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Investigators from Children’s Minnesota, Minneapolis, MN, conducted a retrospective study to describe firearm injuries among youths presenting to emergency departments (ED) in the US. For the study, they abstracted data from the National Trauma Data Bank (NTDB). The NTDB collects de-identified information on patients seen at >700 trauma centers in the US. Study participants were youths <19 years old who were identified by ICD-9 codes as having a firearm injury and seen at a participating trauma center between 2009 and 2014. ICD-9 codes were also used to determine cause of injury and included assault, self-inflicted, unintentional, legal intervention, or undetermined. Additional information abstracted on study patients included age, sex, race/ethnicity (Black, white, Hispanic, or other/unknown), type of trauma center (adult [ATC], pediatric [PTC], or mixed adult and pediatric [MTC]), and outcome. Chi-square tests were used to compare types of injuries by demographic groups and visits for firearm injuries at different types of trauma centers. Logistic regression was used to assess risk of death in study patients.
Among a total of 466,403 visits by youths <19 years old to participating trauma centers during the study period, 21,416 (4.6%) were for firearm injuries. Among patients with a firearm injury, 83.2% were 15-18 years old, 87.1% were male, and 61.3% were Black. The most common cause of firearm injury was assault (78.1%), followed by unintentional injury (12.6%), self-inflicted (4.7%), undetermined (3.7%), and legal intervention (0.8%). Among youths with firearm injuries, 64.9% were seen in ATCs, 29.1% in MTCs, and 6.0% in PTCs (P <0.001). Overall, there was a significant difference in cause of firearm injury in youths of different race/ethnicity groups (P <0.001). Among those injured by firearm assault, 66.9% were Black, 18.3% Hispanic, and 8.4% white. Conversely, 62.8% of those with self-inflicted injuries were white, 20.7% Black, and 11.5% Hispanic. Of those injured by legal intervention, 52.3% were Black, 23.0% Hispanic, and 18.5% white. There were 2,866 deaths in youths with firearm injuries, accounting for 26% of all deaths among patients in this age group included in the NTDB; 80.8% of firearm deaths occurred in those 15-18 years old. Although 70.1% of deaths from firearm injuries were caused by assault, the risk of death from a self-inflicted injury was significantly higher than from an assault (OR, 5.31; 95% CI, 4.50, 6.26). Among children 11-14 years old, the case fatality rate from self-inflicted firearm injury was 54.7%. Among those with unintentional firearm injuries, the case fatality rates were 18.3% for those <2 years old, and 13.8% for those 3-10 years old.
The authors conclude that between 2009 and 2014, almost 10 youths were seen daily at US trauma centers for firearm injuries.
Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary does not contain a...
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