1
|
Whitman EL, Sentilles C, Sheffer BW, Spence DD, Rowland JK, Naser AM, Sawyer JR, Warner WC, Williams RF, Kelly DM. Pediatric Firearm Trauma on the Rise: A Retrospective Review of Over 1,100 Cases in 12 Years at One Center. J Pediatr Surg 2024; 59:161594. [PMID: 38944592 DOI: 10.1016/j.jpedsurg.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Gunshot injuries are the leading cause of death among children in the United States. The goal of this study was to better understand if certain age groups, mechanisms of injury, and type of firearms were associated with the increasing rates of pediatric gun-related trauma. We hypothesized that the extremities were disproportionately targeted when compared with the random likelihood of striking specific body-surface areas. METHODS This study includes pediatric firearm-related injury (FRI) patients who presented to a single free-standing level 1 pediatric hospital or died at the scene from 2010 to 2021. The hospital data was collected prospectively as part of a level 1 trauma system electronic database. Death data was collected from the local coroner's office. RESULTS Between 2010 and 2021, 1,126 pediatric FRI occurred in the geographic region studied. Demographic information available for 1,118 patients showed that 897 (80.23%) were male, and that black individuals had a statistically significant increased rate of FRI compared with white or Hispanic individuals. Mean age was 13.69 years. Most injuries were caused by handguns. CONCLUSIONS This data could help leaders design strategies to combat the violence, such as legislation that limits handgun access to all, especially children, and mandates safe storage of handguns. Gun-lock programs, universal background checks, and firearm-ownership education also might help stem this tide of violence. LEVEL OF EVIDENCE Level II Prognosis study.
Collapse
Affiliation(s)
- Elizabeth L Whitman
- College of Medicine, University of Tennessee Health Science Center, 910 Madison Ave., Memphis, TN 38163, USA
| | - Claire Sentilles
- College of Medicine, University of Tennessee Health Science Center, 910 Madison Ave., Memphis, TN 38163, USA
| | - Benjamin W Sheffer
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1400 S. Germantown Road, Germantown, TN 38138, USA
| | - David D Spence
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1400 S. Germantown Road, Germantown, TN 38138, USA
| | | | - Abu Mohd Naser
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Robison Hall, 3825 DeSoto Avenue, Memphis, TN 38152, USA
| | - Jeffrey R Sawyer
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1400 S. Germantown Road, Germantown, TN 38138, USA
| | - William C Warner
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1400 S. Germantown Road, Germantown, TN 38138, USA
| | - Regan F Williams
- Department of Surgery and Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Suite 320, Memphis, TN 38105, USA
| | - Derek M Kelly
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1400 S. Germantown Road, Germantown, TN 38138, USA.
| |
Collapse
|
2
|
Bernardin ME, Cutler KO. Emergency Department Usage Patterns Among Pediatric Victims of Gun Violence and Physical Assault. Pediatr Emerg Care 2024; 40:415-420. [PMID: 38048545 DOI: 10.1097/pec.0000000000003089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Violent injuries are a common reason for pediatric emergency department (ED) visits, with gun violence being the leading cause of violent death among children. The objective of this study was to assess for patterns of pediatric ED usage that are associated with future ED visits for violent injuries. METHODS This case-control study included youths aged 6 to 19 years who presented to a pediatric ED over a 3-year period due to a physical assault (PA) or their first known gunshot wound (GSW). We compared them with age-, race-, and sex-matched youths presenting for nonviolent medical complaints. All previous ED visits were coded as (1) injuries due to a previous PA, (2) mental/behavioral health visits, (3) sexual/reproductive health visits, (4) sexual assault, or (5) concerns for child abuse. We used multivariate logistic regression to identify patterns of previous ED usage associated with future ED visits for injuries related to PA and/or GSW. RESULTS The PA and GSW groups used the ED for previous PAs, mental/behavioral health, sexual/reproductive health, sexual assault, and/or child abuse concerns on average 4 to 8 times as often as the control group. Previous ED visits for mental/behavioral health (odds ratio [OR] 5), sexual/reproductive health (OR 3), sexual assault (OR 9), and prior PA (OR 8) were predictive of a future ED visit for PA. Male sex (OR 6) and previous ED visits for PA (OR 5) were predictive of a future ED visit for GSW. Two percent of the PA group and 9% of the GSW group returned to the ED with a subsequent GSW in the following 16 to 40 months. CONCLUSIONS Emergency department visits due to interpersonal violence, mental/behavioral health, sexual/reproductive health, and sexual assault are associated with recurrent ED visits for violent injuries. Awareness of patterns of ED usage may aid in identifying patients at high risk for violence and increase opportunities for preventative interventions.
Collapse
Affiliation(s)
| | - Keven O Cutler
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO
| |
Collapse
|
3
|
O'Guinn ML, Siddiqui S, Ourshalimian S, Chaudhari PP, Spurrier R. Firearm Injuries in Lower Opportunity Neighborhoods During the COVID Pandemic. Pediatrics 2023; 152:e2023062530. [PMID: 37599643 DOI: 10.1542/peds.2023-062530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVES We aimed to describe changes in pediatric firearm injury rates, severity, and outcomes after the coronavirus disease 2019 stay-at-home order in Los Angeles (LA) County. METHODS A multicenter, retrospective, cross-sectional study was conducted on firearm injuries involving children aged <18-years in LA County before and after the pandemic. Trauma activation data of 15 trauma centers in LA County from the Trauma and Emergency Medicine Information System Registry were abstracted from January 1, 2018, to December 31, 2021. The beginning of the pandemic was set as March 19, 2020, the date the county stay-at-home order was issued, separating the prepandemic and during-pandemic periods. Rates of firearm injuries, severity, discharge capacity, and Child Opportunity Index (COI) were compared between the groups. Analysis was performed with χ2 tests and segmented regression. RESULTS Of the 7693 trauma activations, 530 (6.9%) were from firearm injuries, including 260 (49.1%) in the prepandemic group and 270 (50.9%) in the during-pandemic group. No increase was observed in overall rate of firearm injuries after the stay-at-home order was issued (P = .13). However, firearm injury rates increased in very low COI neighborhoods (P = .01). Mechanism of injury, mortality rates, discharge capacity, and injury severity score did not differ between prepandemic and during-pandemic periods (all P values ≥.05). CONCLUSIONS Although there was no overall increase in pediatric firearm injuries during the pandemic, there was a disproportionate increase in areas of very low neighborhood COI. Further examination of community disparity should be a focus for education, intervention, and development.
