LAUSR

BACKGROUND Pediatric firearm injury is a leading cause of death for U.S. children. We sought to further characterize children who die from these injuries using a validated national database. METHODS The National Trauma Data Bank 2010-2016 was queried for patients ages 0 to 19 years old. International Classification of Diseases external cause of injury codes were used to classify patients by intent. Differences between groups were analyzed using chi-squared or Mann-Whitney U tests. Patterns over time were analyzed using non-parametric tests for trend. Multivariable logistic regression was employed to investigate associations between the above factors and mortality. RESULTS There were a total of 45,288 children with firearm injuries, 12.0% (n = 5,412) who died. Those who died were younger and more often white than survivors. Mortality was associated with increased injury severity, shock on presentation, and polytrauma (p < 0.001 for all). There was an increasing trend in the proportion of self-inflicted injuries over the study period (p < 0.001), and mortality from these self-inflicted injuries increased concordantly (35.3% in 2010 to 47.8% in 2016, p = 0.001). Location of severe injuries had significant different mortality rates, ranging from 51.3% of head injuries to 3.9% in the extremities. In the multivariable model, treatment at a pediatric trauma center was protective against mortality, with ORs of 2.10 (CI: 1.64 - 2.68) and 1.80 (CI: 1.39 - 2.32) for death at adult and dual-designated trauma centers, respectively. This finding was confirmed in age-stratified cohorts. CONCLUSIONS Proportions of self-inflicted pediatric firearm injury in the NTDB increased from 2010 to 2016, as did mortality from self-inflicted injury. As mortality is highest in this subpopulation, prevention and treatment efforts should be prioritized in this group of firearm-injured children. LEVEL OF EVIDENCE III - Retrospective cohort study.