2021, Volume 10
2020, Volume 9
2019, Volume 8
2018, Volume 7
2017, Volume 6
2016, Volume 5
2015, Volume 4
2014, Volume 3
2013, Volume 2
2012, Volume 1
Volume 10 , Issue 6 , November 2021 , Pages: 173 - 179
Rural Versus Urban Pediatric Firearm Injuries: A 10-year Review at a Level 1 Trauma Center
Chelsea Day, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA
Andrea Diebel, St. Davis Children’s Hospital, Austin, USA
Oluwaseun Oke, Children’s Medical Center, Dallas, USA
Jo-Ann Nesiama, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA
Received: Sep. 20, 2021;       Accepted: Oct. 15, 2021;       Published: Nov. 5, 2021
DOI: 10.11648/j.cmr.20211006.11        View        Downloads  
While hospitalization rates in rural versus urban pediatric firearm injuries nationwide has been previously investigated, studies highlighting the differences across the spectrum of pediatric care are limited. The purpose of this study is to describe the epidemiology of pediatric firearm injuries in a North Texas level 1 trauma center in rural versus urban settings and supplement knowledge for injury prevention. Retrospective review of the trauma registry was done to identify children 0-18 years of age admitted to the Emergency department, inpatient service, or clinics between 2009-2019 for firearm injuries. Data points were cross-referenced through chart reviews. A descriptive analysis was conducted on data collected and stratified by location of injury; rural vs urban. Demographic data, type of firearm used (air propelled or powder propelled), shooter relationship, and injury severity scores were also collected. A chi-square analysis was conducted to determine associations and logistic regression analysis to determine the odds ratio of associations. A total of 247 patients met study criteria. Males accounted for 73% of all victims, of which 58% were in urban areas. Stratified by race, 36% of patients were Hispanic, followed by 30% White (p<0.001). Patients were slightly younger in rural areas 8.2±3.74 compared to their urban counterparts 9.2±4.34 (p=0.129). Air propelled firearms were used most often in both rural (52.2%) and urban (54.2%) areas (p=0.808). Black children were 3.6 times (CI: 1.8-7.5) more likely to sustain injuries from powder propelled firearms as compared to their White counterparts (p<0.001). Most shooters in both rural and urban areas were family members (57.5% and 39.7% respectively: p=0.112). Most injuries were unintentional; 95.6% of rural and 74.5% of urban injuries (p<0.002). Most injuries were classified as minor according to the injury severity score: rural 42.2% and urban 71.1%. However, injuries occurring in rural areas had a higher percentage in the moderate (28.9%), serious (11.1%) and severe (17.8%) categories respectively (p<0.001). In conclusion, firearm injuries occurred mostly in urban areas. The mean age of the patients was younger than 10 years. Additionally, injuries were often unintentional, caused by family members. More seriously injured children were in rural areas. This highlights the importance of firearm education to families with children.
Ballistic, Emergency Department, Firearm, Injury, Injury Severity Score
To cite this article
Chelsea Day, Andrea Diebel, Oluwaseun Oke, Jo-Ann Nesiama, Rural Versus Urban Pediatric Firearm Injuries: A 10-year Review at a Level 1 Trauma Center, Clinical Medicine Research. Vol. 10, No. 6, 2021, pp. 173-179. doi: 10.11648/j.cmr.20211006.11
Copyright © 2021 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
[ 1 ]
National Center for Injury Prevention and Control, WISQARS query system. Available at Data reviewed 2008-2017. Accessed May 4, 2021.
[ 2 ]
Fowler KA, Dahlberg LL, Haileyesus T, Gutierrez C, Bacon S. Childhood Firearm Injuries in the United States. Pediatrics. 2017; 140 (1): 1-11. doi: 10.1542/peds.2016-3486.
[ 3 ]
Robert, Steinbrook, Stern Rachel J., and Redberg Rita F. 2017. “Firearm Violence: A JAMA Internal Medicine Series.” JAMA Internal Medicine, no. 1: 19. doi: 10.1001/jamainternmed.2016.7180.
[ 4 ]
DiScala C, Sege R. Outcomes in children and young adults who are hospitalized for firearms-related injuries. Pediatrics. 2004; (5): 1306.
[ 5 ]
Srinivasan S, Mannix R, Lois K Lee. Epidemiology of paediatric firearm injuries in the USA, 2001-2010. Archives of Disease in Childhood. 2014; (4): 331.
