Trauma continues to be a leading cause of death and disability in the pediatric population. We retrospectively reviewed 139 cases of gunshot wounds (GSW) in patients under 17 years of age, who were admitted to Children's Hospital of Philadelphia from January 1, 1986 to June 30, 1992. There were 4,587 trauma admissions during this period, and the proportion of GSW victims increased from 1.02% in the first 12 months to 5.6% in the final 12 months of the study (P < .001). The average age of patients treated for GSW was 11.5 +/- 4.4 years. Eighty percent were male, 88.5% were black, and the average hospital stay was 5.6 +/- 8.5 days. In this group, the mean trauma score was 14.5 (range, 1 to 16), and the mean injury severity score was 9.8 (range, 1 to 75). There were 11 deaths (7.9%), with head injuries the most common cause (20.6%). The predicted probability of survival for the patients who died was 0.31, compared with 0.97 for those who survived. The extremities were the most commonly injured area, (41%) but GSW to the abdomen were the most likely to require operative intervention (85.7%). The shootings were considered intentional in only 26.6%), and the assailant was known in 32.4% of instances. Of the teenage patients tested for substance abuse, results were positive for 36%. The majority of GSW victims (68%) had public or no insurance. In contrast, of the overall hospital population, only 40% had public or no insurance. Over the period of study, the hospital lost an estimated $1.63 million in the care of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)