Collapse
Affiliation(s)
- MaKayla L O'Guinn
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Sami Siddiqui
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Shadassa Ourshalimian
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Pradip P Chaudhari
- Department of Pedicatrics, Keck School of Medicine of University of Southern California, Los Angeles, California
- Division of Emergency Medicine & Transport Medicine, Children's Hospital Los Angeles, 4650 W Sunset Blvd, Los Angeles, California
| | - Ryan Spurrier
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
| |
Collapse
|
4
|
Tatebe LC, Cone JT, Slidell MB, Chang G, Jonikas M, Stewart A, Doherty J, Arunkumar P, Schlanser V, Dennis AJ. When public health crises collide: 5 years of pediatric firearm injury prevention opportunities. Trauma Surg Acute Care Open 2023; 8:e001026. [PMID: 37303982 PMCID: PMC10254944 DOI: 10.1136/tsaco-2022-001026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/08/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Prior publications on pediatric firearm-related injuries have emphasized significant social disparities. The pandemic has heightened a variety of these societal stresses. We sought to evaluate how we must now adapt our injury prevention strategies. Patients and methods Firearm-related injuries in children 15 years old and under at five urban level 1 trauma centers between January 2016 and December 2020 were retrospectively reviewed. Age, gender, race/ethnicity, Injury Severity Score, situation, timing of injury around school/curfew, and mortality were evaluated. Medical examiner data identified additional deaths. Results There were 615 injuries identified including 67 from the medical examiner. Overall, 80.2% were male with median age of 14 years (range 0-15; IQR 12-15). Black children comprised 77.2% of injured children while only representing 36% of local schools. Community violence (intentional interpersonal or bystander) injuries were 67.2% of the cohort; 7.8% were negligent discharges; and 2.6% suicide. Median age for intentional interpersonal injuries was 14 years (IQR 14-15) compared with 12 years (IQR 6-14, p<0.001) for negligent discharges. Far more injuries were seen in the summer after the stay-at-home order (p<0.001). Community violence and negligent discharges increased in 2020 (p=0.004 and p=0.04, respectively). Annual suicides also increased linearly (p=0.006). 5.5% of injuries were during school; 56.7% after school or during non-school days; and 34.3% were after legal curfew. Mortality rate was 21.3%. Conclusions Pediatric firearm-related injuries have increased during the past 5 years. Prevention strategies have not been effective during this time interval. Prevention opportunities were identified specifically in the preteenage years to address interpersonal de-escalation training, safe handling/storage, and suicide mitigation. Efforts directed at those most vulnerable need to be reconsidered and examined for their utility and effectiveness. Level of evidence Level III; epidemiological study type.
Collapse
Affiliation(s)
- Leah C Tatebe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer T Cone
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Mark B Slidell
- Department of Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois, USA
| | - Grace Chang
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Meghan Jonikas
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Amy Stewart
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - James Doherty
- Department of Surgery, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Ponni Arunkumar
- Department of Pathology, Northwestern University, Chicago, Illinois, USA
| | | | - Andrew J Dennis
- Department of Trauma, Cook County Health, Chicago, Illinois, USA
| |
Collapse
|
5
|
Negriff S, Sidell M, Nau C, Sharp AL, Koebnick C, Contreras R, Grant DSL, Kim JK, Hechter RC. Factors Associated With Firearm Injury Among Pediatric Members of a Large Integrated Healthcare System. Acad Pediatr 2022; 23:604-609. [PMID: 36122825 DOI: 10.1016/j.acap.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Few studies have tested multiple socio-ecological risk factors assocated with firearm injury among pediatric populations and distinguished self-inflicted from non-self-inflicted injury. To address this gap, the current study examined demographic, individual psychosocial, and neighborhood variables as risk factors for firearm injury among a large cohort of children and adolescents. METHODS Retrospective cohort study. Data were obtained from the electronic health records of a large integrated healthcare system. The cohort included children <18 years with at least one clinical encounter between January 1, 2010 and December 31, 2018. Poisson regression was used to examine demographic (age, gender, race and ethnicity, Medicaid status), psychosocial (depression, substance use disorder, medical comorbidities), and neighborhood education variables as potential risk factors for non-self-inflicted and self-inflicted firearm injuries. RESULTS For non-self-inflicted injury, the highest relative risk was found for children age 12-17 years old compared to 0-5 year olds (RR = 37.57); other risk factors included male gender, Black and Hispanic race and ethnicity (compared to White race), being a Medicaid recipient, lower neighborhood education, and substance use disorder diagnosis. For self-inflicted injury, only age 12-17 years old and male gender were associated with increased risk. CONCLUSIONS These results reinforce the established higher risk for firearm injury among adolescent males, highlight differences between self-inflicted and non-self-inflicted injuries, and the need to consider demographic, psychosocial, and neighborhood variables as risk factors to inform interventions aimed to reduce firearm injuries among children and adolescents.
Collapse
Affiliation(s)
- Sonya Negriff
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Health Systems Science, Pasadena, CA USA (S Negriff, C Nau, AL Sharp, and RC Hechter).
| | - Margo Sidell
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter)
| | - Claudia Nau
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Health Systems Science, Pasadena, CA USA (S Negriff, C Nau, AL Sharp, and RC Hechter)
| | - Adam L Sharp
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Health Systems Science, Pasadena, CA USA (S Negriff, C Nau, AL Sharp, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Clinical Science, Pasadena, CA USA (AL Sharp)
| | - Corinna Koebnick
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter)
| | - Richard Contreras
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter)
| | - Deborah S Ling Grant
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter)
| | - Johnathan K Kim
- Kaiser Permanente Southern California Department of Psychiatry, Riverside, CA USA (JK Kim)
| | - Rulin C Hechter
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Health Systems Science, Pasadena, CA USA (S Negriff, C Nau, AL Sharp, and RC Hechter)
| |
Collapse
|
6
|
Woodruff G, Palmer L, Fontane E, Kalynych C, Hendry P, Thomas A, Crandall M. Nine years of pediatric gunshot wounds: a descriptive analysis. Prev Med Rep 2022; 28:101890. [PMID: 35832637 PMCID: PMC9272024 DOI: 10.1016/j.pmedr.2022.101890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/26/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Firearm injury increases with age with previous studies examining ages 0–14 vs. 15–18. There is poor documentation in the literature of key demographic details surrounding the injury. There are important demographic differences that exist between older adolescent (13–14 years) and younger children (0–12 years). Adolescents aged 13 years and older have similar profile to older adolescents/teens and may benefit from interventions such as violence intervention programs.
Pediatric firearm violence carries significant morbidity and mortality. Studies targeting children ≤14 years are limited. Our goal was to study the distribution and determinants of GSWs in the pediatric population. We performed a retrospective review of children ≤14 years presenting with GSWs at this level 1 trauma center. This cohort was split into younger children, 0–12 years, and older children, 13–14 years. Summary and bivariate statistics were calculated using Stata v10. 142 patients (68.3% black, 76.7% male) were identified. Injuries more often occurred at home (39.6%) by family or friends (60.7%). Older children often suffered handgun injuries (85.5%) and more often were sent immediately to the OR on presentation (29.2%). Younger children more often suffered from air-gun (50%) and pistols (40%). Younger children more commonly had blood transfusions (9.4%) compared to exploratory laparotomy in older children (13.5%). The most common disposition from the ED was home (36.2%). Descriptive data entailing incident specifics such as time of injury and CPS involvement were frequently missing in the healthcare record. Older children were more likely to be injured by strangers, have longer lengths of stay especially associated with surgical operations, and have a disposition of immediate arrest compared to their younger cohort. Consequently, this group may benefit from interventions typically aimed at older patients such as violence intervention programs. When available, differences in demographics and outcomes were identified which could shape novel prevention strategies for firearm injury.
