P3.138: Risk and Protective Factors for Pediatric Firearm Injuries: A Systematic Review

Background: Firearm injuries cause significant morbidity and mortality for children and adolescents in the United States, disproportionately affecting racial minorities and low-income communities. There remain gaps in understanding the risk factors and protective factors for pediatric firearm injuries. This is particularly true in younger children, for whom risk factors may differ from older adolescents. This systematic review identified factors influencing pediatric firearm injuries, focusing on modifiable risk and protective factors.

Methods: A medical librarian trained in the systematic review process searched the following databases: MEDLINE, Scopus, Embase and PsycINFO. Keywords and controlled vocabularies were utilized to capture the concepts of gunshot wounds and firearm injuries in the pediatric population. Studies published within the last 10 years (2014-2024), included children ≤ 16 years, examined risk and protective factors related to firearm injuries and outcomes, and had a comparison group were included.

Results: A total of 5,947 citations were captured through the database search. 2,749 de-duplicated citations were uploaded onto Covidence. Of these, 391 articles underwent full text review and 10 studies were found to meet eligibility criteria. Modifiable risk factors included firearm storage practices, firearm legislation, exposure to community violence, insurance status, and socioeconomic status. Non-modifiable risk factors included Black race, male sex, adverse childhood experiences, and geographic location (urban/rural). Younger victims (≤10 years old) often had a known relationship (i.e., parents, caregivers) with the perpetrator and there was a high rate of unintentional injuries (46.4%, 31.2-89.4) while older adolescents were more likely to have been injured by strangers and acquaintances. Firearm legislation such as the Federal Assault Weapons Ban had measurable effects on reducing pediatric firearm injuries and deaths. There was limited data evaluating how interventions like firearm safety education or community and school programs reduced injury rates.

Conclusion: Modifiable risk factors for pediatric firearm injury with the strongest evidence base included legislation, firearm storage practices, socioeconomic disparities, and community violence exposure. Given the significant proportion of unintentional injuries and a common relationship between perpetrators and victims, targeted interventions, such as parental counseling in health care settings or school-based programs, may be effective in prevention but require further evaluation. Firearm safety laws targeted at secure storage requirements and detailed background checks may help in reducing pediatric firearm injuries.