M. Guhan1, M. A. Kasbaum1, E. Benavidez1, J. Carter1,2, A. Martinez2, C. Seger1, B. Naik-Mathuria1,2 1Baylor College Of Medicine, Houston, TX, USA 2Texas Children’s Hospital, Houston, TX, USA
Introduction: Firearm injury is now the leading cause of death in children and adolescents. Hospital-based violence intervention programs are geared towards adults affected by homicide, and focus on social support. Suicide prevention is often focused on mental health. It is unclear whether these interventions are also effective to prevent pediatric firearm deaths. We hypothesized that pediatric and adult firearm injury deaths are different enough that they require different prevention strategies.
Methods: Retrospective review of medical examiner records of deaths caused by firearm from the largest urban county in Texas. Demographics, injury data, social data, and shooting circumstances were collected. Data from pediatric (ped) patients (0-17 years) was compared to adults.
Results: Between 2018 and 2020, there were 117 pediatric firearm victims (median age 14) and 1,803 adult victims (median age 39). The majority of victims were of Black race (ped 44% vs adult 37%) and male (ped 86% vs adult 87%). Homicide was the most common shooting cause for both groups (ped 58% vs adult 55%); however, the prevalence of suicide and unintentional shootings differed significantly (suicide ped 21% vs adult 42%, p<0.01; unintentional ped 16% vs adult 1%, p<0.01). Shooting times were similar among the groups (6am-4pm ped 35% vs adult 30%, 4-10pm ped 26% vs adult 38%, night ped 29% vs adult 32%). Home of victim or family was the most common shooting location for both groups (ped 43% vs adult 45%). Adults were more likely to die prior to reaching a trauma center than children (83% vs 50%, p<0.01). A known mental health disorder was similar in those who died of firearm suicide (ped 56% vs adult 43%, p=0.15). Alcohol use was more common in adults (ped 5% vs adult 32%, p<0.01), but drug use was similar (ped 25% vs adult 23%, p=0.69).
Discussion: The main difference between adult and pediatric firearm deaths in this urban setting was the higher incidence of unintentional deaths and lower incidence of suicide in children. However, most other factors were actually quite similar. Secure or out-of-home household firearm storage education could potentially prevent the unintentional shootings in pediatric firearm victims and suicide in both groups. However, improving community safety to reduce homicides to both children and adults is vital, and hospital-based violence intervention programs that connect with community-based firearm violence prevention resources are likely beneficial for pediatric as well as adult trauma centers.