Statement of Purpose Firearm-related (FR) injuries are the leading cause of death from traumatic brain injury (TBI) in the US. Little is known about the characteristics of children treated in a hospital for a FR TBI. In 1999 the CDC published a Report to Congress on the magnitude of firearms in TBI’s Subsequent reports have not addressed firearms. We aim to characterise the epidemiology of severe FR paediatric TBI treated in the hospital.

Methods/Approach We used data from the Approaches and Decisions in Acute Paediatric TBI (ADAPT) Trial, a 49-site comparative effectiveness study. Consecutive children (age <18 y) in hospital for severe TBI (GCS≤8) were enrolled. Parametric (Chi-square) and nonparametric tests (Fisher’s exact, Wilcoxon rank sum) were used.

Results A total of 1000 children were enrolled in ADAPT in 49 sites, 705 in the US, and 295 in India, Great Britain, Australia, South Africa and New Zealand. 50 had a FR TBI ‘“ 48 in the US, two internationally. Twelve were self-inflicted, 20 were assaults and 18 were unintentional. The majority of children with a self-inflicted (75%) and unintentional (56%) FR TBI were white, and 40% of children with an assault were black. Average ages for the three groups were 10 years (self-inflicted), 7 years (unintentional), and 10 years (assaults). When compared to children with non-FR TBI’s, children with any type of FR TBI were more likely to be older (9 years vs. 7 years, p=0.03), male (82% vs. 64%, p=0.01), Black (32% vs. 21%, p=0.03), non-Hispanic (69% vs. 50%, p=0.007) and to arrive at the hospital sooner (1.3 vs 1.8 hours, p=0.02).

Conclusions Few reports exist detailing the epidemiology of FR TBI’s among children. These data show that the epidemiology characteristics of FR TBI are different than non-FR TBI. Further research should address the clinical and long-term outcome of FR TBI’s.