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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1306-1312

Outcomes in Children and Young Adults Who Are Hospitalized for Firearms-Related Injuries

Carla DiScala, PhD and Robert Sege, MD, PhD

From the Department of Pediatrics, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts

Objectives. To compare outcomes by intent of nonfatal firearms-related injuries in a hospitalized population, newborn to 19 years of age, and estimate the national incidence of ensuing disability.

Methods. Descriptive statistics and comparative analysis using {chi}2, odds ratio, and t test were applied to data from the National Pediatric Trauma Registry (NPTR) and the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission. Demographics, preinjury medical history, scene of injury, primary body part injured, severity of injury, utilization of resources, short-term and long-term disability, medical cause of disability, and disposition at discharge were studied.

Results. NPTR unintentional (n = 268) and assault-related firearms-related injuries (n = 506) were compared. In both groups, the majority of patients were male (80%). Compared with the unintentionally injured, the assaulted children were older and more frequently black (59.3% vs 32.5%). Approximately 17% in both groups had a preinjury history of medical/psychosocial problems. Unintentional injuries occurred mainly in private dwellings (75.7%), and assaults occurred in public places/street (53.8%). In both groups, injuries to multiple body regions were prevalent, and a substantial proportion sustained injuries of serious to critical level. Most children were transported by ambulance, but a significant proportion in the unintentional group were transported by helicopter. The rate of admission to the intensive care unit was ~40% for both groups. The unintentionally injured had a higher rate of surgical intervention (66.8% vs 50.8%) and stayed in the hospital longer than the assaulted ones (median: 5 days vs 3 days). Almost half of the children in both groups were discharged with disability, and ~87% returned to their home. Applying the NPTR disability rate to National Electronic Injury Surveillance System estimates of hospitalization suggests that ~3200 children nationwide develop disability from firearms-related injuries annually.

Conclusions. Nonfatal firearms-related injuries in a pediatric population are associated with a high use of medical resources and lasting disability. Public policies should be developed and implemented to reduce the occurrence of these catastrophic events.

Key Words: pediatric • trauma • injury • disability

Abbreviations: NEISS, National Electronic Injury Surveillance System • CDC, Centers for Disease Control and Prevention • NPTR, National Pediatric Trauma Registry • ED, emergency department • ISS, Injury Severity Score • OR, odds ratio

Received for publication Mar 21, 2003; Accepted Oct 7, 2003.