Collapse
|
7
|
Doh KF, Sheline EK, Wetzel M, Xiang Y, Morris CR, Simon HK. Pediatric firearm and motor vehicle collision injuries in the United States: Diverging trends. Am J Emerg Med 2021; 53:59-62. [PMID: 34979410 DOI: 10.1016/j.ajem.2021.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kiesha Fraser Doh
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America; Children's Healthcare of Atlanta, Atlanta, GA, United States of America.
| | - Erica K Sheline
- Children's Hospital of Colorado and Denver Health Medical Center, University of Colorado School of Medicine, Anschutz Medical Campus, United States of America
| | - Martha Wetzel
- Department of Pediatrics, Biostatistics Core, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Yijin Xiang
- Department of Pediatrics, Biostatistics Core, Emory University School of Medicine, Atlanta, GA, United States of America; Department of Pediatrics, Biostatistics Core, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Claudia R Morris
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America; Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America; Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| |
Collapse
|
8
|
Sidhu S, Mandelbaum A, Dobaria V, Williamson CG, Tran Z, Sullins V, Benharash P. National Trends in the Cost Burden of Pediatric Gunshot Wounds Across the United States. J Pediatr 2021; 236:172-178.e4. [PMID: 33991544 DOI: 10.1016/j.jpeds.2021.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/23/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To characterize hospitalization costs attributable to gun-related injuries in children across the US. STUDY DESIGN The 2005-2017 National Inpatient Sample was used to identify all pediatric admissions for gunshot wounds (GSW). Patients were stratified by International Classification of Diseases procedural codes for trauma-related operations. Annual trends in GSW hospitalizations and costs were analyzed with survey-weighted estimates. Multivariable regressions were used to identify factors associated with high-cost hospitalizations. RESULTS During the study period, an estimated 36 283 pediatric patients were admitted for a GSW, with 43.1% undergoing an operative intervention during hospitalization. Admissions for pediatric firearm injuries decreased from 3246 in 2005 to 3185 in 2017 (NPtrend < .001). The median inflation-adjusted cost was $12 408 (IQR $6253-$24 585). Median costs rose significantly from $10 749 in 2005 to $16 157 in 2017 (P < .001). Compared with those who did not undergo surgical interventions, operative patients incurred increased median costs ($18 576 vs $8942, P < .001). Assault and self-harm injuries as well as several operations were independently associated with classification in the highest cost tertile. CONCLUSIONS Admissions for pediatric firearm injuries were associated with a significant socioeconomic burden in the US, with increasing resource use over time. Pediatric gun violence is a major public health crisis that warrants further research and advocacy to reduce its prevalence and social impact.
Collapse
Affiliation(s)
- Sonam Sidhu
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA; Division of Pediatric Critical Care, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Ava Mandelbaum
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Catherine G Williamson
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Veronica Sullins
- Division of Pediatric Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA.
| |
Collapse
|
9
|
Tatebe LC, Sanchez J, Pekarek S, Koo N, Mis J, Schlanser V, Bokhari F, Dennis AJ. Pediatric Firearm-Related Injuries: Taking Kids Out of Harm's Way Begins with Targeted Prevention. J Surg Res 2021; 267:719-725. [PMID: 34284902 DOI: 10.1016/j.jss.2021.04.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/06/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Firearm-related injury is a public health crisis and remains the 3rd most common cause of death from ages 1 15 years. By evaluating events surrounding such injuries, evidence-based intervention strategies efforts may be targeted to maximize impact. MATERIAL AND METHODS A retrospective chart review was performed for firearm-related injuries in patients 15 years-old and under at an urban Pediatric Level 1 Trauma Center between January 2016 and December 2020. Age, gender, race/ethnicity, injury severity score (ISS), reported cause of injury, timing of injury around school and curfew, and mortality were evaluated. Medical Examiner data identified other deaths that occurred within the hospital's catchment area. RESULTS There were 195 injuries including 14 from the Medical Examiner. Overall, 82.6% were male with median age of 14 years (range 1-15; IQR 13-15), and median ISS of 5 (IQR 1-10). African-American children comprised 74.9% of the cohort while only representing 35.9% of local schools. Intentional interpersonal injuries comprised 65.6%; 17.4% were bystanders; 7.2% were negligent discharges; and 0.5% suicide. Median age for intentional interpersonal injuries was 14 years (IQR 13-15) compared to 11 years (IQR 8-14, P = 0.03) for negligent discharges. Regarding timing, 6.9% of injuries occurred during school hours; 56.4% after school or during non-school days; and 36.7% were after legal curfew. Mortality rate was 17.4%. CONCLUSIONS Firearm safety education and community-based violence intervention should start in the pre-teen years. Pediatric firearm-related injury prevention strategies must be multifaceted addressing structural racism, truancy, curfew violation, extra-curricular activities, childcare options, firearm safety education, violence reduction, suicide prevention, and recidivism.
Collapse
Affiliation(s)
- Leah C Tatebe
- Department of Trauma and Burn Surgery, Cook County Health, Rush University, Midwestern University, Chicago, Illinois.
| | - Joseph Sanchez
- Department of Trauma and Burn Surgery, Cook County Health, Northwestern University, Chicago, Illinois
| | - Sydney Pekarek
- Department of Trauma and Burn Surgery, Cook County Health, Midwestern University, Chicago, Illinois
| | - Nathaniel Koo
- Department of Trauma and Burn Surgery, Cook County Health, University of Illinois, Chicago, Illinois
| | - Justin Mis
- Department of Trauma and Burn Surgery, Cook County Health, Midwestern University, Chicago, Illinois
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Cook County Health, Rush University, Midwestern University, Chicago, Illinois
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Cook County Health, Rush University, Chicago, Illinois
| | - Andrew J Dennis
- Department of Trauma and Burn Surgery, Cook County Health, Rush University, Midwestern University, Chicago, Illinois
| |
Collapse
|
10
|
Bernardin ME, Moen J, Schnadower D. Factors associated with pediatric firearm injury and enrollment in a violence intervention program. J Pediatr Surg 2021; 56:754-759. [PMID: 32690290 DOI: 10.1016/j.jpedsurg.2020.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/21/2020] [Accepted: 06/14/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To identify factors associated with firearm injury (FI) and willingness to enroll in a violence intervention program amongst pediatric victims of violence. METHODS Cross-sectional study of victims of violence age 6-19 years presenting to a children's hospital emergency department from 2014 to 2017. Participants were interviewed by social workers prior to being offered enrollment in a violence intervention program. We used multivariate logistic regression analyses to identify factors associated with FI and enrollment in the violence intervention program. RESULTS Four hundred seven patients were analyzed, 156 (38%) of which were victims of FI and 251 (62%) were victims of non-firearm-related physical assaults (PA). Multiple factors were associated with FI including older adolescent age, male sex, separated/divorced parents, losses in family/social network due to violence, being on probation, illicit substance use, gang affiliation, and lack of school enrollment. One hundred four patients (26%) enrolled in the violence intervention program. There was no difference in enrollment between FI and PA. However, older adolescent age, illicit substance use and probation were associated with significantly decreased odds of enrolling in the program. CONCLUSIONS Multiple identifiable and potentially actionable risk factors exist amongst pediatric victims of acute FI. More specific targeting of at-risk groups may improve enrollment in violence interventions programs. LEVEL OF EVIDENCE This is a prognostic study, investigating the natural history of pediatric firearm injuries, factors associated with firearm injuries as well as those associated with patient propensity to enroll in a violence intervention program. This study is observational in nature and utilizes patients with non-firearm-related physical assaults as a control group, making this study Level III evidence.
