Characteristics of Penetrating Abdominal Firearm Injuries in Children

Abstract

Penetrating injuries of the abdomen which occur primarily from gunshots and stabbing become increasingly prevalent in children. Our purpose is to assess the presentation, management and outcome of children with penetrating abdominal firearm injuries (PAFI) and to evaluate the value of Injury Severity Score (ISS) for predicting injury severity and eventual morbidity and mortality in children with PAFI. Between 1985 and 1997, 69 children < or = 15 years of age with PAFI were hospitalized at our institution. Their hospital records were reviewed retrospectively. Of the 69 children with PAFI, 53 were boys and 16 were girls. The mean age was 9.6. The causes of PAFI were explosives (44%), gunshot (39%) and shotgun injuries (17%). The most common organ injured was the small bowel followed by colon and liver respectively. Postoperative complications were seen in 12 children. The mean value of ISS was 16.8; 41 children had an ISS value of > or = 16. The value of ISS was significantly higher in children with complication than in those without complication. The children with ISS value > or = 16 were hospitalized significantly longer than those with < or = 15 of ISS. Particularly shotgun injuries were commonly associated with severe morbidity. ISS can be useful for predicting the severity of injury and the occurrence of morbidity.

Management of Anorectal Injuries in Children: An Eighteen-Year Experience

“…In a recent report, 11 of 16 such injuries were due to sexual abuse (3). In the southeastern part of Turkey, children are common victims of road-traffic accidents, falls from heights and penetration injuries (8,23). Therefore the mechanism of injury was usually blunt trauma (76%) in the majority of our patients.…”

Penetrating injuries in children: Is there a message?

“…Much of the information on non‐operative management has been derived from adult experience or from countries with a much higher incidence of serious penetrating injury 27−30 . Children, with their thinner thoracoabdominal wall and higher concen­tration of viscera within a smaller volume, are more likely to sustain a significant injury and require operative intervention 26,31 . As highlighted in one of the case examples in the present study, exploration under local anaesthesia outside the operating theatre can be inaccurate and often fails to identify the true path of the penetrating wound.…”

“…These data suggest early paediatric surgical involvement or transfer of the patient to an institution where the appropriate anaesthetic, surgical and intensive care expertise is available. In the Australian context, where the individual paediatric clinician's experience of significant penetrating trauma remains low (in comparison to the USA or South Africa), we would advocate routine exploration of nearly all wounds in the operating theatre 26 . In two of the patients in the present series (both stab wounds to the torso), haemodynamic stability following initial resuscitation prompted the treating surgeon to defer surgical intervention until the patient had deteriorated.…”

Vulnerability of children to gunshot trauma in violence-prone environment: The case of South Africa

“…The tragic consequences for children of the presence of firearms in the society are increasing worldwide. [5,26,27] In South Africa in 2004, there were 4.5 million registered firearms, including 2.8 million handguns. Additionally, there were an estimated 500,000 to 1 million illegal firearms in circulation; one firearm for every eight to nine South Africans.…”