accidental. This highlights a potential area for intervention using evidence-based safe storage recommendations.