Collapse
Affiliation(s)
- Mary Elizabeth Bernardin
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO.
| | - Joseph Moen
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
11
|
Boschert EN, Stubblefield CE, Reid KJ, Schwend RM. Twenty-two Years of Pediatric Musculoskeletal Firearm Injuries: Adverse Outcomes for the Very Young. J Pediatr Orthop 2021; 41:e153-e160. [PMID: 33055517 DOI: 10.1097/bpo.0000000000001682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Firearm injuries are a significant cause of morbidity and mortality for children in the United States. The purpose of this study is to investigate the 22-year experience of pediatric firearm-related musculoskeletal injuries at a major pediatric level 1 hospital and to analyze the risk of adverse outcomes in children under 10 years of age. METHODS An institutional review board-approved, retrospective cohort analysis was conducted on pediatric firearm-related musculoskeletal injuries at our institution from 1995 to 2017. A total of 189 children aged 0 to 18 years were identified using International Classification of Diseases, 9th Revision/10th Revision codes, focusing on musculoskeletal injuries by firearms. Exclusion criteria were primary treatment at an outside hospital, isolated nonmusculoskeletal injuries (eg, traumatic brain injury), and death before orthopaedic intervention. Two cohorts were included: age below 10 years and age 10 years and above. Primary outcome measure was a serious adverse outcome (death, growth disturbance, amputation, or impairment). Standard statistical analysis was used for demographic data, along with linear mixed models and multivariable logistic regression for adverse outcome. RESULTS Of the 189 children, 46 (24.3%) were below 10 years of age and 143 (75.7%) were 10 years and above. Fifty-two (27.5%) of the total group had an adverse outcome, with 19 (41.3%) aged below 10 years and 33 (23.1%) aged 10 years and above (P=0.016). Adverse outcomes were 3 deaths, 17 growth disturbances, 7 amputations, and 44 impairments. For those below 10 years of age, rural location (P=0.024), need for surgical treatment (P=0.041), femur injury (P=0.032), peripheral nerve injury (P=0.006), and number of surgeries (P=0.022) were associated with an adverse outcome. CONCLUSIONS Over one fourth of survivors of musculoskeletal firearm injuries had an adverse outcome. Children 10 years and above represent the majority of firearm injuries in our population; however, when injured, those below 10 years are more likely to have an adverse outcome. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
| | - Connor E Stubblefield
- Children's Mercy Hospital, Kansas City, MO
- University of Kansas School of Medicine, Kansas City, KS
| | | | | |
Collapse
|
12
|
Pediatric firearm injuries: A Midwest experience. J Pediatr Surg 2020; 55:2140-2143. [PMID: 32718671 DOI: 10.1016/j.jpedsurg.2020.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 05/25/2020] [Accepted: 06/18/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Firearm injuries remain a significant public health concern. As a Level 1 Pediatric Trauma Center with a wide and diverse catchment, we sought to define our own experience as well as identify the affected patient population. METHODS A retrospective review was conducted utilizing our institution's trauma registry including all pediatric patients (age ≤ 17 years) who presented with a firearm injury between 2012 and 2017. Patients were stratified by age group as well as by geographic location. Outcomes as well as circumstances of the shooting were measured. RESULTS A total of 236 patients were included. One hundred thirteen patients (47.9%) were ≤12 years while 123 (52.1%) were between the ages of 13 and 17 years. The younger group had a 52.2% operative intervention rate while the older group had a 37.2% operative intervention rate (p = 0.005) while there was no difference in mortality rate. Patients in the younger group tended to be injured by someone who was known to the patient (self: 22.1%, family/friend: 44.3%) as an accidental shooting (61.9%) while patients in the older group were usually injured by a stranger (58.5%) as an assault (61.8%). When stratified by location, the majority of patients were from large cities. However, after adjusting for population, the firearm injury rate was the highest in the small cities. The majority of the shootings in these small cities were accidental, even after stratifying by age (young group: 81.4% small cities vs 50% large cities, p = 0.0008%; older group: 62.5% small cities vs 25.2% large cities, p = 0.0005). CONCLUSIONS Although gun violence in the pediatric population is traditionally viewed as an "urban" problem among teens, our research shows that young children also suffer the consequences of firearm injuries and that rural areas are afflicted particularly by accidental firearm discharges. This may represent a new targeted audience for outreach. LEVEL OF EVIDENCE III.
Collapse
|
13
|
Borg BA, Krouse CB, McLeod JS, Shanti CM, Donoghue L. Circumstances surrounding gun violence with youths in an urban setting. J Pediatr Surg 2020; 55:1234-1237. [PMID: 31740025 DOI: 10.1016/j.jpedsurg.2019.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Our pediatric trauma center has noted an increase in the occurrence of gunshot wounds in children. We aimed to understand the circumstances surrounding these injuries in order to provide targeted injury prevention methodologies. METHODS A retrospective review was performed on patients who presented with a gunshot wound to our Level I Pediatric Trauma Center and two neighboring Adult Trauma Centers between 2013 and 2017. RESULTS Three hundred twenty-six patients (6 months to 18 years) were treated for gunshot wounds. Patients were African American (86%), Caucasian (9%), and other races (5%). Eight zip-codes were identified as high-risk, accounting for 52% of patients. Most injuries (86%) were from powder firearms. Known circumstances (n = 275) included drive-by shootings (47%), unlocked guns (19%), crime related (13%), altercation between adolescents (7%), cross-fire from adult altercation (6%), home invasion (6%), and suicide attempts (2%). There was a progressive increase of 50% over the last 4 years. The increase in incidence was predominantly from an increase in drive-by shootings; however, the incidence of injuries from unlocked guns has remained relatively constant per year. Mortality was 6%. CONCLUSION Identifying high-risk zones for drive-by shootings and other crimes is critical for developing system-focused interventions. Zip-code data stratified by age and circumstances, will allow for targeted community outreach on gun safety education, in an effort to reduce the incidence of injuries from unlocked guns. LEVEL OF EVIDENCE Prognostic and Epidemiologic study, Level III.
Collapse
Affiliation(s)
- Breanna A Borg
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Carolyn B Krouse
- Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan.
