Epidemiology, Intent, and Severity of Nonpowder Firearm Injuries in Patients Presenting to Pediatric Emergency Departments

Objective: To describe the epidemiology, intent, and severity of nonpowder firearm injuries in pediatric emergency department (ED) visits. Methods: This was a review of visits by patients 0 to 17 years old who presented to EDs within the Pediatric Emergency Care Applied Research Network (PECARN) Registry with a potential nonpowder firearm injury between 2012 and 2019. Visits were identified by International Classification of Diseases (ICD) codes, with review of discrete and narrative data, including demographics, affected body region, intent of injury, age of the person inflicting the injury, interventions in the ED, and disposition. Results: Eight hundred three potential ED visits for nonpowder firearm injuries were identified, with 774 meeting inclusion criteria. The average age of the patient injured was 11.7 years, and most were male (86.7%). Common body parts injured were the eye (34.0%), upper extremity (19.9%), and face (14.7%). In total, 14.6% of injuries were reported as assaultive, and 60.6% were reported as accidental. The shooter was identified as a child or adolescent in 66.5% and an adult in 2.8% of narratives. In the ED, 74.2% of patients had imaging studies obtained, 73.0% had sub-specialists consulted, and 23.9% had procedures performed. 1 in 5 injuries resulted in either admission (11.7%), emergent operative treatment (6.9%), or death (0.1%). Conclusions: Nonpowder firearms remain a source of preventable injuries in children and involve substantial health care resources. Most commonly, these injuries are inflicted by children and are accidental, though assaults also account for at least 1 in 7 injuries. These data emphasize the need for further injury prevention efforts directed at nonpowder firearms.