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Mulugeta MG, Bailey G, Parsons K, Gillespie S, Johnson LM, Doh KF, Reisner A, Blackwell LS. Trends in pediatric firearm-related injuries and disparities in acute outcomes. Front Public Health 2024; 12:1339394. [PMID: 38566791 PMCID: PMC10985139 DOI: 10.3389/fpubh.2024.1339394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Firearm-related injuries (FRI) are an increasing cause of death and injury in children. The etiology for this rise is multifactorial and includes socioeconomic factors. Despite its prevalence and documented increase over COVID-19, there is a paucity of research on disparities and the influence of social determinants of health (SDH) in pediatric FRI. This study aims to explore the epidemiology of this vulnerable population in Atlanta, trends over time and relevant dates such as COVID-19 and a state firearm law, and disparities in clinical outcomes. Methods Retrospective cohort of patients with FRI (0-20 years-old, x̄=9.8, Median = 11) presenting to our hospital EDs from January 2014 to April 2023 (N = 701) and eligible for the Trauma Registry. This period includes two major events, namely the COVID-19 pandemic (March 2020), and passage of state law Constitutional Carry Act (SB 319) (April 2022), allowing for permit-less concealed firearm carry. Single series interrupted time series (ITS) models were run and clinical outcome differences between race and insurance groups were calculated unadjusted and adjusted for confounders using inverse propensity treatment weights (IPTW). The primary outcome was mortality; secondary are admission and discharge. Results Majority of FRI involved patients who were male (76.7%), Black (74.9%), publicly insured (82.6%), ≤12 years-old (61.8%), and injured by unintentional shootings (45.6%) or assault (43.7%). During COVID-19, there was a sustained increase in FRI rate by 0.42 patients per 1,000 trauma visits per month (95% CI 0.02-0.82, p = 0.042); post-SB 319 it was 2.3 patients per 1,000 trauma visits per month (95% CI 0.23-4.31, p = 0.029). Publicly insured patients had 58% lower odds of mortality than privately insured patients (OR 0.42, 95% CI 0.18-0.99, p = 0.047). When controlled for race and mechanism of injury, among other confounding factors, this association was not significant (p = 0.652). Conclusion Pediatric FRI are increasing over time, with disproportionate burdens on Black patients, at our hospitals. Disparities in mortality based on insurance necessitate further study. As social and economic repercussions of COVID-19 are still present, and state firearm law SB 319 is still in effect, assessment of ongoing trends is warranted to inform preventative strategies.
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Affiliation(s)
| | | | - Kendall Parsons
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura M. Johnson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Kiesha Fraser Doh
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Andrew Reisner
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura S. Blackwell
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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Valencia-Sanchez BA, Zhou S, Koempel JA, Patel VA. Endoscopic pediatric endonasal retrieval of transorbital projectile: An illustrative multimedia report. Am J Otolaryngol 2024; 45:104056. [PMID: 37734366 DOI: 10.1016/j.amjoto.2023.104056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
Air guns, particularly BB (ball-bearing or bullet ball) guns, have gained significant power and velocity over the last few decades. More than 145,000 pediatric patients suffered injuries attributed to air guns in the United States between 2001 and 2011, and approximately 22,000 pediatric emergency department visits are attributed to air gun-related injuries annually (Hyak et al., 2020 [1]). This study aims to describe an effective surgical technique in addressing maxillofacial injuries caused by BB gun projectiles in the pediatric population. We present a detailed surgical approach for endoscopic endonasal retrieval of a transorbital projectile in a 13-year-old male who sustained a maxillofacial BB gun injury, with the goal of restoring sinonasal function in a minimally invasive fashion.
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Affiliation(s)
| | - Sheng Zhou
- Division of Pediatric Otolaryngology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jeffrey A Koempel
- Division of Pediatric Otolaryngology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Vijay A Patel
- Department of Otolaryngology - Head and Neck Surgery, University of California San Diego, La Jolla, CA, USA; Division of Pediatric Otolaryngology, Rady Children's Hospital - San Diego, San Diego, CA, USA.