| | - Jennifer S McLeod
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Christina M Shanti
- Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan
| | - Lydia Donoghue
- Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan
| |
Collapse
|
14
|
Hatchimonji JS, Swendiman RA, Goldshore MA, Blinman TA, Nance ML, Allukian M, Nace GW. Pediatric firearm mortality in the United States, 2010 to 2016: A National Trauma Data Bank analysis. J Trauma Acute Care Surg 2020; 88:402-407. [PMID: 31895332 DOI: 10.1097/ta.0000000000002573] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric firearm injury is a leading cause of death for U.S. children. We sought to further characterize children who die from these injuries using a validated national database. METHODS The National Trauma Data Bank 2010 to 2016 was queried for patients aged 0 to 19 years old. International Classification of Diseases external cause of injury codes were used to classify patients by intent. Differences between groups were analyzed using χ or Mann-Whitney U tests. Patterns over time were analyzed using nonparametric tests for trend. Multivariable logistic regression was used to investigate associations between the above factors and mortality. RESULTS There were a total of 45,288 children with firearm injuries, 12.0% (n = 5,412) of whom died. Those who died were younger and more often white than survivors. Mortality was associated with increased injury severity, shock on presentation, and polytrauma (p < 0.001 for all). There was an increasing trend in the proportion of self-inflicted injuries over the study period (p < 0.001), and mortality from these self-inflicted injuries increased concordantly (35.3% in 2010 to 47.8% in 2016, p = 0.001). Location of severe injuries had significant different mortality rates, ranging from 51.3% of head injuries to 3.9% in the extremities. In the multivariable model, treatment at a pediatric trauma center was protective against mortality, with odds ratios of 2.10 (confidence interval, 1.64-2.68) and 1.80 (confidence interval, 1.39-2.32) for death at adult and dual-designated trauma centers, respectively. This finding was confirmed in age-stratified cohorts. CONCLUSION Proportions of self-inflicted pediatric firearm injury in the National Trauma Data Bank increased from 2010 to 2016, as did mortality from self-inflicted injury. Because mortality is highest in this subpopulation, prevention and treatment efforts should be prioritized in this group of firearm-injured children. LEVEL OF EVIDENCE Epidemiological study, level V.
Collapse
Affiliation(s)
- Justin S Hatchimonji
- From the Department of Surgery (J.S.H., R.A.S., M.A.G.), Perelman School of Medicine, University of Pennsylvania; and Division of Pediatric General, Thoracic and Fetal Surgery (T.A.B., M.L.N., M.A., G.W.N.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | | | | | |
Collapse
|
15
|
Trends in Firearm Injuries Among Children and Teenagers in the United States. J Surg Res 2020; 245:529-536. [DOI: 10.1016/j.jss.2019.07.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/22/2019] [Accepted: 07/18/2019] [Indexed: 01/12/2023]
|
16
|
Beraldo RF, Forlin E. Firearm-Related Musculoskeletal Injuries in Brazilian Children and Teenagers. Rev Bras Ortop 2019; 54:685-691. [PMID: 31875067 PMCID: PMC6923644 DOI: 10.1055/s-0039-1697021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 01/04/2023] Open
Abstract
Objective
To evaluate and describe musculoskeletal injuries by firearms in children and adolescents attended in a major trauma center.
Methods
This was a retrospective study that evaluated the medical records of < 18 years old patients who were victims of injuries by firearms and who presented to the emergency department of our hospital, from January 2014 to December 2016. A total of 51 patients were excluded for not showing musculoskeletal injures or for other reasons, while 126 were included. The collected data were: gender; age; way of admission; body site hit; fractures; complications and sequelae; associated injures; hospitalization time; surgeries; deaths.
Results
Out of 126 patients included, 107 were male (84.9%) and 19 were female (15.1%). The mean age was 15 years and 5 months old (range: 2y + 8 months to 17y + 11 months years old). A total of 70 patients were hospitalized (55.6%), with a mean hospital stay of 9.6 days, and 21 patients were hospitalized in the intensive care unit (ICU) for a mean of 14.7 days. A total of 37 patients needed orthopedic surgery (29.4%). There were 6 deaths (4.8%). The thigh was the most hit region, in 43 injuries (24.7%). Six patients had spinal cord sequelae, and eight patients had peripheral nerves injuries. A total of 58 patients (46%) had 71 fractures, and the femur was the most hit (15.5%). A total of 52 (41.3%) patients presented with associated injuries. In the 71 fractures, the treatment was conservative in 45 (63.4%), surgical in 23 (32.4%). Three injuries resulted in death (4.2%).
Conclusion
Adolescents and males are at-risk groups for firearms injuries, and the lesions are mainly on the lower limbs. Less than half of the patients had fractures, but many had complex lesions with potential for severe sequelae.
Collapse
Affiliation(s)
| | - Edilson Forlin
- Departamento de Ortopedia e Traumatologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| |
Collapse
|
17
|
Jones M, Kistamgari S, Smith GA. Nonpowder Firearm Injuries to Children Treated in Emergency Departments. Pediatrics 2019; 144:peds.2019-2739. [PMID: 31767715 DOI: 10.1542/peds.2019-2739] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate nonpowder firearm injuries treated in US emergency departments among children <18 years old. METHODS National Electronic Injury Surveillance System data from 1990 through 2016 were analyzed. RESULTS An estimated 364 133 (95% confidence interval 314 540-413 727) children <18 years old were treated in US emergency departments for injuries related to nonpowder firearms from 1990 to 2016, averaging 13 486 children annually. From 1990 to 2016, the number and rate of nonpowder firearm injuries decreased by 47.8% (P < .001) and 54.5% (P < .001), respectively. Most injuries occurred among 6- to 12-year-olds (47.4%) and 13- to 17-year-olds (47.0%). Boys accounted for 87.1% of injured children, the most common diagnosis was foreign body (46.3%), and 7.1% of children were admitted. BB guns accounted for 80.8% of injuries, followed by pellet guns (15.5%), paintball guns (3.0%), and airsoft guns (0.6%). The rate of eye injuries increased by 30.3% during the study period. Eye injuries accounted for 14.8% of all injuries and the most common diagnoses were corneal abrasion (35.1%), hyphema (12.5%), globe rupture (10.4%), and foreign body (8.6%). CONCLUSIONS Although the number and rate of nonpowder firearm injuries declined during the study period, nonpowder firearms remain a frequent and important source of preventable and often serious injury to children. The severity and increasing rate of eye injuries related to nonpowder firearms is especially concerning. Increased prevention efforts are needed in the form of stricter and more consistent safety legislation at the state level, as well as child and parental education regarding proper supervision, firearm handling, and use of protective eyewear.
Collapse
Affiliation(s)
- Margaret Jones
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Gary A Smith
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; .,Department of Pediatrics.,Child Injury Prevention Alliance, Columbus, Ohio
| |
Collapse
|
18
|
Tracy BM, Smith RN, Miller K, Clayton E, Bailey K, Gerrin C, Eversley-Kelso T, Carney D, MacNew H. Community distress predicts youth gun violence. J Pediatr Surg 2019; 54:2375-2381. [PMID: 31072680 DOI: 10.1016/j.jpedsurg.2019.03.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/14/2019] [Accepted: 03/25/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The purpose of this study was to investigate our institution's experience with pediatric firearm events. We sought to determine the relationship between a community's level of socioeconomic distress and the incidence of youth gun violence. METHODS We performed a retrospective review of children <18 years involved in firearm events. Using visual cluster analysis, we portrayed all firearm events and violent firearm events (assaults + homicides). Distressed community indices (DCIs) were obtained from an interface that uses US Census Bureau data. Incident rate ratios (IRRs) were calculated for firearm circumstances (i.e. assault, homicide, suicide) using a DCI. Significant IRRs were analyzed to discern which DCI metrics contributed most to gun violence. RESULTS There were 114 children involved in firearm events; 66 were county residents. The DCI of injury location significantly predicted total firearm events (IRR 1.02, 95% CI 1.01-1.03), assaults (IRR 1.02, 95% CI 1.01-1.05), and violent firearm events (IRR 1.03, 95% CI 1.01-1.05). The proportion of adults without a high school diploma, poverty rate, median income ratio, and housing vacancy rate were highly predictive of gun violence (VIP >1). CONCLUSION Community distress significantly predicts pediatric firearm violence. Local interventions should target neighborhoods with high levels of distress to prevent further youth gun violence. LEVEL OF EVIDENCE Retrospective study, IV.
