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Sunderland M, Lafranchise E, Durrant A. Pediatric Aortic Injury From a BB Gun Injury Requiring Emergent Thoracotomy. Am Surg 2023; 89:1138-1140. [PMID: 35448928 DOI: 10.1177/0003134820971575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The leading cause of morbidity and mortality in the pediatric population is unintentional injury. Emergent thoracotomies are rarely performed in pediatric patients, especially in the very young pediatric population. We present a case of a 10-year-old male who survived emergent clamshell thoracotomy for penetrating chest trauma. SUMMARY Our patient sustained aortic lacerations after being shot with an air-powered rifle. Thoracotomy was performed in the emergency department. The incision was extended to a clamshell thoracotomy for repair of the aortic lacerations. He survived and made a full recovery. CONCLUSION This case is one of the youngest reported survivors of an emergent thoracotomy. Air-powered gun injuries can be life-threatening despite their perception as safe toys for children. Surprisingly, there is very little regulation on sale of air guns to minors in the United States. Increased public awareness and regulation of sale may prevent unintentional injury in this population.
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Affiliation(s)
| | | | - Audrey Durrant
- Department of General Surgery, University of South Florida, USA
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Toigo S, Pollock NJ, Liu L, Contreras G, McFaull SR, Thompson W. Fatal and non-fatal firearm-related injuries in Canada, 2016-2020: a population-based study using three administrative databases. Inj Epidemiol 2023; 10:10. [PMID: 36788597 PMCID: PMC9930327 DOI: 10.1186/s40621-023-00422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Firearms are a substantial cause of injury-related morbidity and mortality in Canada and globally, though evidence from contexts other than the USA is relatively limited. We examined deaths, hospitalizations and emergency department (ED) visits due to firearm-related injuries in Canada to identify population groups at increased risk of fatal and non-fatal outcomes. METHODS We conducted a population-based study using three national administrative databases on deaths, hospitalizations, and ED visits. ICD-10 codes were used to identify firearm-related injuries from January 1, 2016, through December 31, 2020. Fatal and non-fatal firearm injuries were classified as suicide/self-harm, homicide/assault, unintentional, undetermined or legal intervention injuries. We analyzed the data with counts, rates and proportions, stratified by sex, age group, province/territory, and year. RESULTS Over the 5-year period, we identified 4005 deaths, 3169 hospitalizations, and 2847 ED visits related to firearm injuries in various jurisdictions in Canada. Males comprised the majority of fatal and non-fatal injury cases. The highest rates of fatal and non-fatal firearm injuries were among 20- to 34-year-olds. The leading cause of fatal firearm injuries was self-harm (72.3%). For non-fatal firearm hospitalizations and ED visits, assault (48.8%) and unintentional injuries (62.8%) were the leading causes of injury. Rates varied by province and territory. CONCLUSIONS Our results showed that males comprised the majority of fatal and non-fatal firearm injuries in Canada. The rates of both fatal and non-fatal firearm injuries were highest among the 20- to 34-year-old age group. This comprehensive overview of the epidemiology of firearm injuries in Canada provides baseline data for ongoing surveillance and policy evaluation related to public health interventions.
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Affiliation(s)
- Stephanie Toigo
- Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.
| | - Nathaniel J. Pollock
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Li Liu
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Gisèle Contreras
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Steven R. McFaull
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Wendy Thompson
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
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Donnelly KA, Badolato GM, Goyal MK. Determining Intentionality of Pediatric Firearm Injuries by International Classification of Disease Code. Pediatr Emerg Care 2022; 38:e306-e309. [PMID: 33105466 DOI: 10.1097/pec.0000000000002272] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Firearm injuries are a leading cause of serious injury and death in childhood. The accuracy of International Classification of Disease (ICD) codes to assign intent is unclear. The objective of this study was to assess the validity of documented ICD codes for firearm injury intent compared with chart review. METHODS We performed a retrospective cohort study of children (<= 18 years) presenting to a tertiary care level 1 pediatric trauma center with firearm injuries between 2006 and 2017. We compared agreement between ICD codes and intent of injury determined by medical record review using Cohen κ. Intent for medical record review was assigned via the injury spectrum of intentionality (suicide attempt, accidental firing, mistaken target, firearm assault and unknown). For comparison with ICD codes, all medical record review cases marked as mistaken target were classified as accidental. A sensitivity analysis was then performed, coding all mistaken targets as assault. RESULTS There were 122 cases identified over the study period. The most common intent by ICD code was assault (n = 80, 65.6%). Medical record review categorized most injuries as mistaken targets. When mistaken target was categorized as accidental, most firearm injuries were coded as accidental (n = 89, 72.9%) Similar results were seen when mistaken target was categorized as assault, most injuries were categorized as assault (n = 79, 79.5%) Cohen κ was 0.15 when mistaken targets were categorized as accident and 0.30 when categorized as assault. CONCLUSIONS The ICD codes do not fully describe the intent of firearm injury. Revising ICD codes to account for mistaken targets could help to improve the validity of ICD codes for intent.
