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Firearm injuries in children: a missed opportunity for firearm safety education
  1. Sarah C Stokes,
  2. Nikia R McFadden,
  3. Edgardo S Salcedo,
  4. Alana L Beres
  1. Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
  1. Correspondence to Dr Sarah C Stokes, Department of Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA; scstokes{at}


Background Surgeons frequently care for children who have sustained gunshot wounds (GSWs). However, firearm safety education is not a focus in general surgery training. We hypothesised that firearm safety discussions do not routinely take place when children present to a trauma centre with a GSW.

Method A retrospective review of patients <18 years presenting with GSWs to a level 1 paediatric trauma centre from 2009 to 2019 was performed. The primary outcome was discussion of firearm safety with the patient or family. The secondary outcome was notification of child protective services (CPS).

Results A total of 226 patients with GSWs were identified, 22% were unintentional and 63% were assault. Firearm safety discussions took place in 10 cases (4.4%). Firearm safety discussions were more likely to occur after unintentional injuries compared with other mechanisms (16.0% vs 1.3%, p<0.001). CPS was contacted in 29 cases (13%). CPS notification was more likely for unintentional injuries compared with other mechanisms (40% vs 3.9%, p<0.001) and for younger patients (7 years vs 15 years, p<0.001).

Conclusion At a paediatric trauma centre, firearm safety discussions occurred in 4.4% of cases of children presenting with a GSW. There is a significant room for improvement in providing safety education interventions.

  • counseling
  • education
  • firearm
  • child
  • adolescent

Statistics from


  • Contributors SCS, NRM and ALB conceived of and designed the study. SCS collected the data and prepared the first draft of the manuscript. All authors were involved in interpretation of the data, revision of the manuscript and provided final approval for submission.

  • Funding NRM was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved with a waiver for informed consent by the Institutional Review Board at UCDH (IRB #935667).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Deidentified data are available by request from

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