National Benchmarks for Penetrating Head Injury in U.S. Children and Adolescents: Mechanism, Intent, and Disparities in Mortality.

Authors

Alexander S Mina, Jeffrey W Chen, Keely Wolf, Adam M Vogel, Howard I Pryor

Published in

Journal of pediatric surgery. Pages 163284. Jul 02, 2026. Epub Jul 02, 2026.

Abstract

To establish contemporary national benchmarks for penetrating head injury (PPHI) in children and adolescents by characterizing its epidemiology, age, race/ethnicity, mechanism, and intent, and to identify independent predictors of mortality, in order to inform age- and mechanism-specific prevention.
Retrospective cohort study of children and adolescents aged 1-17 years with PPHI in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database, 2019-2023. PPHI comprised firearm, cut/pierce, and animal-bite mechanisms with documented head-region involvement. Patients were stratified into four developmental age groups (1-4, 5-9, 10-14, 15-17 years). Outcomes included overall (emergency department and in-hospital) mortality, neurosurgical intervention, length of stay, and hospital-acquired infection (HAI). Animal bites were summarized as a separate descriptive subgroup; the multivariable mortality model was restricted to firearm and cut/pierce mechanisms, with a sensitivity analysis varying the head-injury severity threshold.
Among 9,046 children and adolescents with PPHI, 73.8% were male and 49.9% were aged 15-17 years. Mechanism and intent shifted markedly with age: animal bites predominated among children aged 1-4 years (61.3% of that group), whereas firearms accounted for 88.2% of injuries in adolescents aged 15-17 years. Injuries were predominantly unintentional before age 10 (80.9%); self-inflicted injury peaked at ages 10-14 (21.1%); and assault predominated at ages 15-17 (63.4%). Overall mortality was 25.4% and rose from 12.2% in children aged 1-9 years to 31.3% in those aged 10-17 years. Firearms caused 6,199 injuries (68.5%) and 97.7% of all deaths. Independent predictors of mortality included firearm mechanism, self-inflicted intent, non-Hispanic Black race, lower Glasgow Coma Scale score, higher Injury Severity Score, and direct (non-transferred) arrival.
PPHI in U.S. children and adolescents comprises three distinct epidemiologic phenotypes, animal bites in young children, self-inflicted firearm injury peaking in early adolescence, and firearm assault concentrated among older, predominantly non-Hispanic Black adolescents. Firearms drive nearly all mortality. These national benchmarks support tailored, phenotype-specific prevention rather than a single undifferentiated strategy.

PMID:
42392255
Bibliographic data and abstract were imported from PubMed on 03 Jul 2026.

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