Collapse
Affiliation(s)
- Brett M Tracy
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Krista Miller
- Department of Surgery, Memorial University Medical Center, Savannah, Georgia.
| | - Eric Clayton
- Department of Surgery, Memorial University Medical Center, Savannah, Georgia.
| | - Kathryn Bailey
- Department of Surgery, Memorial University Medical Center, Savannah, Georgia.
| | - Carrol Gerrin
- Department of Surgery, Memorial University Medical Center, Savannah, Georgia.
| | | | - David Carney
- Department of Surgery, Memorial University Medical Center, Savannah, Georgia.
| | - Heather MacNew
- Department of Surgery, Memorial University Medical Center, Savannah, Georgia.
| |
Collapse
|
19
|
Wolf AE, Garrison MM, Mills B, Chan T, Rowhani-Rahbar A. Evaluation of Injury Severity and Resource Utilization in Pediatric Firearm and Sharp Force Injuries. JAMA Netw Open 2019; 2:e1912850. [PMID: 31596492 PMCID: PMC6802232 DOI: 10.1001/jamanetworkopen.2019.12850] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/20/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Pediatric firearm injuries are a serious and growing public health problem, constituting the second leading cause of death in children and adolescents in the United States. Firearm injuries have a high case fatality, but knowledge is limited to date regarding their injury severity and health care utilization burden compared with those of other penetrating injuries, especially among children with critical injury. Objective To describe and compare the resource utilization, injury severity, and short-term clinical outcomes associated with pediatric firearm injuries and other penetrating trauma. Design, Setting, and Participants This retrospective cohort study used data from the National Trauma Data Bank, an encounter-level registry of trauma data in the United States, from January 1, 2007, to December 31, 2016. Encounters for firearm injury (n = 25 155) or cut or pierce injury (21 270) in children 17 years or younger were analyzed. Statistical analysis was conducted from July 15, 2018, to June 5, 2019. Exposures Firearm injury compared with cut or pierce injury encounters. Main Outcomes and Measures Intensive care unit (ICU) admission, hospital and ICU length of stay (LOS), and Injury Severity Score (ISS). Results A total of 25 155 firearm injury encounters and 21 270 cut or pierce injury encounters were analyzed. Most firearm and cut or pierce injuries occurred among boys (21 573 [85.8%] and 15 864 [74.6%]) and adolescents aged 15 to 17 years (18 807 [74.8%] and 10 895 [51.2%]). A greater proportion of those with firearm injuries were African American children compared with those with cut or pierce injuries (15 019 [61.3%] vs 6397 [31.2%]). A greater proportion of those with firearm injuries compared with cut or pierce injuries were admitted to the ICU (7682 [30.5%] vs 2712 [12.8%]). Compared with cut or pierce injuries, firearm injuries were associated with a higher mean (SD) ISS (4.6 [6.8] vs 10.9 [12.7] points), longer mean (SD) hospital LOS (2.8 [4.1] vs 5.0 [8.4] days), and longer mean (SD) ICU LOS (3.1 [4.5] vs 5.1 [7.7] days). Firearm injuries accounted for 126 027 hospital days and 39 255 ICU days, whereas cut or pierce injuries accounted for 58 705 hospital days and 8353 ICU days. After adjustments for age, sex, year, and hospital, those with firearm injuries were more likely to require ICU admission (relative risk [RR], 2.3; 95% CI, 2.1-2.5; P < .001) and to have higher ISS scores (6.7 points higher for all injuries; 95% CI, 6.1-7.2) compared with those with cut or pierce injuries, even among critical injuries. Multinomial logistic regression demonstrated higher risk of prolonged hospital LOS (RR ratio, 4.11; 95% CI, 3.46-4.89; P < .001) and ICU LOS (RR ratio, 2.2; 95% CI, 1.9-2.3) for firearm injuries compared with cut or pierce injuries. Conclusions and Relevance This study found that pediatric firearm injuries were associated with greater severity and health care utilization compared with penetrating trauma from other mechanisms, suggesting that the mechanism of injury is an important consideration in penetrating sharp force trauma in children and adolescents. Public health measures, legislative efforts, and safe storage practices are among the interventions needed to reduce pediatric firearm injuries.
Collapse
Affiliation(s)
- Ashley E. Wolf
- Division of Critical Care Medicine, Seattle Children’s Hospital, University of Washington, Seattle
- School of Public Health, Department of Health Services, University of Washington, Seattle
| | | | - Brianna Mills
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Titus Chan
- Division of Critical Care Medicine, Seattle Children’s Hospital, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle
- School of Public Health, Department of Epidemiology, University of Washington, Seattle
| |
Collapse
|
20
|
Bayouth L, Lukens-Bull K, Gurien L, Tepas JJ, Crandall M. Twenty years of pediatric gunshot wounds in our community: Have we made a difference? J Pediatr Surg 2019; 54:160-164. [PMID: 30482538 DOI: 10.1016/j.jpedsurg.2018.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND/PURPOSE Pediatric gunshot wounds (GSWs) carry significant incidence, mortality, and cost. We evaluated 20 years of GSW demographics at this level 1 trauma center and constructed a risk map triangulating areas of high incidence with risk factors. METHODS Children 0-18 years suffering a GSW between 1996 and 2016 were identified via our trauma registry. Hospital charges, demographic, socioeconomic, and institutional variables were retrospectively reviewed. Multivariable logistic regression identified predictors of mortality. Geographic information system (GIS) mapping of incident location and residence identified areas of higher incidence. RESULTS The cohort (n = 898) was 86.4% male. Mean age was 15.6 ± 3.4 years. Median Injury Severity Score (ISS) was 9 (1-75). Procedural and/or operative intervention occurred in 52.9%. Intent included assault (81.5%) and unintentional injury (12.8%). Hospital charges showed significant annual increase. Annual incidence varied without trend (p = 0.89). Mapping revealed significant clustering of GSWs in known lower socioeconomic areas. Yearly and total GSWs were highest in one particular zip code. ISS was a significant predictor of mortality (n = 18) (OR 1.19, 95% CI 1.15-1.22, p < 0.001). CONCLUSIONS Our impoverished neighborhoods have higher pediatric GSW incidence, unchanged over 20 years. Alternative community-based prevention efforts should involve neighborhood capacity building and economic strengthening. TYPE OF STUDY Retrospective study. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Lilly Bayouth
- Department of Surgery, Brody School of Medicine at East Carolina University
| | - Katryne Lukens-Bull
- Center for Health Equity and Quality Research, University of Florida College of Medicine Jacksonville
| | - Lori Gurien
- Department of Surgery, University of Florida College of Medicine Jacksonville
| | - Joseph J Tepas
- Department of Pediatric Surgery, University of Florida College of Medicine Jacksonville
| | - Marie Crandall
- Department of Surgery, University of Florida College of Medicine Jacksonville.
