Indicators of potential disability among pediatric firearm injury survivors

Background: Pediatric firearm injury represents an increasing national crisis. While many injuries are fatal, a greater proportion of children survive, often facing significant long-term disabilities. This study aims to characterize the outcomes of pediatric firearm injury and identify predictors of persisting symptoms. Methods: We conducted a retrospective cohort study of patients aged 0–17 years treated for firearm injuries at three Level I trauma centers in a major U.S. city from 2018 to 2020. Data was collected from trauma registries, medical charts, and public records, including demographics, details regarding shooting context, injury data, clinical management, and outcomes. Persisting symptoms were defined as symptoms related to the injury documented at 3 or more months after hospital discharge. Multivariable logistic regression analyses were used to identify predictors of persisting symptoms. Results: Of 360 pediatric survivors, 287 (79.7 %) had follow-up data available. Among them, 83 (28.9 %) experienced persisting physical or mental health symptoms, with impaired mobility being the most common symptom affecting 39 patients (47 %). Adjusted analyses demonstrated that higher New Injury Severity Score, intensive care unit admission, and extremity injuries were significantly associated with increased odds of persisting symptoms. Age, gender, race/ethnicity, and shooting context were not statistically significant predictors. Seventy-three patients (20.3 %) were lost to follow-up and were a marginally older sub-population. Conclusions: Nearly one-third of pediatric firearm injury survivors experience persisting symptoms beyond 3 months post-injury. These data highlight the need for long-term follow-up, active screening for physical and psychological sequelae, and early referral to rehabilitation and mental health services to help prevent long-term disability.