Gunshot Injuries in Children Served by Emergency Services

Abstract

OBJECTIVE To describe the incidence, injury severity, resource use, mortality, and costs for children with gunshot injuries, compared with other injury mechanisms. METHODS This was a population-based, retrospective cohort study (January 1, 2006–December 31, 2008) including all injured children age ≤19 years with a 9-1-1 response from 47 emergency medical services agencies transporting to 93 hospitals in 5 regions of the western United States. Outcomes included population-adjusted incidence, injury severity score ≥16, major surgery, blood transfusion, mortality, and average per-patient acute care costs. RESULTS A total of 49 983 injured children had a 9-1-1 emergency medical services response, including 505 (1.0%) with gunshot injuries (83.2% age 15–19 years, 84.5% male). The population-adjusted annual incidence of gunshot injuries was 7.5 cases/100 000 children, which varied 16-fold between regions. Compared with children who had other mechanisms of injury, those injured by gunshot had the highest proportion of serious injuries (23%, 95% confidence interval [CI] 17.6–28.4), major surgery (32%, 95% CI 26.1–38.5), in-hospital mortality (8.0%, 95% CI 4.7–11.4), and costs ($28 510 per patient, 95% CI 22 193–34 827). CONCLUSIONS Despite being less common than other injury mechanisms, gunshot injuries cause a disproportionate burden of adverse outcomes in children, particularly among older adolescent males. Public health, injury prevention, and health policy solutions are needed to reduce gunshot injuries in children.

Bullet Vascular Injury at a Pediatric Age: A Two-Case Report from Saudi Arabia

“…In the United States, weapons have a mortality rate of 10.26 per 100,000 people, with 606 (1.9%) of these deaths being accidental [9]. Gunshots caused the most serious injuries in children aged 18 and under, with 32% requiring major surgery, 8% resulting in in-hospital mortality, and an average cost of USD 28,510 per patient [10].…”

Analysis of Children Brought to the Emergency Department Due to Gunshot Injuries: A 7-Year Retrospective Analysis

“…This mortality rate was affected by the injury site and the number of injured organs (9). According to a study by Newgard et al, although GSIs constitute only 1% of disabled children, it was observed that they were associated with more than 20% of deaths after injury (12). In another study, although GSI-related deaths constituted 22.5% of children and adolescents within the age range of 1 -19 years, they constituted 32.2% of all injury deaths among adolescents aged 15 -19 years (13).…”

Individual and neighborhood level characteristics of pediatric firearm injuries presenting at trauma centers in Colorado

“…Previous research has identified that up to 30.0% of pediatric patients injured by firearms die at the scene. 33 While our data consist of patients who presented to one of the four major PTCs in the state, we are underestimating total pediatric firearm injuries because we did not include firearm injuries from additional EDs, injuries that were fatal before arrival to the ED, or those that did not require ED care. The trauma registry data include injuries from air guns; however, it should be noted that injuries from air, BB, and pellet guns are not considered firearm injuries per the Centers for Disease Control and Prevention but are causes of gunshot wounds.…”

“…Furthermore, the data presented herein are only descriptive and cannot infer the specific cause of disparities in pediatric firearm-related violence in our state. Previous research has identified that up to 30.0% of pediatric patients injured by firearms die at the scene 33 . While our data consist of patients who presented to one of the four major PTCs in the state, we are underestimating total pediatric firearm injuries because we did not include firearm injuries from additional EDs, injuries that were fatal before arrival to the ED, or those that did not require ED care.…”