Statement of Purpose There is a lack of consensus regarding age- and intent-related differences in the burden of non-fatal firearm injuries. We determined the time trends in burden and costs of age- and intent-specific non-fatal firearm injuries presenting to US emergency departments (EDs) differentiated by survival after treatment to correctly estimate non-fatal injuries.

Methods We performed a retrospective study of the Healthcare Cost and Utilization Program Nationwide Emergency Department Survey (NEDS) from 2006 to 2016. We present survey-weighted counts, proportions, means, and rates, and confidence intervals of national and age groups (0–4, 5–9, 10–14, 15–17, 18–44, 45–64, 65–84, >84 years) specific ED discharges for firearm injuries. Inflation-adjusted charges were applied to costs.

Results There were a total of 1,033,771 ED visits for firearm injuries from 2006 to 2016 and 6.8% died in the ED. The firearm injury ED rates remained steady, while ED death rates declined slightly during 11-years. There was also a slight decline in firearm ED visits in children (0–17), but the largest burden was between 18–44 years (20.8 per 100,000) with stable rates. Assault injuries declined from 39.7% to 36.4% overall with a significant drop in all age groups, while unintentional injuries increased from 46.4% to 54.7% overall and in all age groups. There were significant declines in legal intervention injuries. The total charges were $3,777,264,968 ($369,006,396/year) and increased across time in all subgroups. The mean predicted charges increased from $2,386 to $3,975 among those discharged alive versus $1,322 to $2,203 among those who died in ED.

Conclusions The burden of firearm injury treated in ED is among young adults. Interventions and programs to reduce firearm violence should include non-fatal injuries as they live with ongoing morbidity and economic burden.

Significance There is a need for an accurate and standardized data collection of firearm injuries.