PC1028: Firearm Injury Epidemiology at a Pediatric Level 1 Trauma Center Before and During the COVID-19 Pandemic

Background: Firearms are a leading cause of death in children and firearm violence in the United States is a known public health crisis. Record breaking firearm sales and background checks indicating an increase in demand for firearms followed the COVID-19 “stay-at home orders” in March 2020. We aim to describe the changes in pediatric firearm related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic.

Methods: We performed a retrospective review examining patient records of a level 1 trauma center in a busy southern metropolitan area from 2019 to 2021. We investigated patient demographics and risk factors of pediatric firearm visits presenting to the Pediatric Emergency Department annually with descriptive statistics. We also examined percent changes in patient characteristics over time using Poisson regression models.

Results: The total number of pediatric firearm related injury cases increased from 2019 to 2020 and remained elevated in 2021 (88 vs 118 vs 115). There was an increase in injuries in African Americans (30.7%, 2019; 39.8%, 2020; 47.8%, 2021) and patients with mental illness (10.2%, 2019; 22.9%, 2020; 14%, 2021) as well as injuries where the shooter was a known friend (5.7%, 2019; 12.7%, 2020; 7.8%, 2021). The injuries occurring at home (22.7%, 2019; 29.7%, 2020; 24.3%, 2021) were more often without adult supervision in 2020 (22.7%, 2019; 30.5%, 2020; 20.0, 2021) and where the firearm was left unlocked (88.9%, 2019; 100%, 2020; 84.6%, 2021).

Conclusion: The total number of pediatric firearm related injuries increased for the two years of the COVID-19 pandemic compared to the prior year. There were more African American patients, patients in single parent households or who had a history of mental illness affected during the pandemic. There was also an initial increase in injuries occurring at home where the shooter was a known family member or friend, and the firearm was not properly stored. Increases in pediatric firearm related injuries in already vulnerable populations should therefore prompt initiatives and future studies to mitigate the risk of injury and death.