title: Guns and states: pediatric firearm injury.
abstract: BACKGROUND
  A recent report indicates that firearm-related injuries are responsible for 30% of pediatric trauma fatality. The literature is however limited in examining pediatric firearm injuries and variations in state gun control laws. Therefore, we sought to examine the association between pediatric firearm injuries and the Stand-Your-Ground (SYG) and Child Access Protection (CAP) laws.
  
  
  METHODS
  All pediatric (age, 0-20 years) hospitalizations with firearm injuries were identified from the Kids' Inpatient Database from 2006 and 2009. States were compared for SYG and CAP laws.
  
  
  RESULTS
  A total of 19,233 firearm injury hospitalizations were identified, with 64.7% assault, 27.2% accidental, and 3.1% suicide injury. Demographics for assault injury were as follows: mean age of 17.6 years, 88.4% male, 44.4% black, 18.2% Hispanic, 70.5% from metropolitan areas, and 50.1% from the poorest median income neighborhoods. Suicide injury cases were more likely to be white (57.8% vs. 16.6%, p < 0.001) and female (15.1% vs. 9.8%, p < 0.001). States with the SYG law were associated with increased accidental injury (odds ratio [OR], 1.282; p < 0.001). There was no statistical association between CAP law and the incidence of accidental injury or suicide. Multivariate logistic regression analysis found other predictive demographic factors for firearm injury: black (OR, 6.164), urban areas (OR, 1.557), poorest median income neighborhoods (OR, 2.785), male (OR, 28.602), and 16 years or older (OR, 37.308). Total economic burden was estimated at more than $1 billion dollars, with a median length of stay of 3 days, 8.4% discharge to rehabilitation, and 6.2% in-hospital mortality.
  
  
  CONCLUSIONS
  Pediatric firearm injuries continue to be a significant source of morbidity, mortality, and economic burden. A significant increase in accidental firearm injuries in states with the SYG law may highlight inadvertent effects of the law. Race, sex, and median income are additional contributing factors. Advocacy and focused educational efforts for specific socioeconomic and racial groups may potentially reduce firearm injuries.
  
  
  METHODS
  Prognostic study, level II.
authors.affiliation: St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135, USA. Justin.Lee@tufts.edu
authors.forename: Justin
authors.initials: J
authors.lastname: Lee
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Moriarty
authors.forename: David B
authors.initials: DB
authors.lastname: Tashjian
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Patterson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002651:Child Advocacy / Q000331:legislation & jurisprudence*; D002675:Child, Preschool; D016208:Databases, Factual; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005389:Firearms / Q000331:legislation & jurisprudence*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011203:Poverty; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States; D014505:Urban Population; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult