Research shows significant association between emergency department visits for firearm and motor vehicle-related crashes

DENVER — One in four patients treated in an emergency department for firearm injuries had been treated in a prior visit for injuries caused by a motor vehicle crash or other violent incident, according to new research presented during the American Academy of Pediatrics 2025 National Conference & Exhibition. The significant association between types of injuries could indicate a pattern of risky behaviors.

The authors of an abstract, “Associational Analysis for Pediatric Firearm Injury Risk,” found that children and youth with firearm, non-firearm violent, and motor vehicle crash injuries visited a Midwest hospital system’s emergency department on multiple occasions within a four-year period. They will present their findings during the AAP national conference at the Colorado Convention Center from Sept. 26-30.

“As a pediatric emergency physician, I see firsthand how trauma doesn’t happen in isolation,” said Mike Levas, MD, senior author and pediatrics professor at the Medical College of Wisconsin and Medical Director of Project Ujima, Children’s Wisconsin’s hospital-based violence intervention program.

“Our study reveals a troubling pattern: nearly one in four children with firearm injuries return to the emergency room with another violent or crash-related injury within just four years. These aren’t random events—they’re interconnected.”

Researchers analyzed records from 2,614 emergency department visits between 2018-2022, finding the type and severity of a child's repeat injuries were predictive of whether they'd return to the emergency department in the future with a firearm injury. The findings revealed a significant association between motor vehicle crashes and firearm injury, with motor vehicle crashes and violent injuries serving as predictors for subsequent firearm injury.

Maria Beyer, study author and community health evaluation manager, said that partnership between community, clinical, and scientific team members is essential to generate evidence-based insights, which are necessary to create meaningful, sustainable solutions.

“Our community health teams work closely with kids and families to understand their experiences, alongside clinical teams who have robust information at their fingertips through a patient’s medical history and are repeatedly treating kids for these injuries,” she said. “Together they share observations and compile evidence, setting the stage for the kind of statistical modeling we were able to achieve through this study.”

The authors conclude their findings will help inform ways to prevent or intervene early to lessen future risks of injury or death.

The authors did not receive financial support for this research.

Maria Beyer is scheduled to present the research, which is below, from noon-1 p.m. Sunday, Sept. 28 in the Poster Hall. To request an interview with the authors, contact Sara Silver Traband at Ssilvertraband@childrenswi.org.

In addition, Ms. Beyer and senior author Dr. Mike Levas will be among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from noon-1:30 p.m. Saturday, Sept. 27, in the National Conference Press Room, CCC 705/707. During the meeting, you may reach AAP media relations staff at 303-228-8338.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Program Name: 2025 Call for Abstracts

Submission Type: Council on Injury, Violence, and Poison Prevention Program and Firearm Injury Prevention Special Interest Group

Abstract Title: Associational Analysis for Pediatric Firearm Injury Risk

Maria Beyer

Shorewood, WI, United States

Nationally, children and youth have experienced significant increases in injuries related to firearms and motor vehicle crashes (MVCs). A midwestern pediatric health system observes similar trends, with many patients with firearm injury presenting with a history of MVC-related injuries and other violent injuries with growing frequency. To investigate the potential relationship between injury types and identify predictive factors for subsequent firearm injuries, authors conducted secondary analyses focused on potential associations between injuries and the role of injury severity across repeat encounters. A deeper understanding of injury patterns and their risk factors may facilitate the development of targeted early interventions and preventive strategies.

A four-year retrospective study was conducted of 0–17-year-old patients presenting in the Emergency Department (ED) with violent and MVC injuries from January 1, 2018 through December 31, 2022. Study methods include descriptive, correlation, and chi-squared analyses to examine demographics and the association between MVC and firearm injury, with stepwise logistic regression modeling to identify predictive factors for future firearm injury.

Nearly one in four patients (23.6%) with firearm injury had more than one encounter in the ED for firearm, non-firearm violent, or MVC injury within the four-year timeframe. Chi-square tests for independence indicate a statistically significant association between MVC and firearm injury (2 (1, n = 2614) = 9.683). Regression analysis indicate a statistically significant model with five predictive factors for firearm injury at a third ED encounter: age, first encounter MVC injury, first encounter acuity, second encounter violent injury, and second encounter acuity (2 (11, n = 84) = 31.228, p = .001). After adjusting for all other factors in the model, with each worsening in acuity score at first encounter patients have twelve times greater risk for firearm injury at third encounter (OR = .083, p < .05, 95% CI: .010, .691), and patients with a violent injury at second encounter have ten times greater risk for firearm injury at third encounter (OR = 10.298, p < .10, 95% CI: .685, 154.737).

These findings reveal a significant association between MVC and firearm injury, with MVC and violent injuries serving as predictors for subsequent firearm injury. These results underscore the importance of early intervention in addressing the risk of firearm injury. Further investigation is needed to identify best practices for connecting resources for youth presenting with MVC and non-firearm violent injuries to prevent future firearm injury and death. Additionally, opportunities exist to explore risk stratification within clinical and community practice to focus limited resources on patients at higher risk for firearm injury and death. Leveraging this data to inform clinical and community intervention decision-making can prevent further injury, reduce financial costs to health systems, and improve individual and community health outcomes.