<i>Notes from the Field:</i> Trends in Emergency Department Visits for Firearm Injuries — United States, January 2018–December 2023

Research has highlighted recent increases in fatal and nonfatal firearm injuries (1-3).For example, from 2019 to 2020, firearm homicides and nonfatal firearm injury-related emergency department (ED) visits increased approximately 35% and 37%, respectively (1,2).These increases coincided in part with the COVID-19 pandemic and other sociocultural factors, such as strained law enforcement-community relationships, increases in firearm purchases and some types of crime, and increased discussion about systemic inequities (e.g., in economic, educational, and employment opportunities) that were potentially exacerbated by pandemic conditions (1-5).A year-over-year comparison of firearm injury-related ED visits could provide important insight into the direction of trends, which can help guide ongoing firearm injury prevention efforts.* Electronic health record data from EDs participating in CDC's NSSP (https:// www.cdc.gov/nssp/index.html),which covers approximately 80% of U.S. EDs, are included in this report.To reduce impact of reporting pattern changes, which vary across jurisdictions, analyses were restricted to facilities with a coefficient of variation of <40% for total visit volume and with >75% complete information on discharge diagnoses during 2018-2023; the final sample represents 1,794 facilities (43% of total facilities that contribute data to NSSP). ED visit counts for initial firearm injury encounters were identified using the CDC Firearm Injury v2 syndrome definition (https://knowledgerepository. syndromicsurveillance.org/cdc-firearm-injury-v2).VRs of firearm injury rates were calculated as (ED visits for firearm injury during surveillance period / all ED visits during surveillance period) / (ED visits for firearm injury during comparison period / all ED visits during comparison period).Ratios >1 indicate a higher proportion of ED visits for firearm injury during surveillance period than during the comparison period.