Comparison of Clinical Characteristics and Costs of Emergency Department Visits for Pediatric Non-Firearm and Firearm Trauma in the United States

Lois K. Lee, MD, MPH
Ayesha Dholakia, MD
Katherine Douglas, MD
Brianna Irons, MD, MPH
Jake Hodas, BA
Michael Monuteaux, ScD
Eric Fleegler, MD, MPH

Traumatic injuries are a frequent presentation for emergency department (ED) visits for US youth 0-17 years old. Firearms represent a relatively small proportion of ED visits for trauma; however, these injuries are at risk for high clinical severity and cost. The objectives of this are to compare clinical characteristics and healthcare costs of pediatric firearm vs. non-firearm injuries among U.S. ED visits.

This is a cross-sectional, retrospective study of pediatric traumatic injuries using the 2022 National Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project (HCUP). We included youth 1-17 years old with traumatic injuries, identified by ICD-10 codes. The primary study outcomes were: 1) high acuity care (death in the ED, hospitalization, or transfer to another hospital); 2) ED costs; and 3) total hospital costs. We generated national estimates using NEDS survey weighting. We estimated costs from hospital charges using the HCUP hospital-specific cost-to-charge ratios. We estimated multivariable regression models (logistic for high acuity outcome, generalized linear models with log link for costs), reporting adjusted odds ratios (aOR) and mean percent changes with 95% confidence intervals (CI), respectively. Models were adjusted for patient factors and hospital characteristics.

From the NEDS sample of 5,911,798 US pediatric ED visits in 2022, an estimated 1,144,076 (19.3%) were for pediatric traumatic injuries. This resulted in a population estimate of 4,942,841 (95%CI 4,528,368-5,356,313) non-firearm (99.8%) and 11,772 (95%CI 9,805-13,740) firearm (0.2%) injuries. For non-firearm trauma 54.7% of patients had public insurance and for firearm trauma 72.9% had public insurance (Table 1). For non-firearm injuries the median ED charge was $2,012 (95%CI 1,142-3,503) and median total charge was $2,026 (95%CI 1,149-3,610). For firearm injuries the median ED charge was $6,524 (3,428-16,243) and median total charge was $18,877 (95%CI 6,214-61,899). In the multivariable models, for the outcome of high acuity care, firearms had increased odds (aOR 15.59, 95%CI 13.13- 18.52) compared to non-firearm trauma. The ED costs of firearm injuries were nearly 2 times greater (adjusted mean percent difference: 171%, 95%CI 146% - 198%) compared to non-firearm trauma. For total costs, there was a four-fold increase associated with firearm injuries (aOR 413%, 95%CI 342% - 495%) compared to non-firearm injuries (Table 2).

In 2022, traumatic injuries accounted for nearly one in five pediatric ED visits. Firearms represented a small proportion but had much higher acuity and costs. A multi-pronged approach for injury prevention is essential to decrease injuries among youth.

1) Describe the epidemiology of pediatric ED visits for trauma, including non-firearm and firearm injuries.
2) Examine differences in high acuity ED outcomes for traumatic injuries between non-firearm and firearm injuries.
3) Analyze differences in ED and total hospital costs for traumatic injuries between non-firearm and firearm injuries.