R. J. McLoughlin1, C. Murray1, S. Rice2, M. P. Hirsh1, M. Cleary1, J. T. Aidlen1 1University Of Massachusetts Medical School,Surgery,Worcester, MA, USA 2University Of Massachusetts Medical School,Worcester, MA, USA
Introduction:
Unintentional firearm injuries in the pediatric population are common and carry a significant risk of mortality. We aim to describe the most common injuries associated with unintentional firearm discharges.
Methods:
A cross-sectional analysis was performed by combining the Kids’ Inpatient Database for study years of 2006, 2009, and 2012. We identified cases (age <21 years) of accidental firearm-related injury (AFI) using external cause of injury codes. Patient characteristics and injuries were analyzed using ICD-9 codes, and national estimates were obtained using case weighting. Multiple multivariable logistic regressions were performed adjusting for gender, race, age, payer, income quartile, setting, and region.
Results:
There were 4,696 admissions for AFI. The defining patient characteristics were high-school age or older (85.2%), male (87.8%), black (48.4%), urban setting (59.5%) and occurred in the South (46.8%). There were approximately 30 AFI weekly and mortality was 5%. The most common injuries overall were any fracture (48.8%), open wound of the extremities (34.5%) and open wound of the head, neck, or trunk (24.0%). Other notable injuries were any thoracic injury (13.3%), any abdominal injury (18.8%), any blood vessel injury (11.0%) and intracranial injury (8.22%). When analyzed by age group, there was an increase of the proportion of patients having any type of fracture from elementary to post-high school (42.0% to 52.2%, p-value 0.01) whereas the elementary school age group had the highest proportion of intracranial injuries (18.5%). Adjusted logistic regression showed that compared to post-high school, elementary school age were at significantly higher risk of an intracranial injury (aOR 3.28, 95% CI 2.14-5.05) but lower risk of any fracture (aOR 0.67, 95%CI 0.49-0.92).
Conclusion:
Unintentional firearm injuries cause a wide variety of injury patterns likely related to the varying nature of the accidents themselves. Younger children are at higher risk of intracranial injuries whereas older children have higher risks of fractures. To improve injury prevention and public safety, gun safety and education programs should focus on all children and their caregivers and be tailored to injury patterns most likely to occur based on age.
