Radiological method and findings in pediatric cranial firearm injuries

Abstract

Background Firearm Injuries are growing problem due to rising civil wars, terrorist acts, and the spread of personal armament. Notably, there has been a reported rise in firearm injury and fatal cases among children and young people, who are particularly vulnerable to widespread violent behavior. Early diagnosis and treatment, including radiological imaging after initial intervention, can reduce mortality and morbidity in firearm injury cases Objective To explore the demographic characteristics and computerized tomography findings of pediatric patients with cranial firearm injuries and comparing the advantages and disadvantages of conventional radiography and tomography. Materials and methods This study included cases of cranial firearm injuries presented to the pediatric emergency department of XXX City Training and Research Hospital between January 1, 2018, and December 31, 2021. Data recorded for each case included age, gender, clinical course, and weapon type. Cranial tomography images were reviewed for entry and exit wounds, bullet trajectory, brain damage, bone fractures, distribution of bone fragments, bullet core fragments and their distribution. Results Of the 12 cases included in this study, 10 were male, 2 were female, with a mean age of 143 ± 46.5 months. In the five cases injured by a shotgun, subcutaneous pellets were seen in the penetration area at bone and parenchymal doses on cranial tomography axial images. In 2 cases of handgun injury, a subcutaneous bullet core was found in the temporal region while another bullet core had penetrated the skin and bone in the frontal region without causing any brain tissue damage. In four cases with handgun injuries, the bullet core penetrated the skin and cranial bones, causing brain tissue damage. Seven cases with subcutaneous pellets or bullet cores identified radiologically were treated in emergency department. Five patients with firearm injuries required hospitalization, of which two did not survive. Conclusion Cranial tomography has many advantages over x-ray ımaging. Axial images provide essential information on the bullet core, entry and exit wounds, primary and secondary parenchymal damage, hemorrhage, edema, bone fractures, and bullet or pellet residue. This imaging modality aids clinicians in deciding on medical or surgical interventions, selecting treatment types, monitoring treatment efficacy, and predicting mortality. It is an effective, recommended method that offers forensic physicians rapid and reliable insights into weapon type, bullet core trajectory, and skull fractures, thereby facilitating both clinical and forensic assessments.