Firearm Injuries Lead to More Complications, Greater Risk of Death and Higher Inpatient Costs Than Other Injuries

New research presented at the American Academy of Pediatrics 2024 National Conference & Exhibition evaluated firearm injuries, penetrating injuries and blunt force injuries over four years

ORLANDO, Fla.— Children who are injured by firearms require significantly more inpatient care, have higher medical complication rates and face a greater risk of death than children with other forms of trauma, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition in Orlando, FL.

The abstract, “Pediatric Firearm Injuries: Unveiling the Unmatched Healthcare Burden and Costs,” to be presented during the conference Sept. 27-Oct. 1 at the Orange County Convention Center, evaluated data from patients ages 21 and younger between 2017 and 2020. Using data provided by the National Inpatient Sample (NIS), researchers compared complications, costs and mortality risks of injuries caused by firearms, penetrating trauma (such as stab wounds), or blunt trauma (such as from motor vehicle collisions).

“Children are particularly vulnerable to the devastating impact of gun violence, often resulting in severe, life-altering and life-long injuries,” said Colleen Nofi, DO, PhD, MBA, MSc, surgeon at Northwell Health’s Cohen Children’s Medical Center, scientist at the Feinstein Institutes for Medical Research, and lead author on paper. “Our study shows that children injured by firearms are more likely to need life-saving procedures, inpatient interventions, and major surgeries than other traumas, all of which will profoundly affect survivors’ lives forever -- as well increased health care costs.”

The abstract analyzes 82,405 patients whose injuries were categorized using the International Classification of Disease, 10th revision injury codes. Of the total patients, 6,615 sustained firearm injuries; 9,787 were penetrating traumas; and 66,003 were blunt traumas. 

Researchers found the procedures and operations more frequently required for firearm injuries, such as major organ resections, breathing device insertions, and ostomies, often result in significant morbidity and long-term consequences. Additionally, firearm injuries confer significantly greater costs than other types of trauma. 
The results showed that Black patients were more often injured by firearms (57%), compared to only 14% and 17% for penetrating and blunt trauma, respectively. A majority of firearm injured patients were in the lowest income quartile (53%) compared to penetrating and blunt trauma patients, at 29% and 32%, respectively.

The mean length of a patient’s stay in the hospital was significantly greater for firearm injuries, at 10.8 days, compared with 8.3 days for penetrating injuries and 9.8 days for those with blunt trauma.

“These findings highlight the urgent need for targeted prevention, supportive measures, and resource allocation to mitigate the devastating impact of firearm injuries on children and healthcare systems alike,” Dr. Nofi said.

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Media Relations

Northwell Health contact: Matthew Libassi at mlibassi@northwell.edu or Dr. Nofi may be reached at cnofi@northwell.edu  

The study was funded by the Center for Gun Violence Prevention, Northwell Health. 

Study author Dr. Nofi  is scheduled to present her research, which is below, from 10:30 AM to 11:30 AM on Saturday September 28, 2024, at the Hyatt Regency Ballroom. To request an interview with the authors, contact Colleen Nofi at cnofi@northwell.edu.

In addition, Dr. Nofi will be among highlighted abstract authors who will give brief presentations and be available for interviews during a press conference at 12:00-1:30 PM on Saturday, Sept. 28, 2024, in the National Conference Press Room, W208 AB. During the meeting, you may reach AAP media relations staff at 407-685-5401.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.  

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Abstract

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Section on Surgery

Abstract Title: Pediatric Firearm Injuries: Unveiling the Unmatched Healthcare Burden and Costs

Colleen Nofi

Manhasset, NY, United States

Trauma is a leading cause of morbidity and mortality in the U.S. As of 2020, firearm injuries became the leading cause of death in children. Although the heightened mortality risk of firearm injury is known, the burden of inpatient care for initially nonfatal firearm injuries is poorly understood. This study aimed to characterize the inpatient burden of care and association of increased charges for firearm injuries compared to other penetrating and blunt traumas in the pediatric population.

The National Inpatient Sample (NIS) was analyzed for pediatric patients (age 0-21) with International Classification of Disease, 10th revision injury codes for firearm injury, penetrating trauma, and blunt trauma from 2017-2020. Demographic information, hospital interventions, and outcomes were compared. Multivariable regression was performed to evaluate predictors of hospital charges.

82,405 patients were identified, of which 6,615 were firearm injuries, 9,787 were penetrating traumas, and 66,003 were blunt traumas. The national total estimate over the 4 years was 33,075 firearm injuries, 48,935 penetrating traumas, and 330,015 blunt traumas. The mean age differed by mechanism: 17 years for firearm, 16 years for penetrating, and 12 years for blunt traumas. The distribution of race significantly differed by mechanism, as firearm injuries more commonly impacted Black patients at 57%, compared to only 14% and 17% for penetrating and blunt trauma, respectively (p< 0.001). Traumas disproportionally impacted males with the greatest gap for firearm injury (87%) compared to penetrating and blunt trauma (36% and 63%, respectively, p< 0.001). Median income quartiles also differed by traumatic mechanism, where a majority of firearm injured patients were in the lowest income quartile (53%) compared to penetrating and blunt trauma patients (29% and 32%, respectively). Patients sustaining firearm injuries incurred a significantly greater burden of inpatient care, assessed by transfusions, CPR, ECMO, and major surgical procedures including pericardiotomy, chest tube placement, exploratory laparotomy, exploratory thoracotomy, solid organ resections, tracheostomy, and feeding tube placements (Table 1). Firearm injured patients also exhibited higher rates of complications than other traumatic mechanisms and greater rate of inpatient death (Table 2). Mean length of inpatient stay was significantly greater for firearm injuries (10.8 days) compared to penetrating (8.3 days) and blunt trauma (9.8 days, p< 0.001). When controlling for age, sex, race, insurance, region, and median household income, firearm injury was predictive of greater hospital charges with an incidence rate ratio (IRR) of 1.27 relative to blunt trauma, whereas the IRR for penetrating trauma was 0.39 (p< 0.001).

Firearm injuries impose significantly greater burden of inpatient surgical care, interventions, complications, hospital charges, and mortality compared to other traumatic mechanisms. These findings underscore the urgent need for targeted prevention, supportive measures, and resource allocation to mitigate the devastating impact of firearm injuries on children and healthcare systems alike.

Table 1: Inpatient Care Differs by Trauma Type  

CPR, cardiopulmonary resuscitation; ECMO, extracorporeal membrane oxygenation. *Censored for absolute number of cases <10.

Table 2: Complications and Disposition Differ by Trauma Type  

*Censored for absolute number of cases <10.