P2.P313: Pediatric Firearm Injuries: Unveiling the Unmatched Healthcare Burden and Costs

Background: Trauma is a leading cause of morbidity and mortality in the U.S. As of 2020, firearm injuries became the leading cause of death in children. Although the heightened mortality risk of firearm injury is known, the burden of inpatient care for initially nonfatal firearm injuries is poorly understood. This study aimed to characterize the inpatient burden of care and association of increased charges for firearm injuries compared to other penetrating and blunt traumas in the pediatric population.

Methods: The National Inpatient Sample (NIS) was analyzed for pediatric patients (age 0-21) with International Classification of Disease, 10th revision injury codes for firearm injury, penetrating trauma, and blunt trauma from 2017-2020. Demographic information, hospital interventions, and outcomes were compared. Multivariable regression was performed to evaluate predictors of hospital charges.

Results: 82,405 patients were identified, of which 6,615 were firearm injuries, 9,787 were penetrating traumas, and 66,003 were blunt traumas. The national total estimate over the 4 years was 33,075 firearm injuries, 48,935 penetrating traumas, and 330,015 blunt traumas. The mean age differed by mechanism: 17 years for firearm, 16 years for penetrating, and 12 years for blunt traumas. The distribution of race significantly differed by mechanism, as firearm injuries more commonly impacted Black patients at 57%, compared to only 14% and 17% for penetrating and blunt trauma, respectively (p < 0.001). Traumas disproportionally impacted males with the greatest gap for firearm injury (87%) compared to penetrating and blunt trauma (36% and 63%, respectively, p< 0.001). Median income quartiles also differed by traumatic mechanism, where a majority of firearm injured patients were in the lowest income quartile (53%) compared to penetrating and blunt trauma patients (29% and 32%, respectively). Patients sustaining firearm injuries incurred a significantly greater burden of inpatient care, assessed by transfusions, CPR, ECMO, and major surgical procedures including pericardiotomy, chest tube placement, exploratory laparotomy, exploratory thoracotomy, solid organ resections, tracheostomy, and feeding tube placements (Table 1). Firearm injured patients also exhibited higher rates of complications than other traumatic mechanisms and greater rate of inpatient death (Table 2). Mean length of inpatient stay was significantly greater for firearm injuries (10.8 days) compared to penetrating (8.3 days) and blunt trauma (9.8 days, p< 0.001). When controlling for age, sex, race, insurance, region, and median household income, firearm injury was predictive of greater hospital charges with an incidence rate ratio (IRR) of 1.27 relative to blunt trauma, whereas the IRR for penetrating trauma was 0.39 (p < 0.001).

Conclusion: Firearm injuries impose significantly greater burden of inpatient surgical care, interventions, complications, hospital charges, and mortality compared to other traumatic mechanisms. These findings underscore the urgent need for targeted prevention, supportive measures, and resource allocation to mitigate the devastating impact of firearm injuries on children and healthcare systems alike.