Background: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on global health, economies, and society, further increasing strain on public healthcare, while exacerbating psychosocial stressors. Multiple single-center and regional studies have shown an overall increase in national rates of firearm injury-related emergency department (ED) visits (FIRE) during the COVID-19 pandemic. This study evaluates national trends and influencing factors using data from over 699.68 million ED visits (2016-2020) from the National Inpatient Sample (NIS) database.

Methods: In this retrospective study, we analyzed 533,206 patients presenting with firearm-related injuries to EDs (2016-2020) using NIS data. Variables included patient demographics, hospital characteristics, and in-hospital outcomes. The primary outcome was the annual incidence and trends of firearm injury-related ED visits. Secondary outcomes included ED mortality, patient disposition, and trends specific to cause gender, and mood/adjustment disorders. Statistical significance was determined using the Cochran-Mantel-Haenszel test, with P values < 0.05 considered significant.

Results: Firearm injuries were significantly more likely to involve men than women (86.3% vs. 13.7%, p< 0.001, respectively) and individuals in the age group 18–49 compared to those under 18 years of age (84.3% vs. 15.7%, p< 0.001, respectively). Overall, 5.2% (27693) of patients died in the ED. We found a significant positive trend for the association between overall FIRE visits and female gender (P = 0.001), specific age categories (30-49 years, P < 0.001), and type of hospital (metropolitan teaching hospital, P = 0.02). Conversely, a negative trend was noted between overall FIRE visits and male gender (P < 0.001), individuals < 18 years of age (P = 0.03), type of hospital (metropolitan non-teaching hospital, P = 0.004), and private health insurance (P = 0.003).

Conclusions: This study highlights key trends in firearm-related injuries pre- and during the COVID-19 pandemic. Notably, demographic factors like gender, age, and hospital type influenced these trends, while psychological health factors didn’t significantly impact the incidence. Addressing firearm-related injuries as a public health issue is critical, necessitating comprehensive strategies to effectively reduce their incidence and impact effectively.