LAUSR

Traumatic brain injury is a major cause of mortality and long-term morbidity in the pediatric population. Given renewed legislative efforts aimed at reducing firearm violence and harm, we sought to investigate the impact of firearms on mortality associated with TBI. A multicentric, retrospective cohort analysis of pediatric patients with TBI was conducted using the National Trauma Data Bank from 2011 to 2014. The primary outcome was mortality within the hospital; the primary exposure was firearm-related vs. non-firearm-related TBI. Pediatric patients with firearm-related TBI (n = 1,417; median [IQR] age 16 [13-17]) and non-firearm-related TBI (n = 123,740; median [IQR] age 11 [5-15]) were included. Firearm injuries included intentional harm by others (56%), suicide attempts (29%), and accidental harm by others (15%). The majority of African-American firearm-related TBIs presented after assault (79.6%), whereas the majority of White cases presented after suicide attempts (55.6%). Firearm-related cases presented with an average adjusted GCS 3.4 points lower than non-firearm-related TBI. 50.0% of firearm-related cases died while in the hospital compared to 2.8% of non-firearm cases. The firearm injury type with the highest rate of mortality was self-harm/suicide attempts (69.8%). Relative to non-firearm cases, firearm injuries were identified to be an independent predictor of in-hospital mortality (OR 8.3; 95% CI 7.1-9.7); firearm suicide attempt injuries were the most lethal (OR 13.0; 95% CI 9.9-17.0). Although firearm injuries comprised only 1.1% of all TBIs, they were the cause of injury in 16.7% of all deaths. Male sex, Black race, and public and self-pay insurance predicted firearm injuries. Firearm-related injuries are associated with disproportionately high mortality in pediatric TBI, especially in suicide attempts. African-Americans are at disproportionately high risk of firearm assault relative to Whites. Public health and policy interventions could target youth firearm injuries and potentially prevent a significant portion of TBI deaths.