P3.130: Sustained Surge: Temporal Trends in Pediatric Firearm Injury Encounters Before and After COVID-19 (2016–2023)

Background: Firearm injuries (FIs) remain the leading cause of death among children and adolescents in the United States, underscoring the need for comprehensive surveillance and prevention strategies. While prior studies have examined the burden of pediatric FIs, they have not captured temporal trends in FI encounters over time. Few studies have assessed how the frequency of emergency department (ED) visits for FIs were impacted by the COVID-19 pandemic. This study aimed to use a large multicenter database to analyze trends in pediatric ED visits related to FIs and to assess the impact of seasonal variations.

Methods: We conducted a retrospective cohort study using the Pediatric Health Information System (PHIS) database, including ED visits (January 2016 – December 2023) for children < 18 years of age with an International Classification of Diseases, 10th revision, diagnosis indicating FI. The primary outcome was the number of FI-related ED visits per month. Poisson regression models and time series decomposition were used to assess temporal and seasonal trends before and after the onset of the COVID-19 pandemic.

Results: A total of 6,358 pediatric FI ED encounters were identified. Of these, 3369 (53.0%) were hospitalized, 991 (15.6%) required intensive care unit admission, and 408 (6.4%) resulted in in-hospital death. Poisson regression identified three distinct time periods with differing rates of firearm injury encounters (Figure 1). From 2016 to early 2020, pediatric FI encounters increased at an annual rate of 5.5%. Between February and June 2020, the rate of pediatric FI encounters increased at an annual rate of 350%, corresponding to a 13.4% monthly increase. Following June 2020, rates stabilized, showing a 2.6% annual decrease in pediatric FI encounters from 2021 to 2023. Time series decomposition analysis revealed a clear seasonal pattern, with periodic fluctuations in encounter rates suggesting consistent temporal variability (Figure 2). Additionally, the trend analysis confirmed that while FI encounters remained high post-2020, the rate of increase slowed.

Conclusion: Pediatric FI ED visits within the PHIS network increased significantly from 2016 to 2023, with a sharp rise in early 2020 coinciding with the onset of the COVID-19 pandemic. This surge may reflect the impact of pandemic-related societal changes, including school closures, social disruption, and increased firearm access. Post-2020, rates stabilized at elevated levels, suggesting a new baseline. Strong seasonal patterns indicate predictable fluctuations that could inform targeted prevention efforts. These findings highlight the critical importance of continued surveillance, policy interventions, and community-based strategies to mitigate firearm-related harm in children.