INTRODUCTION Trauma remains the leading cause of death in children and adolescents. Here, we explore the hypothesis that vascular injury portends worse outcomes in pediatric patients after trauma. METHODS A retrospective, single-center analysis of patients 18 years or younger treated for traumatic injuries sustained between 2004 and 2019. An institutional trauma registry was queried for demographic and clinical data. Differences in mortality, need for operative intervention and injury mechanism were assessed. RESULTS During the 15-year study period, 1567 patients were treated for traumatic injuries with a 12% (190) incidence of vascular trauma. Patients with vascular injury had a higher prevalence of penetrating trauma (64% vs 32%, p <0.0001) and black race (70% vs 55%, p <0.001) relative to those with general injuries. Gun-related injury (89%) was the primary source of penetrating trauma. Overall, patients with vascular trauma faced greater morbidity as indicated by higher injury severity scores (20.7±1.1 vs 12.0±0.34, p <0.0001) at the time of presentation. In addition, need for operative intervention (65% vs 22%, p <0.0001) and death on arrival (6.8% vs 2.5%, p <0.001) were more likely in the vascular injury group. Black race (OR 6.1 [2.4-20.6], <0.001), penetrating trauma (OR 5.8 [2.7-14.2], <0.001) and vascular injury (OR 2.9 [1.4-5.6], 0.002) were associated with higher likelihood of mortality. On multivariate analysis, penetrating trauma (OR 3.4 [1.4-10.0], 0.013) was the only independent risk factor for death when accounting for vascular injury, age, race, gender and method of payment. CONCLUSION Gun violence has become major source of morbidity for pediatric trauma patients and carries a high risk for vascular injury, predisposing to worse mortality outcomes. These patients are typically of higher acuity and frequently require operative intervention. Trauma remains the leading cause of death in children and adolescents. Here, we explore the hypothesis that vascular injury portends worse outcomes in pediatric patients after trauma. A retrospective, single-center analysis of patients 18 years or younger treated for traumatic injuries sustained between 2004 and 2019. An institutional trauma registry was queried for demographic and clinical data. Differences in mortality, need for operative intervention and injury mechanism were assessed. During the 15-year study period, 1567 patients were treated for traumatic injuries with a 12% (190) incidence of vascular trauma. Patients with vascular injury had a higher prevalence of penetrating trauma (64% vs 32%, p <0.0001) and black race (70% vs 55%, p <0.001) relative to those with general injuries. Gun-related injury (89%) was the primary source of penetrating trauma. Overall, patients with vascular trauma faced greater morbidity as indicated by higher injury severity scores (20.7±1.1 vs 12.0±0.34, p <0.0001) at the time of presentation. In addition, need for operative intervention (65% vs 22%, p <0.0001) and death on arrival (6.8% vs 2.5%, p <0.001) were more likely in the vascular injury group. Black race (OR 6.1 [2.4-20.6], <0.001), penetrating trauma (OR 5.8 [2.7-14.2], <0.001) and vascular injury (OR 2.9 [1.4-5.6], 0.002) were associated with higher likelihood of mortality. On multivariate analysis, penetrating trauma (OR 3.4 [1.4-10.0], 0.013) was the only independent risk factor for death when accounting for vascular injury, age, race, gender and method of payment. Gun violence has become major source of morbidity for pediatric trauma patients and carries a high risk for vascular injury, predisposing to worse mortality outcomes. These patients are typically of higher acuity and frequently require operative intervention.