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Huerta CT, Saberi RA, Gilna GP, Escobar VAP, Perez EA, Sola JE, Thorson CM, McCrea HJ. Using intent to get ahead of pediatric cranial firearm injuries. Injury 2024; 55:111167. [PMID: 37923676 DOI: 10.1016/j.injury.2023.111167] [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: 03/15/2023] [Revised: 09/22/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Pediatric firearm injuries (PFI) are a public health crisis. Little is known about how injury intent may influence the outcome of pediatric cranial firearm injuries (PCFI). The current study sought to compare demographics and outcomes of PCFI based on intent of injury. METHODS The Nationwide Readmission Database (2010-2014) was queried to identify patients <18 years old with PCFI. Demographics and outcomes were compared by injury intent (assault, self-inflicted, unintentional), and results were weighted for national estimates to create a population-based cohort study. RESULTS There were 1,365 cases of PCFI identified for an incidence of 11% of all PFI. The majority of patients were male (83 %), >13 years (81 %), and had an injury severity score >15 (79 %). Overall PCFI mortality was 43 %, compared to 6 % for all PFI. Assault was the most common intent (51 %), followed by self-inflicted (25 %), and unintentional (24 %). Assault was more likely to occur in patients from low-income households (61 % vs. 31 % self-inflicted vs. 42 % unintentional), p < 0.001. Unintentional injuries occurred in those <13 years old (40 % vs. 12 % assault vs. 16 % self-inflicted) and more often resulted in facial fracture (19 % vs. 11 % vs. 13 %), all p < 0.001. Readmission rate within the year was 21 %. The majority (56 %) of readmissions were unplanned, and the rate was highest for assault (77 % vs. <1 % self-inflicted vs. 44 % unintentional, p < 0.001). CONCLUSIONS PCFI are associated with significant morbidity and mortality. Demographics and outcomes vary by intent of injury; knowledge of these patterns can direct future interventions to reduce injuries and impact outcomes.
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Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Gareth P Gilna
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | | | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Heather J McCrea
- Department of Neurosurgery and Pediatrics, University of Miami Miller School of Medicine and Jackson Health System, Miami, FL, United States of America.
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Ferrari E, Guard T, Prakash V, Shih M, Kirkwood M, Siah M. Acute limb ischemia secondary to bullet embolism following a cardiac gunshot wound in a pediatric patient. J Vasc Surg Cases Innov Tech 2023; 9:101231. [PMID: 37799838 PMCID: PMC10547786 DOI: 10.1016/j.jvscit.2023.101231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/11/2023] [Indexed: 10/07/2023] Open
Abstract
Bullet embolism following a gunshot wound to the heart is a very unusual cause of acute limb ischemia. We report the case of a 3-year-old boy who sustained a penetrating cardiac trauma secondary to an accidental self-inflicted gunshot wound with a BB (ball bearing) gun. The BB pellet entered the left ventricle and embolized into the peripheral circulation, lodging at the bifurcation of the left common femoral artery. This resulted in acute left lower extremity ischemia. The patient was successfully treated by open common femoral artery exploration and foreign body removal.
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Affiliation(s)
- Eliza Ferrari
- Division of Vascular Surgery, University of Texas Southwestern Medical School, Dallas, TX
| | - Tiffany Guard
- Division of Vascular Surgery, University of Texas Southwestern Medical School, Dallas, TX
| | - Vivek Prakash
- Division of Vascular Surgery, University of Texas Southwestern Medical School, Dallas, TX
| | - Michael Shih
- Division of Vascular Surgery, University of Texas Southwestern Medical School, Dallas, TX
| | - Melissa Kirkwood
- Division of Vascular Surgery, University of Texas Southwestern Medical School, Dallas, TX
| | - Michael Siah
- Division of Vascular Surgery, University of Texas Southwestern Medical School, Dallas, TX
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Shah FQ, Qureshi TS, Nawaz S, Kaushik M. Clinical spectrum and functional outcome of firearm pellet-related eye injuries: A prospective follow-up study. Injury 2022; 53:2998-3004. [PMID: 35691765 DOI: 10.1016/j.injury.2022.05.051] [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: 03/25/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the prognostic significance of various clinical features and surgical techniques concerning anatomical and visual outcomes in shotgun pellet-inflicted ocular trauma. METHODS This prospective follow-up study was done at a tertiary care institute in Kashmir, India. Six hundred sixty-four eyes of 643 patients with firearm pellet-related ocular trauma were followed up for 6 months. RESULTS Ocular injury involved one eye in 622 (96.7%) patients and both eyes in 21 (3.3%) patients. Open globe injury (OGI) occurred in 451 (67.9%) eyes with perforating injury being the commonest type (248 eyes, 54.9%). For perforating injuries, entry wounds in the cornea and limbus had the worst prognosis. Closed globe injury (CGI) occurred in 213 (32.1%) eyes. An anatomical success rate of 66.3% (n = 250) was achieved for 56.8% (377/664) eyes requiring an average of 2.8 (SD 0.5) surgeries per eye. OGI was associated with poor outcomes in 259 (57.4%) and CGI with good outcomes in 200 (93.9%) eyes. The visual outcome had a significant association with grade and zone of injury both in OGI and CGI, and with the type of injury in OGI (p < .0001 each). Ocular trauma score (OTS) had a significant association with the degree of vision impairment (p < .0001). WHO category 0 visual impairment was seen in 270 (40.7%) eyes, category 1 in 85 (12.8%), category 2 in 35 (5.3%), category 3 in 30 (4.5%), category 4 in 172 (25.9%), and category 5 in 72 (10.8%) eyes irrespective of type of injury at 6 months post-treatment. CONCLUSIONS The perforating injury was the commonest type of injury caused by shotgun pellets. The site of the entry wound in perforating injury had prognostic significance. The outcome was generally poor in OGI and good in CGI.
