A Holistic Approach to Childhood Firearm Injuries

Christian D. PulciniJennifer A. HoffmannElizabeth R. AlpernSofia Chaudhary, Peter F. EhrlichJoel A. FeinEric W. FleeglerMonika K. GoyalMatt HallKristyn N. JeffriesRachel MyersKaren M. SheehanMark ZamaniBonnie T. ZimaStephen HargartenCHARGE Group


Firearm injury is a leading cause of death among children and adolescents. Approximately 33 000 children were killed by firearms in the decade between 2012 and 2021, with an annual rate that increased 50% between 2019 (1732) and 2021 (2590). For every 1 of these lives tragically lost, 4 children survive their firearm injuries. This substantial rise in preventable death and injury among children by firearms underscores the need for firearm injury reduction to be a national priority area for policymakers, community leaders, clinicians, advocates, and researchers.

The authors of recent studies estimate that 40% of children who survive firearm injuries suffer chronic, complex medical conditions, with an associated $100 million in additional health care expenditures in the year after the injury. Of children who survive firearm injuries, between 47% and 70% are discharged directly from the emergency department (ED), resulting in only a brief window to recognize and begin to address the consequences of traumatic injury. In addition, there are well-described racial, ethnic, and socioeconomic disparities in firearm injury patterns. For example, children from disinvested neighborhoods are more likely to be affected by firearm injury and return to the same neighborhoods in which their injury occurred.Non-Hispanic Black males and females are 19-fold and 13-fold, respectively, more likely to experience nonfatal firearm assaults compared with non-Hispanic white males and females.

These findings only begin to describe the experiences of firearm-injured children and their families. To illustrate this, we describe a real patient vignette (name changed). The elements of the vignette are familiar to many clinicians, given similar stories unfold daily across the United States.

Keywords: Firearms, Psychosocial Health, Public Health, gunshot wounds, holistic approach