572 - Trend in pediatric gunshot injuries during the COVID-19 pandemic in San Antonio

Poster Number: 572
Publication Number: 572.240

Twiza C. Mambwe, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States; Wouter Koek, UT Health, San Antonio, TX, United States; Veronica Armijo-Garcia, UT Health San Antonio, San Antonio, TX, United States

Background: Gunshot injuries (GSI) result in 1300 childhood deaths and many more hospitalizations each year [1]. Government lock downs, restrictions in social gatherings, economic instability and social unrest have made for uncertain times while firearm purchases have increased. [2,3]. Multiple studies have found correlation between increase gun purchases and an increase in GSI in the general population[4,5]. To date, the incidence of GSI in the pediatric population during the COVID-19 lock down period has not been decribed.
We hypothesize that there was an increased incidence of GSI in children during the COVID-19 pandemic lockdown in our patient population.

Objective:
Quantify and compare the incidence of GSI in the pediatric patient population in our hospital before and during the COVID-19 pandemic.

Design/Methods:
A retrospective chart review of a single center, community pediatric intensive care unit (PICU). Inclusion: patients ages 1 day to less than 18 years admitted to PICU with new principal diagnosis of GSI. Exclusion: prior history of GSI admitted with an unrelated diagnosis. We compared data from January 1st, 2018 to February 29th, 2020, to data from March 1st, 2020 to January 31st, 2021. Data included age, sex, ethnicity, date of injury, mode of injury, and mortality. 

Results: While the total number of trauma admissions remained constant, the incidence of GSI doubled during the COVID lock down period compared to the two prior years. A log linear model yielded a statistically significant increase in GSI with no change in the rate of total trauma admissions, p value = 0.006. The gender, age, injury mode, ethnicity and mortality of GSI patients remained unchanged (table 3-8).Conclusion(s):
The results show a significant increase in pediatric GSI since the COVID-19 lock down began. Comparing the duration of time between all three time periods, the COVID 19 period was shorter, thus the increasing trend is clinically significant. The study showed a positive correlation between the rise in pediatric GSI and COVID-19 lock down period, but it did not identify any specific catalysts such as social justice unrest, economic downfall, and political unrest. A larger study is necessary to assess if this trend in pediatric gunshot injuries is seen everywhere and to identify at risk areas and analyze factors that could contribute.

Table 1 and Table 2Table 1: shows the number of gunshot injuries and the total number of trauma admissions for each time period. The total number of admissions stayed relatively the same, but the number of gunshot injuries doubled in Covid lock down period (Time 3). Statistically significant with p value of 0.006. Table 2: Relative incidence of GSI compared over 2 different time periods. The rate ratio (RR) of GSI between time 1-time 2 is 1- so there is no difference in incidence. There is a 2-fold increase between time 2-time 3 (RR of 2.7). The CI for time 2-time 3 is large but does not contain 1, statistically significant.
Graph 1 and Graph 2Graph 1: shows absolute incidence in gunshot injuries
Graph 2: shows relative incidence in gunshot injuries