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Affiliation(s)
- Faisal Qayoom Shah
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Tariq Syed Qureshi
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shah Nawaz
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Madhurima Kaushik
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
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Gigola F, Grimaldi C, Bici K, Ghionzoli M, Spinelli C, Muiesan P, Morabito A. Epidemiology and Surgical Management of Foreign Bodies in the Liver in the Pediatric Population: A Systematic Review of the Literature. CHILDREN 2022; 9:children9020120. [PMID: 35204841 PMCID: PMC8870636 DOI: 10.3390/children9020120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022]
Abstract
Retention of foreign bodies (FB) in the liver parenchyma is a rare event in children but it can bring a heavy burden in terms of immediate and long-term complications. Multiple materials can migrate inside the liver. Clinical manifestations may vary, depending on the nature of the foreign body, its route of penetration and timing after the initial event. Moreover, the location of the FB inside the liver parenchyma may pose specific issues related to the possible complications of a challenging surgical extraction. Different clinical settings and the need for highly specialized surgical skills may influence the overall management of these children. Given the rarity of this event, a systematic review of the literature on this topic was conducted and confirmed the pivotal role of surgery in the pediatric population.
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Affiliation(s)
- Francesca Gigola
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
| | - Chiara Grimaldi
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
- Correspondence:
| | - Kejd Bici
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
| | - Claudio Spinelli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, 56100 Pisa, Italy;
| | - Paolo Muiesan
- Department of Hepatobiliary Surgery, Careggi University Hospital, 50134 Florence, Italy;
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
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Abstract
Objective Injuries associated with firearms are a significant health burden. However, there is no comprehensive study of firearm spinal injuries over a large population. It was the purpose of this study to analyze the demographics of spinal firearm injuries across the entire United States for all ages using a national database. Methods A retrospective review of prospectively collected data using the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2015 (ICPSR 37276) was performed. The demographic variables of patients with spinal injuries due to firearms were analyzed with statistical analyses accounting for the weighted, stratified nature of the data, using SUDAAN 11.0.01™ software (RTI International, Research Triangle Park, North Carolina, 2013). A p-value of < 0.05 was considered statistically significant. Results For the years 1993 through 2015, there were an estimated 2,667,896 emergency department (ED) visits for injuries due to firearms; 10,296 of these injuries (0.4%) involved the spine. The vast majority (98.2%) were due to powder firearm gunshot wounds. Those with a spine injury were more likely to have been injured in an assault (83.7% vs. 60.2%), involved a handgun (83.5% vs. 60.2%), were male (90.8% vs. 86.4%), were admitted to the hospital (86.8% vs. 30.9%), and were seen in urban hospitals (86.7 vs. 64.6%). The average age was 28 years with very few on those < 14 years of age. Illicit drug involvement was over four times as frequent in those with a spine injury (34.7% vs. 8.0%). The cervical spine was involved in 30%, thoracic in 32%, lumbar in 32%, and sacrum in 6%. A fracture occurred in 91.8% and neurologic injury in 33%. Injuries to the thoracic spine had the highest percentage of neurologic involvement (50.4%). There was an annual percentage decrease for patients with and without spine involvement in the 1990s, followed by increases through 2015. The average percentage increase for patients with a spine injury was 10.3% per year from 1997 onwards (p < 10-6), significantly greater than the 1.5% for those without spinal involvement (p = 0.0001) from 1999 onwards. Conclusions This nation-wide study of spinal injuries associated with firearms covering all ages can be used as baseline data for future firearm studies. A reduction in the incidence of such injuries can be guided by our findings but may be difficult due to sociopolitical barriers (e.g. socioeconomic status of the injured patients, differences in political opinion regarding gun control in the US, and geospatial patterns of firearm injury).
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Affiliation(s)
- Randall T Loder
- Orthopaedic Surgery, Riley Hospital for Children, Indianapolis, USA
| | - Abhipri Mishra
- Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bradley Atoa
- Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Allison Young
- Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA
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Fox PR, Hohenhaus AE, Kharbush RJ. Air Gun Ballistic Projectile Lodged in the Interventricular Septum of an Asymptomatic Dog. ACTA ACUST UNITED AC 2020; 4:531-533. [PMID: 33376848 PMCID: PMC7756176 DOI: 10.1016/j.case.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A gunshot to a dog embedded a metallic projectile in the interventricular septum. Direct cardiac penetration or venous embolism to the heart were hypothesized. No effusion, shunting, arrhythmia, or hemodynamic compromise was present. Serial echocardiography to monitor for delayed cardiac complications was elected.
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Affiliation(s)
- Philip R Fox
- Department of Cardiology and Caspary Research Institute, The Animal Medical Center, New York, New York
| | - Ann E Hohenhaus
- The Cancer Institute, The Animal Medical Center, New York, New York
| | - Rima J Kharbush
- Department of Cardiology, The Animal Medical Center, New York, New York
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