The impact of the COVID-19 pandemic on pediatric firearm injuries in Colorado

J Pediatr Surg. 2023 Feb;58(2):344-349. doi: 10.1016/j.jpedsurg.2022.10.043. Epub 2022 Oct 23.


Background: In 2019 firearm injuries surpassed automobile-related injuries as the leading cause of pediatric death in Colorado. In the spring of 2020, the COVID-19 pandemic led to community-level social, economic, and health impacts as well as changes to injury epidemiology. Thus, we sought to determine the impact of the COVID-19 pandemic on pediatric firearm injuries in Colorado.

Methods: We conducted a retrospective review of pediatric firearm injured patients (≤ 18-years-old) evaluated at three trauma centers in Colorado from 2018-2021. Patients were stratified into two groups based on the time of their firearm injury: pre- COVID injuries and post- COVID injuries. Group differences were examined using t-tests for continuous variables and Chi Squared or Fisher's exact tests for categorical variables.

Results: Overall, 343 firearm injuries occurred during the study period. There was a significant increase in firearm injuries as a proportion of overall pediatric ED trauma evaluations following the onset of the COVID-19 pandemic (pre COVID: 5.18/100 trauma evaluations; post COVID: 8.61/100 trauma evaluations, p<0.0001). Assaults were the most common injury intent seen both pre and post COVID (70.3% vs. 56.7%, respectively); however, unintentional injuries increased significantly from 10.3% to 22.5% (p = 0.004) following the onset of the pandemic. Additionally, the COVID-19 pandemic was associated with a 177% increase in unintentional injuries in adolescents.

Conclusion: Pediatric firearm injuries, particularly unintentional injuries, increased significantly in Colorado following the onset of the COVID-19 pandemic. The substantial increase in unintentional injuries among adolescents highlights the necessity of multi-disciplinary approaches to limit or regulate their access to firearms.

Level of evidence: Level III.

Study type: Retrospective.

Keywords: COVID-19 pandemic; Pediatric firearm injury; Pediatric trauma.

MeSH terms

  • Accidental Injuries*
  • Adolescent
  • COVID-19* / epidemiology
  • Child
  • Colorado / epidemiology
  • Firearms*
  • Humans
  • Pandemics
  • Retrospective Studies
  • Wounds, Gunshot* / epidemiology