| |
Collapse
|
21
|
Piatt J. Penetrating spinal injury in childhood: the influence of mechanism on outcome. An epidemiological study. J Neurosurg Pediatr 2018; 22:384-392. [PMID: 29979127 DOI: 10.3171/2018.3.peds1890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Penetrating injury of the spine in childhood commonly causes profound and life-long disability, but it has been the object of very little study. The goal of the current report is to document temporal trends in the nationwide incidence of this condition and to highlight the differences between penetrating injuries and closed injuries. METHODS The Kids' Inpatient Database was queried for spinal injuries in 1997, 2000, 2003, 2006, 2009, and 2012. Penetrating mechanism was determined by diagnostic coding for open injuries and by mechanistic codes for projectiles and knives. Nationwide annual incidences were calculated using weights provided for this purpose. Unweighted data were used as a cross-sectional sample to compare closed and penetrating injuries with respect to demographic and clinical factors. The effect of penetrating mechanism was analyzed in statistical models of death, adverse discharge, and length of stay (LOS). RESULTS The nationwide incidence of penetrating spinal injury in patients less than 18 years of age trended downward over the study period. Patients with penetrating injury were older and much more predominantly male than patients with closed injuries. They resided predominantly in zip codes with lower median household incomes, and they were much more likely to have public health insurance or none at all. They were predominantly black or Hispanic. The risk of hospital death was no different, but penetrating injuries were associated with much higher rates of adverse discharge after LOS, averaging twice as long as closed injuries. Brain, visceral, and vascular injuries were powerful predictors of hospital death, as was upper cervical level of injury. The most powerful predictor of adverse discharge and LOS was spinal cord injury, followed by brain, visceral, and vascular injury and penetrating mechanism. CONCLUSIONS Because its pathophysiology requires no elucidation, because the consequences for quality of life are dire, and because the population at risk is well defined, penetrating spinal injury in childhood ought to be an attractive target for public health interventions.
Collapse
|
22
|
Abstract
BACKGROUND Firearm-associated injuries are the second leading cause of death in children in the United States. Fractures are common comorbid injuries in young patients with firearm-associated injuries. The purpose of this study was to define the burden of firearm-associated fractures (FAFs) in children and adolescents in the United States. METHODS We analyzed the 2003-2012 Kids' Inpatient Database. Patients were grouped into 4 age groups: 0 to 4, 5 to 9, 10 to 14, and 15 to 20 years old. Sample observations with both an external cause of injury code indicating gunshot injury and a diagnosis code indicating orthopaedic fracture (extremity, pelvis, or spine) were identified as cases of FAF. Sex, age, race, cause of injury, and fracture-related operating room procedures were catalogued. Population-level incidence was calculated for each year studied. RESULTS From 2003 to 2012, the incidence of FAF in patients 20 years and below of age increased from 73 to 96 cases per 100,000 admissions (P=0.009). The 0 to 4 age group saw the largest increase in injury frequency (141%, P=0.08). There was a 4-fold increase in the rate of unintentional injury in this subgroup. The most common age group affected by FAFs was 15 to 20 year olds. Minorities and male individuals were disproportionately affected. Assault and unintentional causes were the most common reasons for injury. CONCLUSIONS The frequency of FAF in patients 20 years and below of age increased over the study period, with almost 1 case per 1000 admissions in 2012. The finding that certain subpopulations are disproportionately affected reflects the complex sociologic factors influencing gun violence in the United States. LEVEL OF EVIDENCE Level III-retrospective cohort study.
Collapse
|
23
|
Groh EM, Feingold PL, Hashimoto B, McDuffie LA, Markel TA. Temporal Variations in Pediatric Trauma: Rationale for Altered Resource Utilization. Am Surg 2018. [DOI: 10.1177/000313481808400624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma is a major cause of morbidity and mortality in the pediatric population. However, temporal variations of trauma have not been well characterized and may have implications for appropriate allocation of hospital resources. Data from patients evaluated at an ACS-verified Level I pediatric trauma center between 2011 and 2015 were retrospectively analyzed. Date and time of injury, type of injury (blunt vs penetrating), and postemergency department disposition were reviewed. To assess temporal trends, heatmaps were constructed and a mixed poisson regression model was used to assess statistical significance. Pediatric trauma from blunt and penetrating injuries occurred at significantly higher rates between the hours of 1800 and 0100, on weekends compared with weekdays, and from May to August compared with November to February. These data provide useful information for hospital resource utilization. The emergency department, operating room, and intensive care unit should be prepared for increased trauma-related volume between May and August, weekends, and evening hours by appropriately increasing staff volume and resource availability.
Collapse
Affiliation(s)
- Eric M. Groh
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Paul L. Feingold
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Barry Hashimoto
- Department of International Studies, American University of Sharjah, Sharjah, United Arab Emirates
| | - Lucas A. McDuffie
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Troy A. Markel
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
24
|
In harm's way: Unintentional firearm injuries in young children. J Pediatr Surg 2018; 53:1020-1023. [PMID: 29729771 DOI: 10.1016/j.jpedsurg.2018.02.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/01/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Firearm-related trauma represents a major source of preventable injury and death. Many firearm injuries in young children are unintentional, and the true incidence may be underestimated. We sought to characterize the morbidity of unintentional firearm injuries. METHODS National Trauma Data Bank data from 2007 to 2014 was obtained for patients aged 0-14 sustaining gunshot wounds (GSW). We analyzed demographics, injury severity score, hospital and ICU length of stay (LOS), ventilator days, discharge to rehab, and mortality. We categorized intention as assault, unintentional, self-inflicted or other, and compared unintentional firearm injuries against all others using Student's t test or chi-square analysis. RESULTS We identified 7487 GSW patients aged 0-14, of whom 2514 (33.6%) sustained unintentional injuries. The mortality rate for unintentionally injured patients was 9.2%, compared with 14.2% for all other intentions (p<0.0001). Unintentionally injured children were more likely to be male (p=0.01) and Caucasian (p<0.0001) and had lower rates of ICU admission (p=0.02), ventilator use (p=0.0004), and discharge to rehab (p<0.0001). CONCLUSIONS Unintentional injuries comprise one-third of firearm injuries and approximately 10% of GSW-related mortality in young children. Since these injuries are entirely preventable, our findings suggest a major opportunity to reduce disease burden. LEVEL OF EVIDENCE IV.
Collapse
|
25
|
Freeman JJ, Bachier-Rodriguez M, Staszak J, Feliz A. A comparison between non-powder gun and powder-gun injuries in a young pediatric population. Injury 2017; 48:1951-1955. [PMID: 28610778 DOI: 10.1016/j.injury.2017.05.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/09/2017] [Accepted: 05/27/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Non-powder guns (NPG) are viewed as toys for children by the general public. Literature on firearm injuries in the pediatric population is increasing, however there are still large gaps in the published literature regarding NPG. We intended to identify and compare the epidemiology, circumstances of injury and outcomes of children with NPG versus powder-gun injuries (GSW). PATIENTS AND METHODS We performed a 6-year retrospective analysis of children 0-14 years old treated for NPG and GSW injuries at our level one pediatric trauma center. Mann-Whitney U test and Pearson's X2 were used to compare continuous and categorical variables, respectively. RESULTS There were 43 NPG and 112 GSWs. Patients were predominantly male (36 children; 84%) NPG vs. 92 children; 82% GSW) with a median age in both groups of 11 years. Analysis of residential zip codes showed that 74% (32 children) NPG injuries and 85% (95 children) GSW lived in regions with higher poverty than the national level. Children with NPG injuries were more likely to be Caucasian (24 children; 56%) and to have suffered an unintentional injury (36 children; 84%), while children with GSW were African-American (80 children; 71%; p=0.0002) and victims of assault (50 children; 45%; p<0.0001). When compared with NPG, children with GSW had more severe injuries, longer hospital stays, and higher overall mortality. There were no significant differences in rate of emergent OR intervention and ED mortality between the two groups. CONCLUSION Our results highlight two important findings. First, NPG injuries were accidental and thus preventable with improved legislation and public education. Second, health disparities related to gun violence among African-Americans are prevalent even in early childhood and prevention efforts should include this younger population.
