Firearm-related deaths in Tennessee children.

Background: The healthcare burden and fatality rate associated with pediatric firearm injuries is increasing substantially. Most published studies evaluating outcomes and disparities of pediatric firearm-related injuries have focused primarily on hospital-level data. This study aimed to investigate mortality indicators among pediatric decedents referred to the Tennessee Chief Medical Examiner (CME) having a confirmed firearm-related cause of death. Methods: In this retrospective cross-sectional study, the Tennessee CME database was queried to reveal 643 death certificates of children ages 17 years and younger who died from a firearm-related injury between 2012 and 2022. Death certificates were surveyed for demographics and residential data. Autopsy reports were reviewed for anatomic injury patterns. The neighborhood of residence for each decedent was geocoded for analysis using the Child Opportunity Index (COI). Pearson, Kruskal-Wallis, Wilcoxon, and linear regression modeling were completed. Results: Significant increases in both homicide (n=369; p<0.0001) and suicide (n=202; p=0.001) were documented over time. Firearm deaths increased with age (median age, 16.0 years; IQR (13-17)), with ≥70% of homicide and suicide cases occurring between ages 15 years and 17 years. 272 homicide decedents (76%) were black, and 165 (82%) suicides were white (p<0.001). Over half of decedents sustained a head wound (p<0.001). Geocoded density maps indicated a correlation between pediatric population race density and predominating manners of firearm death. Residences with a lower COI level were associated with a higher risk of homicide. Conclusion: In this query of the Tennessee CME registry, homicide rates increased and remained higher than all other firearm manners of death impacting children. This study revealed opportunities to affect meaningful change regarding different ages and manners of lethal firearm injuries among children. Level of evidence: III.