Pediatric Firearm Injury Trends: An Analysis Leveraging the Vizient® Clinical Data Base

Editor's note: Hannah Murphy, Lead, Analytics & Insights and Alyssa Harris, Associate Principal, Analytics & Insights also contributed to this blog post.

Welcome to the inaugural post of our Pediatric Research at Vizient blog series. This series highlights some of our latest findings in pediatric medicine and incorporates analysis leveraging the Vizient® Clinical Data Base to support our pediatric research efforts.

First up, we cover recent Vizient research on children presenting to the ED with firearm injuries, findings from which were presented at the 2025 Pediatric Academic Societies Meeting in April.

Firearm injuries are the leading cause of death among US children and teens, representing a critical public health issue. Post–COVID-19 data show that firearm-related emergency department visits among children more than doubled from 2017 to 2022. The current study aimed to describe trends and differences in firearm injuries among youth by segmenting ED discharges by age, demographics and vulnerability.

We examined utilization data for 33.3 million pediatric ED patients from 531 hospitals and 21,806 firearm injuries over a five-year period (2019–2024), leveraging the patent pending Vizient Vulnerability Index (VVI) for a portion of the study. The VVI is a measure of community social determinants of health, which helps health systems understand the influence of a patient’s neighborhood on their health care utilization.

Our findings highlight disparities in youth firearm injury encounters for individuals aged 0 to 19 who were treated and released from the ED in the study time frame. The results that follow pertain to the pediatric population studied.

Key Finding #1: Demographics

Black patients represented a higher proportion of ED discharge volume for firearm injuries compared to overall ED discharge volume, at 58.4% of discharges for firearm injuries versus 24.6% of overall discharges.

Male patients represented a higher proportion of ED discharges for firearm injuries compared to the gender distribution for overall ED discharges, at 84% versus 50%.

Patients covered by Medicaid represented a higher proportion of ED discharge volume for firearm injuries compared to overall ED discharge volume, at 65% versus 60%.

Race Demographics of All Patients Aged 0–19 Discharged From the ED Compared to Those With Firearm Injury, 2019–2024

Note: Percentages may not add to 100% due to rounding. Source: Data from the Vizient Clinical Data Base used by permission of Vizient, Inc. All rights reserved.

Sex Demographics of All Patients Aged 0–19 Discharged From the ED Compared to Those With Firearm Injury, 2019–2024

Source: Data from the Vizient Clinical Data Base used by permission of Vizient, Inc. All rights reserved.

Primary Payer for All Patients Aged 0–19 Discharged From the ED Compared to Those With Firearm Injury, 2019–2024

Source: Data from the Vizient Clinical Data Base used by permission of Vizient, Inc. All rights reserved.

Key Finding #2: High Vulnerability

Patients who live in high-vulnerability zip codes are associated with a higher proportion of firearm injuries compared to all ED volumes, at 52% versus 23%. Furthermore, a predictive model found 201% higher odds of firearm injury ED visits for residents of high-vulnerability neighborhoods than for low-vulnerability neighborhoods.

Vulnerability Level of All Patients Aged 0–19 Discharged From the ED Compared to Those With Firearm Injury, 2019–2024

Sources: Data from the Vizient Clinical Data Base used by permission of Vizient, Inc. All rights reserved; Vizient Vulnerability Index. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com. Accessed April 2025.

Key Finding #3: Predictive Model

A predictive model found 34% higher odds of firearm injury–related ED visits for emergency departments in states without child access prevention (CAP) laws (ie, laws designed to prevent children from accessing firearms). Read more on CAP laws and the states that have them here.

Substance use disorder was also found to strongly increase odds of firearm injury in the ED.

Sg2 Perspective

These findings quantify epidemiological differences, including disproportionate impacts among Black, male, Medicaid-covered youth and increased risk in highly vulnerable neighborhoods and states without CAP laws. The knowledge gleaned from the analysis may help to reduce the risk of gun violence among children in the future.

These data-driven insights also help frame the first steps toward firearm injury prevention and quality improvement, and health systems can leverage them to support numerous strategic objectives, including the following:

• Emergency department preparedness—Identify local segments with the highest firearm injury prevalence rates to better prepare for future utilization. Compare your own patient mix to local and national benchmarks to understand drivers of variance.
• Community-based programming—Socioeconomic support and violence prevention programs can help reduce firearm injury rates. Engage in partnerships with community-based organizations to build targeted prevention programming.
• Evidence-based policymaking—Health systems and associations play a significant role in advocacy, lobbying and policymaking. Bring data-driven insights to inform governmental negotiations.

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