Collapse
Affiliation(s)
- Jennifer J Freeman
- Division of Pediatric Surgery, University of Tennessee, Health Science Center, Le Bonheur Children's Hospital, 49 North Dunlap, Second Floor, Memphis, TN 38105, USA
| | - Marielena Bachier-Rodriguez
- Division of Pediatric Surgery, University of Tennessee, Health Science Center, Le Bonheur Children's Hospital, 49 North Dunlap, Second Floor, Memphis, TN 38105, USA
| | - Jessica Staszak
- Department of General Surgery, University of Tennessee, Health Science Center, 920 Madison Ave., Memphis, TN 38103, United States
| | - Alexander Feliz
- Division of Pediatric Surgery, University of Tennessee, Health Science Center, Le Bonheur Children's Hospital, 49 North Dunlap, Second Floor, Memphis, TN 38105, USA.
| |
Collapse
|
26
|
Joudi N, Tashiro J, Golpanian S, Eidelson SA, Perez EA, Sola JE. Firearm injuries due to legal intervention in children and adolescents: a national analysis. J Surg Res 2017. [DOI: 10.1016/j.jss.2017.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Abstract
Firearm injuries are a major cause of morbidity and mortality among children and adolescents in the United States and take financial and emotional tolls on the affected children, their families, and society as a whole. Musculoskeletal injuries resulting from firearms are common and may involve bones, joints, and neurovascular structures and other soft tissues. Child-specific factors that must be considered in the setting of gunshot injuries include physeal arrest and lead toxicity. Understanding the ballistics associated with various types of weaponry is useful for guiding orthopaedic surgical treatment. Various strategies for preventing these injuries range from educational programs to the enactment of legislation focused on regulating guns and gun ownership. Several prominent medical societies whose members routinely care for children and adolescents with firearm-related injuries, including the American Academy of Pediatrics and the American Pediatric Surgical Association, have issued policy statements aimed at mitigating gun-related injuries and deaths in children. Healthcare providers for young patients with firearm-related musculoskeletal injuries must appreciate the full scope of this important public health issue.
Collapse
|
28
|
Abstract
BACKGROUND Although firearms account for less than 5 % of all pediatric injuries, they have the highest associated case fatality rate. METHODS The registry at a Level-1 trauma center was used to identify firearm injuries (<18 years of age) from 1991 to 2011. Descriptive statistics and risk-adjusted multivariate analyses (MVA) were performed. RESULTS Overall, 1085 patients were identified. Immediate operations were performed in 33 % (n = 358) of patients with most having abdominal surgery (n = 214). Survival was 86 %, but higher for African Americans (OR = 1.92) than for Hispanics (p = 0.006). African Americans were more likely to sustain extremity (OR = 2.26) and less head (OR = 0.36) injuries than Hispanics (p < 0.001). Analysis by injury location showed that head (OR = 14.1) had the highest associated mortality. Other significant predictors included multiple major injury (defined by Abbreviated Injury Scale) with central nervous system involvement (OR = 7.30) and single injuries to the chest (OR = 2.68). These findings were compared to abdominal injuries as the baseline (p < 0.02). MVA demonstrated that Caucasian children had higher mortality (OR = 6.12) vs. Hispanics (p = 0.031). Children admitted with initial pH ≤ 7.15 (OR = 14.8), initial hematocrit ≤30 (OR = 3.24), or Injury Severity Score (ISS) > 15 (OR = 1.08) had higher mortality rates (p < 0.05). CONCLUSION Independent significant indicators of mortality include low initial pH or hematocrit, Caucasian race, high ISS, and those who sustain head injuries.
Collapse
|
29
|
Prahlow JA. Fatal Gunshot Wounds in Young Children. Acad Forensic Pathol 2016; 6:691-702. [PMID: 31239941 DOI: 10.23907/2016.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/09/2016] [Accepted: 10/27/2016] [Indexed: 01/01/2023]
Abstract
Deaths related to firearms are common within the United States. Although relatively rare compared to other age groups, deaths occurring in young children represent a particularly tragic subcategory of firearms-related fatalities. This manuscript provides details regarding several cases of gunshot wound deaths occurring in young children. Included are a variety of situations and scenarios: the child was an innocent bystander struck by gunfire that was intended for another individual; unsafe firearm handling and manipulation by another individual, resulting in the child being shot; unsafe storage of a loaded firearm with resultant accidental discharge of the weapon; a young child having ready access to a loaded handgun and subsequently shooting him/herself; and the child being considered a potential intended target and being shot by another individual. The details of each case are provided, and discussion will focus on realistic strategies that, if implemented, might prevent such deaths from occurring in the future.
Collapse
Affiliation(s)
- Joseph A Prahlow
- Western Michigan University Homer Stryker M.D. School of Medicine - Pathology
| |
Collapse
|
30
|
Monuteaux MC, Mannix R, Fleegler EW, Lee LK. Predictors and Outcomes of Pediatric Firearm Injuries Treated in the Emergency Department: Differences by Mechanism of Intent. Acad Emerg Med 2016; 23:790-5. [PMID: 27084566 DOI: 10.1111/acem.12986] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/02/2016] [Accepted: 04/02/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Firearm injuries among children are a major clinical and public health concern and one of the leading causes of pediatric fatalities. Our objective was to investigate differences in predictors and clinical outcomes between self-inflicted, violent, and unintentional pediatric firearm injuries for patients who present to pediatric emergency departments (EDs). METHODS We conducted a retrospective study of patients 0 to 21 years old treated in 37 pediatric academic EDs from 2004 to 2014. Patients were classified into the injury intent categories of self-inflicted, violent, and unintentional firearm injury using the International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) diagnoses and external causes of injury codes. Multivariable multinomial regression models compared groups. RESULTS We identified 9,628 firearm injuries from 2004 to 2014: 109 (1%) self-inflicted, 2,394 (25%) violent, and 7,125 (74%) unintentional. Male sex, increasing age, nonwhite race, public insurance, residing in an urban zip code, and lower zip code-level median household income were all independently associated with violent firearm injuries, relative to self-inflicted and unintentional injuries. Self-inflicted injuries were at the highest risk for hospital admission, death, intensive care unit services, surgical services, and increased length of stay, followed by violent injuries with intermediate risk and unintentional injuries at the lowest risk CONCLUSIONS Self-inflicted, violent, and unintentional firearm injuries in children had distinct demographic risk factors and clinical and utilization outcomes. Targeted prevention and intervention efforts should be developed to reduce the incidence and severity of these injuries.
Collapse
|
31
|
|