Factors associated with the intent of firearm-related injuries in pediatric trauma patients

Objective: To examine the characteristics of unintentional and assaultive firearm-related pediatric injuries treated in trauma centers. Design: Comparative analysis of patients 14 years or younger who were admitted to the trauma centers because of unintentional firearm related injuries (n=292) vs assaultive firearm-related injuries (n=457). Setting: Sixty-eight trauma centers or children's hospitals in the continental United States and Canada that reported data to the National Pediatric Trauma Registry from January 1, 1990, through December 31, 1994. Main Outcome Measures: Frequency distributions of firearm-related injuries in relation to intent and injury circumstances, odds ratios (ORs) on the intent of injury being assaultive, injury severity scales, and in-hospital fatality rates. Results: The frequency of unintentional firearm-related injuries rose in the afternoons peaking between 4 and 5 PM; they predominantly occurred at home (89%). Assaultive firearm-related injuries peaked sharply between 8 and 9 PM and usually occurred on roads or in other public places (63%). About 3 times as many boys as girls were harmed in firearm-related injuries. Given a firearm-related injury resulting in admission to a trauma center, the adjusted OR of it being assaultive was 2.8 (95% confidence interval [CI], 1.6-4.6) if the victim was a girl, 4.9 (95% CI, 3.1-7.8) if the shooting occurred at night, 2.6 (95% CI, 1.6-4.2) if the shooting occurred on a weekday, and 21.1 (95% CI, 9.1-49.4) if the shooting occurred on a road. Injury patterns and severity were similar between patients with unintentional and assaultive injuries. Overall, 19% of the patients sustained head injuries, which contributed to 90% of the in-hospital deaths. Conclusions: Marked differences in injury circumstances exist between unintentional and assaultive firearm-related injuries among children. The late afternoon hours when many children have come home from school but their parents may still be working have the highest frequency of unintentional firearm-related injuries. The evening peak of assaultive injuries may be related to drug-related and gang-related violence. While it is important to reduce the access of firearms to children, school-based extracurricular and community-based social services should be considered in developing intervention programs.