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93%] to 25/172 [14.53%], P = .746). CONCLUSIONS Using PHIS data, we found a significant increase in median cost per hospitalization and an increase in critical care resource use, including the frequency of invasive mechanical ventilatory assistance, neuromonitoring, operations performed, and transfusion of blood products. Further research is needed to continue to characterize the burden of pediatric critical firearm injury. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE Level III. PURPOSE To provide a compreh