Geospatial Clustering of 9-1-1 Responses for Pediatric Firearm Injuries Over Time

Craig D Newgard; Susan Malveau; Amber Lin; Patrick Carter; Jason Goldstick; Jennifer N B Cook; N Clay Mann; Xubo Song; Sean R Babcock; Nathan Kuppermann; Apoorva Salvi; Mary E Fallat; Peter C Jenkins; Ran Wei

doi:10.1542/peds.2024-068179

Geospatial Clustering of 9-1-1 Responses for Pediatric Firearm Injuries Over Time

Pediatrics. 2025 Mar 12:e2024068179. doi: 10.1542/peds.2024-068179. Online ahead of print.

Authors

Craig D Newgard¹, Susan Malveau¹, Amber Lin¹, Patrick Carter^{2

3}, Jason Goldstick², Jennifer N B Cook¹, N Clay Mann⁴, Xubo Song⁵, Sean R Babcock¹, Nathan Kuppermann⁶, Apoorva Salvi¹, Mary E Fallat⁷, Peter C Jenkins⁸, Ran Wei⁹

Affiliations

¹ Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
² Institute for Firearm Injury Prevention, Injury Prevention Center, Department of Emergency Medicine, University of Michigan School of Medicine, University of Michigan, Ann Arbor, Michigan.
³ Department of Health Behavior & Health Equity, University of Michigan School of Public Health, University of Michigan, Ann Arbor, Michigan.
⁴ Department of Pediatrics, The University of Utah School of Medicine, The University of Utah, Salt Lake City, Utah.
⁵ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
⁶ Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, University of California, Davis, Sacramento, California.
⁷ Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky.
⁸ Department of Surgery, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana.
⁹ School of Public Policy, University of California, Riverside, Riverside, California.

PMID: 40068816
DOI: 10.1542/peds.2024-068179

Abstract

Objectives: We evaluated spatial clustering of pediatric firearm injuries using national 9-1-1 emergency medical services (EMS) responses, locations where these events occurred, and geographic changes over time.

Methods: This was a cross-sectional study from January 1, 2012 through December 31, 2022 using 9-1-1 EMS responses for children in 50 states from the National EMS Information Systems (NEMSIS). For 37 states with continuous data over the study period, we evaluated spatial changes over time. We included children aged 0 to 17 years with a 9-1-1 EMS response including transports, nontransports, and deaths at the scene. We stratified by child (0-10 years) and adolescent (11-17 years) age groups. The outcome was firearm injury, regardless of intent or severity.

Results: There were 10 521 575 9-1-1 EMS responses from 30 393 incident zip codes, including 26 101 (0.25%) for firearm injuries (3679 [14.1%] in children and 22 422 [85.9%] in adolescents). Among 3679 children with firearm injuries, 2975 (80.9%) occurred in their home zip code and 1490 (40.5%) occurred in a cluster. Among 22 422 adolescents with firearm injuries, 15 635 (69.7%) occurred in their home zip code and 11 551 (51.5%) occurred in a cluster. Among 37 states (n = 6 103 297 events, n = 11 433 zip codes), 213 of 446 (47.8%) clustered zip codes for children were new in 2022 and 148 of 461 (32.1%) clustered zip codes for adolescents were new. Results were similar when using home zip codes.

Conclusions: There was spatial clustering of pediatric firearm injuries, commonly in their home zip code. The number of zip codes included in pediatric firearm hotspots is increasing.