Firearm-associated Fractures in Children and Adolescents: Trends in the United States 2003-2012.

BACKGROUND: Firearm-associated injuries are the second leading cause of death in children in the United States. Fractures are common comorbid injuries in young patients with firearm-associated injuries. The purpose of this study was to define the burden of firearm-associated fractures (FAFs) in children and adolescents in the United States.

METHODS: We analyzed the 2003-2012 Kids' Inpatient Database. Patients were grouped into 4 age groups: 0 to 4, 5 to 9, 10 to 14, and 15 to 20 years old. Sample observations with both an external cause of injury code indicating gunshot injury and a diagnosis code indicating orthopaedic fracture (extremity, pelvis, or spine) were identified as cases of FAF. Sex, age, race, cause of injury, and fracture-related operating room procedures were catalogued. Population-level incidence was calculated for each year studied.

RESULTS: From 2003 to 2012, the incidence of FAF in patients 20 years and below of age increased from 73 to 96 cases per 100,000 admissions (P=0.009). The 0 to 4 age group saw the largest increase in injury frequency (141%, P=0.08). There was a 4-fold increase in the rate of unintentional injury in this subgroup. The most common age group affected by FAFs was 15 to 20 year olds. Minorities and male individuals were disproportionately affected. Assault and unintentional causes were the most common reasons for injury.

CONCLUSIONS: The frequency of FAF in patients 20 years and below of age increased over the study period, with almost 1 case per 1000 admissions in 2012. The finding that certain subpopulations are disproportionately affected reflects the complex sociologic factors influencing gun violence in the United States.

LEVEL OF EVIDENCE: Level III-retrospective cohort study.