J. D. Oestreicher1,2, W. Krief1,2, N. Christopherson3,6, C. J. Crilly5, L. Rosen4, F. Bullaro1,2 1Steven And Alexandra Cohen Children’s Medical Center,Pediatric Emergency Medicine,New Hyde Park, NY, USA 2Hofstra Northwell School Of Medicine,Pediatrics,Hempstead, NY, USA 3Northwell Health Trauma Institute,Manhasset, NY, USA 4Feinstein Institute For Medical Research,Biostatistics,Manhasset, NY, USA 5Hofstra Northwell School Of Medicine,Hempstead, NY, USA 6Steven And Alexandra Cohen Children’s Medical Center,New Hyde Park, NY, USA
Introduction:
Gun violence is the second leading cause of pediatric trauma death after only motor vehicles. Though federally funded scientific data have driven life-saving policy from lead poisoning to SIDS, there remain little data on pediatric gun violence. While Congress spends $240 million annually on researching traffic safety, it explicitly bans research on gun violence despite the fact that, with the inclusion of adults, guns and cars kill the same number of Americans annually. Therefore, we sought to describe demographic and clinical characteristics of pediatric firearm and motor vehicle injuries and compare their impact on years of potential life lost (YPLL). We hypothesized that these two mechanisms have similar impact on premature death, thus highlighting this staggering disparity in research.
Methods:
We analyzed data from the National Trauma Data Bank (NTDB) in patients ≤21 years of age presenting to a participating emergency department (ED) with a pediatric firearm (PF) or pediatric motor vehicle (PMV) event from 2009 through 2014. We examined demographic and clinical characteristics of PF and PMV cases using descriptive statistics. The Cochrane-Armitage test was used to trend PF cases over time. YPLL was calculated for PF and PMV cases, using 75 years of age as reference. Because the large sample size yielded p<0.0001 for all comparisons, clinical rather than statistical significance was assessed.
Results:
A total of 1,047,018 pediatric ED visits were identified, with 5.7% PF cases and 27.8% PMV cases. There was a significant decline in PF cases from 2009 (6.2%) to 2014 (5.3%). Demographics for PF cases were as follows: mean age of 17.9 years, 89.0% male, 60.0% African American, 16.9% Hispanic. For PMV: mean age of 15.5 years, 60.6% male, 60.3% Caucasian, and 16.5% Hispanic. PF cases were more likely to die in the ED or hospital (12.5% vs 3.2%), less likely to be transferred to a different hospital (2.5% vs 3.9%), and had similar admission rates (77.5% vs 78.3%) and median lengths of stay (2.0 days). Assault accounted for 79.3% of PF cases, self-inflicted, 4.8%, and accidental, 11.7%. Self-inflicted PF cases had a higher median Injury Severity Score (13) than assault (9) or accidental (4) and were more likely to die (40.2% vs 11.4% vs 6.7%). Accidental PF cases tended to be younger (15.7 years) as compared to assault (18.2 years) and self-inflicted (17.8 years). Among all pediatric ED visits, YPLL from a PF case was 4.1 per 10 visits and, for PMV, 5.4 per 10 visits.
Conclusion:
Motor vehicles and firearms each remain a major cause of premature death. For traumatized children who are brought to an ED, four children die from a gun for every five who die from a motor vehicle, leading to similar and profound YPLL. An evidence-based approach has saved millions of lives from motor vehicle crashes; the same federal funding and research should be directed at the epidemic of pediatric firearm injury.