Retrospective Analysis of Unintentional Firearm Injuries in Children Presenting to a Pediatric Emergency Department

Background: In the US, firearm injury has been documented as the second leading cause of death in children and adolescents - causing 15.4% of deaths in 2016. Research has indicated that the main danger comes from the accessibility of firearms to children, their siblings, and friends. Purpose: The aim of this study is to identify trends and potential factors that place children at higher risk for unintentional firearm injuries. We specifically compared the outcomes and differences between powder guns and air-power guns. This information will be helpful in developing curriculums for injury prevention. Methods: A retrospective cohort study was conducted using medical records from Cook Children's Health Care System (CCHCS). To be included, patients had to be less than 19 years of age and have presented at the CCHCS emergency department (ED) with an unintentional firearm injury between January 1, 2015 and June 30, 2021. For each patient, we recorded data on type of gun, location and scenario of the shooting, and location of injury on patient's body. Results: Two hundred four patients met inclusion criteria. There were 59 (28.9%) shootings by powder guns, including handguns (24.0%), shotguns (2.9%), rifles (1.0%), and unreported (1.0%). The other 145 (71.1%) shootings were by air-power guns, including BB (48.5%), pellet (14.7%), air (4.9%), nerf (2.5%), and paintball (0.5%) guns. Shootings most commonly occurred in the patient's home (76.5%), a friend's home (12.3%), or a family member's home (3.9%). Compared with air-power-gun shootings, powder-gun shootings were statistically significantly more likely to take place outside the patient's home (35.6% vs. 18.6%, p< 0.0001, OR=2.61). The most common locations of gunshot wounds were extremities (44.1%), the face (37.3%), and head or brain (15.2%). Compared with those shot with air-power-gun shootings, powder-gun shootings were significantly less likely to injure the face (22.0% vs. 43.4%, p=0.004, OR=0.37). Upon discharge, 131 patients (64.2%) went home, 65 (31.9%) went to the floor, 2 (1.0%) were transferred to another facility, and 6 (2.9%) decreased. Compared to those shot with air-power guns, patients shot with powder guns were significantly less likely to be discharged home (32.2% vs. 77.2%, p< 0.0001, OR=7.15). Conclusion: Most shootings were by air-power guns. Although most of these were minor injuries, we suggest that children should have proper supervision while these guns are in use. Shootings most commonly occurred in the homes of the patient, friends, or family members. We suggest that many of these unintentional gun injuries could be prevented by use of proper storage and safety measures. The majority of incidents were caused by injury to the face, head, or brain. We suggest that safety equipment such as protective eyewear should be worn when handling firearms to decrease these unintentional injuries.