How Research Is Changing the Trajectory of Pediatric Firearm Injuries

Firearms are the leading cause of death for children and teens in the United States. Yet for years, pediatric firearm injury remained understudied, poorly tracked, and often misunderstood.

Hospitals treated the wound, but the data stopped there.

The Children’s Hospital Association Research in Gun-Related Events (CHARGE) collaborative was formed to change that. CHARGE brings together researchers and clinicians from children’s hospitals across the country to improve the evidence around pediatric firearm injuries and inform public policy and children’s health care.

“We knew firearm injury was a leading cause of death, but when we looked for solid pediatric data — especially beyond fatalities — it just wasn’t there. That disconnect was the starting point,” said Christian Pulcini, MD, assistant professor of emergency medicine and pediatrics at the University of Vermont Larner College of Medicine.

Six years later, CHARGE has become one of the most recognizable and productive research collaboratives in pediatric firearm injury in the nation.

Built to bridge gaps

CHARGE was created with a simple premise: Pediatric firearm injury deserves the same rigor, scale, and urgency applied to other major pediatric health threats.

Rather than focus on a single outcome or discipline, the group prioritizes areas where data has historically been thin or missing altogether, including:

• Nonfatal firearm injury, which accounts for the majority of pediatric firearm harm but has been underreported and inconsistently measured
• Mental health outcomes, including new diagnoses and access to care after injury
• Health equity, examining how race, geography, and socioeconomic factors shape risk and outcomes
• Health care utilization and cost, capturing the long-term burden on families, hospitals, and systems
• Pre-injury risk factors, particularly related to youth suicide and access to guns

Taken together, these focus areas allow the group to examine firearm injury not as a single incident but as a trajectory.

“Firearm injury doesn’t begin or end in the emergency department,” said Sofia Chaudhary, MD, assistant professor of pediatrics and emergency medicine at Emory University School of Medicine and physician at Children’s Healthcare of Atlanta. “For many kids, risk factors led to the injury, and for most kids, the injury marks the beginning of new medical, mental health, and social challenges. We haven’t done a good job capturing that reality in the data.”

Each research project is designed to clarify not only what is happening, but why it matters and where systems could intervene differently.

“If the research can’t inform care, policy, or prevention, then it’s incomplete,” Chaudhary said. “We’re always asking what these findings mean for hospitals and for kids.”

Why CHA’s role is central

That kind of nationally coordinated research would be difficult, if not impossible, without the Children’s Hospital Association (CHA).

CHA provides the infrastructure that allows CHARGE to function as a true multi-institutional research collaborative, including centralized coordination, access to large national data sets, and PhD-level biostatistical expertise.

“This work doesn’t happen on passion alone,” Pulcini said. “You need funding. You need people who know these data sources inside and out, who can move quickly and accurately. CHA makes that possible.”

By convening the experts, scheduling regular meetings, and providing dedicated statistical support, CHA removes barriers that often stall collaborative research.

Clinicians bring clinical insight and research questions; CHA supplies the technical backbone that turns those questions into credible, actionable evidence.

“It lets us focus on what we’re seeing at the bedside and how to translate that into research that actually matters,” Chaudhary said.

From evidence to action

CHARGE’s research is already shaping how pediatric firearm injury is understood and addressed — not only in academic literature, but in clinical, policy, and system‑level conversations.

Across multiple studies, the group’s findings have challenged longstanding assumptions about firearm injury and its aftermath. Research documenting gaps in mental health follow-up after injury has helped underscore that survival does not equate to recovery. Other work examining youth suicide risk has revealed how access, environment, and missed prevention opportunities are key factors.

CHA members have drawn on findings when testifying on child access protection laws, supporting hospital-based violence intervention programs, and shaping quality improvement efforts around firearm safety counseling and suicide prevention.

Just as important, CHARGE has influenced how pediatric firearm injury research is conducted.

The group has identified limitations in national data sources — from inconsistencies in injury coding to gaps in gun storage information — and helped clarify methodological standards that other researchers now rely on. By improving the quality and precision of the evidence itself, CHARGE has raised the bar for the field.

At the same time, the group is laying groundwork for future intervention studies by building the evidence base needed to secure funding and test solutions at scale.

“A lot of what we’re doing now is creating the foundation,” Pulcini said. “You can’t jump straight to large interventions without strong data. That’s what this group is providing — not just for us, but for the field.”

What began as a recognition of a critical blind spot has become one of pediatric research’s most focused efforts to close it.

With CHA’s support, CHARGE is helping ensure that the leading threat to children’s lives receives the sustained attention and evidence it demands.