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Affiliation(s)
- Katie A Donnelly
- From the Children's National Hospital, George Washington University, Washington, DC
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Saunders NR, Moore Hepburn C, Huang A, de Oliveira C, Strauss R, Fiksenbaum L, Pageau P, Liu N, Gomez D, Macpherson A. Firearm injury epidemiology in children and youth in Ontario, Canada: a population-based study. BMJ Open 2021; 11:e053859. [PMID: 34794997 PMCID: PMC8603258 DOI: 10.1136/bmjopen-2021-053859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Despite firearms contributing to significant morbidity and mortality globally, firearm injury epidemiology is seldom described outside of the USA. We examined firearm injuries among youth in Canada, including weapon type, and intent. DESIGN Population-based, pooled cross-sectional study using linked health administrative and demographic databases. SETTING Ontario, Canada. PARTICIPANTS All children and youth from birth to 24 years, residing in Ontario from 1 April 2003 to 31 March 2018. EXPOSURE Firearm injury intent and weapon type using the International Classification of Disease-10 CM codes with Canadian enhancements. Secondary exposures were sociodemographics including age, sex, rurality and income. MAIN OUTCOMES Any hospital or death record of a firearm injury with counts and rates of firearm injuries described overall and stratified by weapon type and injury intent. Multivariable Poisson regression stratified by injury intent was used to calculate rate ratios of firearm injuries by weapon type. RESULTS Of 5486 children and youth with a firearm injury (annual rate: 8.8/100 000 population), 90.7% survived. Most injuries occurred in males (90.1%, 15.5/100 000 population). 62.3% (3416) of injuries were unintentional (5.5/100 000 population) of which 1.9% were deaths, whereas 26.5% (1452) were assault related (2.3/100 00 population) of which 18.7% were deaths. Self-injury accounted for 3.7% (204) of cases of which 72.0% were deaths. Across all intents, adjusted regression models showed males were at an increased risk of injury. Non-powdered firearms accounted for half (48.6%, 3.9/100 000 population) of all injuries. Compared with handguns, non-powdered firearms had a higher risk of causing unintentional injuries (adjusted rate ratio (aRR) 14.75, 95% CI 12.01 to 18.12) but not assault (aRR 0.84, 95% CI 0.70 to 1.00). CONCLUSIONS Firearm injuries are a preventable public health problem among youth in Ontario, Canada. Unintentional injuries and those caused by non-powdered firearms were most common and assault and self-injury contributed to substantial firearm-related deaths and should be a focus of prevention efforts.
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Affiliation(s)
- Natasha Ruth Saunders
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | | | | | | | | - Lisa Fiksenbaum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - David Gomez
- ICES, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alison Macpherson
- ICES, Toronto, Ontario, Canada
- School of Kinesiology and Health Science, York University Faculty of Health, Toronto, Ontario, Canada
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Pediatric firearm injuries: Racial disparities and predictors of healthcare outcomes. J Pediatr Surg 2020; 55:1596-1603. [PMID: 32169340 PMCID: PMC7438258 DOI: 10.1016/j.jpedsurg.2020.02.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/30/2019] [Accepted: 02/17/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE The U.S. has an alarming rate of firearm injuries. Racial disparities among victims and predictors of outcomes are not well established. Our objective was to assess costs, length of stay (LOS), and inpatient mortality among nonfatal and fatal pediatric firearm injuries that required hospitalization. METHODS Pediatric (≤18 years of age) hospitalizations with a firearm injury discharge diagnosis were identified from the national Kids' Inpatient Databases (KID) for 2006 through 2012. Firearm injury intent, weapon type, and hospitalization rates by racial groups were examined. Inpatient mortality, costs, and length of stay were examined using regression models. RESULTS Of 15,211 hospitalizations, the majority of injuries were due to assault (60%) and the intentions of firearm injury differed by race (p < 0.001). The median cost per hospitalization was $10,159 (interquartile range: $5071 to $20,565), totaling more than a quarter of a billion dollars. On regression analysis, Black (OR: 0.41; CI: 0.30-0.55) and Hispanic (OR: 0.47; CI: 0.34-0.66) patients were less likely to die than White patients. CONCLUSION Pediatric firearm injury circumstances and survival vary by race with Whites being more likely to experience unintentional injury and suicide, while Blacks and Hispanics are more likely to experience inflicted injury. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Clinical Research Study.
