• Elizabeth D Cochran, Arti Machchhar, Jingbo Qiao, and Dai H Chung.
• University of Texas Southwestern Medical Center, Department of Surgery, Dallas, TX.
• J. Am. Coll. Surg. 2025 Jan 27.

IntroductionPediatric firearm-related injuries are now the leading cause of death among children in the United States. We sought to characterize the experience of a large free-standing children's hospital treating children with firearm injuries.MethodsWe reviewed all 2012-2022 gunshot wound encounters using the institutional trauma database of an urban Level 1 pediatric trauma center in Texas. Patient demographics, incident characteristics, and clinical outcomes were analyzed. Statistical analysis was performed using ANOVA and chi-square tests to evaluate the influence of socioeconomic factors. Injuries from recreational firearms like BB and pellet guns were excluded from this analysis.ResultsTwo hundred eleven pediatric patients were treated for gunshot wounds during the study period. There was an upward trend in the number of injuries per year, ranging from 6 in 2012 to 39 in 2021. The average patient age was 10.2 years. Violent injuries accounted for 51.7%, while accidental injuries led to 44.1%, and self-inflicted injuries made up 4.3%. Based on the Child Opportunity Index. 63.0% of patients lived in neighborhoods in the lowest opportunity quartile, while only 2.8% of patients lived in neighborhoods in the highest opportunity quartile. 22.7% of patients sustained injuries characterized as "major trauma," as indicated by an Injury Severity Score of >15, and 8.5% of patients died.ConclusionsFirearms pose a substantial risk to children in the United States. There has been an increasing trend in pediatric firearm injuries over the last decade. The majority of children treated for firearm injury at our institution sustained injuries in the setting of gun violence. Injury prevention efforts should be aimed at decreasing intentional pediatric firearm injuries.Copyright © 2025 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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