[ 6 ]
Cunningham RM, Carter PM, Ranney ML, Walton M, Zeoli AM, Alpern ER, Branas C, Beidas RS, Ehrlich PF, Goyal MK, Goldstick JE, Hemenway D, Hargarten SW, King CA, Massey L, Ngo Q, Pizarro J, Prosser L, Rowhani-Rahbar A, Rivara F, Rupp LA, Sigel E, Savolainen J, Zimmerman MA. Prevention of Firearm Injuries Among Children and Adolescents: Consensus-Driven Research Agenda from the Firearm Safety Among Children and Teens (FACTS) Consortium. JAMA Pediatr. 2019 Aug 1; 173 (8): 780-789. doi: 10.1001/jamapediatrics.2019.1494. PMID: 31180470; PMCID: PMC6901804.
[ 7 ]
Kalesan B, Villarreal MD, Keyes KM, Galea S. Gun ownership and social gun culture. Injury Prevention. 2016; (3): 216-20. 2016 Jun; 22 (3): 216-20. doi: 10.1136/injuryprev-2015-041586.
[ 8 ]
Miller M, Azrael D, Hemenway D, Vriniotis M. Firearm storage practices and rates of unintentional firearm deaths in the United States. Accident Analysis & Prevention. 2005; 37 (4): 661-667. doi: 10.1016/j.aap.2005.02.003.
[ 9 ]
Parikh K, Silver A, Patel SJ, Iqbal SF, Goyal M. Pediatric Firearm-Related Injuries in the United States. Hospital pediatrics. 7 (6): 303-312. doi: 10.1542/hpeds.2016-0146.
[ 10 ]
Michael L. N, Lex D, Dennis R. D, Charles C. B, Perry W. S, C. William S. The Rural-Urban Continuum: Variability in Statewide Serious Firearm Injuries in Children and Adolescents. Archives of Pediatrics & Adolescent Medicine. 2002; (8): 781.
[ 11 ]
Senger C, Keijzer R, Smith G, Muensterer OJ. Pediatric firearm injuries: a 10-year single-center experience of 194 patients. Journal of Pediatric Surgery. 2011; 46 (5): 927.
[ 12 ]
Monuteaux MC, Mannix R, Fleegler EW, Lee LK. Predictors and Outcomes of Pediatric Firearm Injuries Treated in the Emergency Department: Differences by Mechanism of Intent. Acad Emerg Med. 2016 Jul; 23 (7): 790-5. doi: 10.1111/acem.12986. Epub 2016 Jun 20. PMID: 27084566.
[ 13 ]
Brewer JW Jr, Cox CS, Fletcher SA, Shah MN, Sandberg M, Sandberg DI. Analysis of pediatric gunshot wounds in Houston, Texas: A social perspective. Journal Of Pediatric Surgery. 2019; 54 (4): 783-791. doi: 10.1016/j.jpedsurg.2018.10.061.
[ 14 ]
Firearm-Related Injuries Affecting the Pediatric Population. Pediatrics. 2000; (4, Part 1 of 2): 888.
[ 15 ]
Nance ML, Carr BG, Kallan MJ, Branas CC, Wiebe DJ. Variation in Pediatric and Adolescent Firearm Mortality Rates in Rural and Urban US Counties. Pediatrics. 2010; 125 (6): 1112-1118. doi: 10.1542/peds.2009-3219.
[ 16 ]
David C. G, Donald T. R, Stephanie A. B. Self-inflicted and Unintentional Firearm Injuries Among Children and Adolescents: The Source of the Firearm. Archives of Pediatrics & Adolescent Medicine. 1999; (8): 875.
[ 17 ]
Herrin BR, Gaither JR. Rural Versus Urban Hospitalizations for Firearm Injuries in Children and Adolescents. Pediatrics. 2018; 142 (2): 1-7. doi: 10.1542/peds.2017-3318.
[ 18 ]
Economic Research Service, United States Department of Agriculture. “2010 Rural-Urban Commuting Area Codes” Last updated Aug 17, 2020. Site visited Oct 29, 2021.
[ 19 ]
WWAMI RUCA Research Center. “RUCA data: Using RUCA data.” Data first available in July 2005. Site last visited on Oct 29, 2021.
[ 20 ]
United States Census Bureau. “Texas: 2010 Population and Housing Unit Counts.” September 2012. Page 46. Site visited on October 31st, 2021.
[ 21 ]
Ngo QM, Sigel E, Moon A, Stein SF, Massey LS, Rivara F, King C, Ilgen M, Cunningham R, Walton MA; FACTS Consortium. State of the science: a scoping review of primary prevention of firearm injuries among children and adolescents. J Behav Med. 2019 Aug; 42 (4): 811-829. doi: 10.1007/s10865-019-00043-2. Epub 2019 Aug 1. PMID: 31367940.
Browse Journals by Subject