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Air Guns: A Contemporary Review of Injuries at Six Pediatric Level I Trauma Centers. J Surg Res 2019; 248:1-6. [PMID: 31837505 DOI: 10.1016/j.jss.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/22/2019] [Accepted: 11/03/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies spanning the last three decades demonstrated the injury causing capability of air gun (AG) projectiles. Recent studies have suggested the impact and incidence of these injuries may be declining because of edcational efforts. We hypothesize that injuries in the pediatric population resulting from AGs remain a significant health concern. METHODS A retrospective review (1/1/2007 to 12/31/2016), of AG-injured children < 19 years old, was performed across six level I Pediatric Trauma Centers, part of the ATOMAC research consortium. AG injuries were defined as injuries sustained by ball-bearing or pellet air-powered guns. Paint ball and soft foam AGs were excluded. Following institutional review board approval, patients were identified by ICD code from the trauma registry. Included were demographic data, injury severity scores, length of stay (LOS), outcome at discharge, and overall cost of admission. Descriptive statistics and parametric tests were employed. RESULTS A total of 499 patients sustained injuries. Mean age 9.5 (±4.0) y; 81% of victims were male; all survived to hospital discharge. 30% (n = 151) required operative intervention. Hospital LOS was 2.3 (±2.2) d; with mean cost of $23,756 (±$34,441). Injury severity score mean of 3.7 (±4.6) on admission. Over 40% of the injuries to the head/thorax that were severe (AIS ≥ 3) required operative intervention (P < 0.001). CONCLUSIONS AG injuries to the head or thorax seen at trauma centers were likely to require operative management. While no fatalities occurred, the cost was substantial. This study demonstrates pediatric injuries resulting from AG projectiles remain a significant health concern.
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Neurosurgical Care of Nonpowder Firearm Injuries: A Narrative Review of the Literature. Emerg Med Int 2019; 2019:4680184. [PMID: 31827929 PMCID: PMC6886332 DOI: 10.1155/2019/4680184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/25/2019] [Indexed: 02/05/2023] Open
Abstract
Background Nonpowder firearms discharge a projectile using compressed gases. Unlike traditional firearms, there is a perception that nonpowder guns do not cause serious injury. However, intracranial injury disproportionally affects children and can cause significant neurological disabilities and mortality. Management of nonpowder firearm injuries has received little attention in the literature and presents unique surgical challenges. Materials and Methods We conducted a narrative review of the literature of the management of nonpowder firearm injuries with particular emphasis on intracranial injury. Results Modern nonpowder firearms have muzzle velocities which are capable of penetrating the skin, eyes, and bone. Direct intracranial injury commonly results from entrance of projectile through thinner portions of the skull. Operative intervention is needed to debride and safely explore the trajectory to remove fragments which can easily cause neurovascular injury. Conclusions Neurosurgeons play a crucial role in managing serious nonpowder firearm injuries. A multidisciplinary team is needed to manage the direct results of penetrating injury and long-term sequalae.
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Santiago-Dieppa DR, Brandel MG, Levy ML, Gonda DD. BB Gunshot Wound to the Head. J Pediatr 2019; 210:237. [PMID: 30857772 DOI: 10.1016/j.jpeds.2019.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - Michael G Brandel
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA
| | - Michael L Levy
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA; Division of Neurosurgery, Rady Children's Hospital, San Diego, CA
| | - David D Gonda
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA; Division of Neurosurgery, Rady Children's Hospital, San Diego, CA
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Niryana W, Irawan H, Widyadharma IPE. An Intracerebral Penetration of Air Shotgun Pellet in Toddler: A Case without Neurological Sequelae. Open Access Maced J Med Sci 2018; 6:1446-1449. [PMID: 30159074 PMCID: PMC6108786 DOI: 10.3889/oamjms.2018.330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND A non-powder firearm including air shotgun remains a significant source of injury to children. It causes severe damage and can involve the brain, eyes, heart, abdomen, and other body parts. CASE REPORT A toddler boy was accidentally shot by an air shotgun at the forehead, and there was no sign of neurological deficit, both before and after surgical removal of the pellet. Herein, we report a case of air shotgun pellet which penetrated a toddler's head from the forehead, all the way up to the occiput. Removal of the pellet was successfully performed without eliciting any neurological sequelae. CONCLUSION Air shotgun pellet may potentially cause severe injury to the central nervous system when the head is affected, which can be safely prevented by a prompt but deliberate surgical removal. The study would also like to emphasise the importance of education to reduce gunshot incidence in the pediatric population.
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Affiliation(s)
- Wayan Niryana
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Hendry Irawan
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Udayana University, Bali, Indonesia
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