FACTORS ASSOCIATED WITH THE INTENT OF FIREARM-RELATED INJURIES IN PEDIATRIC TRAUMA PATIENTS

Objective: To examine the characteristics of unintentional and assault ive firearm-related pediatric injuries treated in trauma centers. Desi gn: Comparative analysis of patients 14 years or younger who were admi tted to the trauma centers because of unintentional firearm-related in juries (n=292) vs assaultive firearm-related injuries (n=457). Setting : Sixty-eight trauma centers or children's hospitals in the continenta l United States and Canada that reported data to the National Pediatri c Trauma Registry from January 1, 1990, through December 31, 1994. Mai n Outcome Measures: Frequency distributions of firearm-related injurie s 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 fire arm-related injuries rose in the afternoons peaking between 4 and 5 PM ; they predominantly occurred at home (89%). Assaultive firearm-relate d injuries peaked sharply between 8 and 9 PM and usually occurred on r oads or in other public places (63%). About 3 times as many boys as gi rls were harmed in firearm-related injuries, Given a firearm-related i njury 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 t he victim was a girl, 4.9 (95% CI, 3.1-7.8) if the shooting occurred a t 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 unintentiona l and assaultive injuries. Overall, 19% of the patients sustained head injuries, which contributed to 90% of the in-hospital deaths. Conclus ions: Marked differences in injury circumstances exist between uninten tional and assaultive firearm-related injuries among children. The lat e afternoon hours when many children have come home from school but th eir parents may still be working have the highest frequency of uninten tional firearm-related injuries. The evening peak of assaultive injuri es may be related to drug-related and gang-related violence, While it is important to reduce the access of firearms to children, school-base d extracurricular and community-based social services should be consid ered in developing intervention programs.