O1015: Pediatric Firearm Injury Emergency Department Visits During the COVID-19 Pandemic: A Multicenter Study

Background: Firearm injuries among children increased during the COVID-19 pandemic, but recent trends in firearm-related emergency department (ED) visits have not been well described. We sought to assess how the pediatric firearm injury ED visit rate during the COVID-19 pandemic differed from expected rates based on pre-pandemic trends.

Methods: We conducted a retrospective cross-sectional study of ED visits for firearm injuries by children under 18 years old at nine hospitals participating in the Pediatric Emergency Care Applied Research Network Registry from January 2017 to November 2022. We compared sociodemographic and clinical characteristics of firearm injury ED visits before the pandemic (January 2017-February 2020) and during the pandemic (March 2020-November 2022). To estimate the expected ED visit rate per 30 days during the pandemic, we calculated prediction estimates and intervals from pre-pandemic ED visit data using multivariable Poisson regression models, accounting for seasonal, geographic, and temporal trends. We calculated the rate ratio (RR) of observed to expected firearm injury ED visits per 30 days, overall and stratified by sociodemographic characteristics.

Results: During the study period, 1902 pediatric firearm injury ED visits occurred at participating hospitals (694 visits pre-pandemic; 1208 visits during the pandemic). Of these, 52.3% were 15-17 years old, 80.0% were male, 63.5% were non-Hispanic Black, 81.1% were publicly insured, and 63.8% were from zip codes with a very low Child Opportunity Index. Triage category level 1 (highest acuity) visits increased from 38.5% pre-pandemic to 46.4% during the pandemic (P=0.027). The percentage of injured children who died in the ED or hospital increased from 3.1% pre-pandemic to 6.1% during the pandemic (P=0.007). Before the pandemic, there were 18.0 firearm injury ED visits per 30 days, which increased to 36.1 visits per 30 days during the pandemic (Figure 1), with an observed to expected visit RR of 2.09 (95% CI 1.63, 2.91). During the pandemic, firearm injury ED visits per 30 days were higher than expected for children 10-14 years old (RR 2.61, 95% CI 1.69, 5.71), 15-17 years old (RR 2.09, 95% CI 1.51, 3.38), males (RR 2.00, 95% CI 1.53, 2.86), females (RR 2.46, 95% CI 1.55, 6.00), Black non-Hispanic children (RR 1.88, 95% CI 1.34, 3.10), and Hispanic children (RR 2.30, 95% CI 1.30, 9.91) (Figure 2). Firearm injury ED visit rates did not differ significantly from expected for children 0-4 years old, 5-9 years old, or for White non-Hispanic children.

Conclusion: Firearm injury ED visit rates by children during the COVID-19 pandemic exceeded twice the rates predicted by pre-pandemic trends. Visit rates were higher than expected for Black and Hispanic children, widening injury disparities that preceded the pandemic. These findings may inform pediatric firearm injury prevention efforts, including during future public health emergencies.