The Long-term Outcome of Retained Foreign Bodies in Pediatric Gunshot Wounds

Mazotas, Ioanna G.; Hamilton, Nicholas A.; McCubbins, Mary A.; Keller, Martin S.

doi:10.1097/jtn.0b013e31827757a7

Cited by 25 publications

(29 citation statements)

References 17 publications

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“…Many patients discharged from the Emergency Department in the later years of the study did not return for foreign body removal or may have followed up at another institution leading to a false trend. A study of children with retained bullets found that 22% had a complication while 13% required removal, regardless of the body area injured [21]. This study also found 13% of patients undergoing delayed operation, many for retained bullets.…”

Section: Discussionmentioning

confidence: 85%

“…Non-operative management of blunt injuries is widely accepted and in the past twenty years non-operative management of penetrating injuries has been discussed in both adult and pediatric populations [19][20][21][22]. There is a high rate of solid organ injury in blunt trauma to the abdomen while firearm and other penetrating injuries often injure hollow organs, requiring operative management [20].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in pediatric firearm-related injuries over the past 10 years at an urban pediatric hospital

Veenstra

Patel

Donoghue

et al. 2015

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Trends in pediatric firearm-related injuries over the past 10 years at an urban pediatric hospital

Veenstra

Patel

Donoghue

et al. 2015

Journal of Pediatric Surgery

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“…Of those, 48 were Level V evidence, reducing the count to seven studies; hand searching the bibliographies of these yielded one additional study. The final number of studies included in this review therefore was eight, including seven Level IV studies (case series) [1,2,11,15,19,22,28] and one Level III study (retrospective study with a control group) [30] (Table 1).…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Indications for late bullet fragment removal were evaluated in a Level IV study performed by Mazotas et al [15]. In this study, which evaluated pediatric patients with retained bullet fragments, 34% of patients had fragmentrelated complications.…”

Section: Selected Indications For Bullet Removalmentioning

confidence: 99%

Retained Bullet Removal in Civilian Pelvis and Extremity Gunshot Injuries: A Systematic Review

Riehl

Sassoon

Connolly

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although gunshot injuries are relatively common, there is little consensus about whether retained bullets or bullet fragments should be removed routinely or only in selected circumstances. Questions/purposes We performed a systematic review of the literature to answer the following questions: (1) Is bullet and/or bullet fragment removal from gunshot injuries to the pelvis or extremities routinely indicated? And, if not, (2) what are the selected indications for removal of bullets and/or bullet fragments? Methods A search of the English-language literature on the topic of gunshot injury and bullet removal was performed using the National Library of Medicine and MEDLINE 1 and supplemented by hand searching of bibliographies of included references. Studies were included if they provided clinical data on one or both of our study questions; included studies were evaluated using the levels of evidence rubric. Most studies on the subject were expert opinion (Level V evidence), and these were excluded; one Level III study and seven Level IV studies were included.Results No studies provided a rationale for routine bullet removal in all cases. The studies identified bullet fragment removal as indicated acutely for those located within a joint, the palm, or the sole. Chronic infection, persistent pain at the bullet site, and lead intoxication were reported as late indications for bullet removal. Conclusions The evidence base for making clinical recommendations on the topic of bullet and bullet fragment removal after gunshot injury is weak. Level I and II evidence is needed to determine the indications for bullet removal after gunshot injury.

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“…4 Keller and coworkers described 244 children who sustained a fire arm wound during a 3 year study period at our pediatric level-one trauma center. 6 With these limited reports for traumatic wound volume, the scope of caring for a pediatric traumatic wound remains unclear. The literature is even less regarding the cost and morbidity associated with caring for traumatic wounds in children.…”

Section: Introductionmentioning

confidence: 99%

Management of Traumatic Wounds and a Novel Approach to Delivering Wound Care in Children

Bernabe

Desmarais

Keller

2014

Advances in Wound Care

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Significance:The costs and morbidity of pediatric traumatic wounds are not well known. The literature lacks a comprehensive review of the volume, management, and outcomes of children sustaining soft tissue injury. We briefly review the existing literature for traumatic wounds such as open fractures and burns. Such injuries require dedicated wound care and we propose a novel approach for more efficient and more effective delivery of dedicated pediatric wound care. Recent Advances: New pediatric literature is emerging regarding the longterm effects of wound care pain in traumatic injuries-especially burns. A variety of wound dressings and alternative management techniques exist and are geared toward reducing wound care pain. Our institution utilizes a unique model to provide adequate sedation and pain control through a dedicated pediatric wound care unit. We believe that this model reduces the cost of wound care by decreasing emergency department and operating room visits as well as hospital length of stay. Critical Issues: First, medical costs related to pediatric traumatic wound care are not insignificant. The need for adequate pain control and sedation in children with complex wounds is traditionally managed with operating room intervention. Afterward, added costs can be from a hospital stay for ongoing acute wound management. Second, morbidities of complex traumatic wounds are shown to be related to the acute wound care received. Future Directions: Further guidelines are needed to determine the most effective and efficient care of complex traumatic soft tissue injuries in the pediatric population. SCOPE AND SIGNIFICANCEAccording to the National Trauma Data Bank, 127,234 children were admitted to a hospital for trauma in 2012. 1 Trauma is well known to be the leading cause of morbidity and mortality in children. The number of soft tissue wounds in this population, though, is not well defined. Wounds result from blunt, penetrating, and thermal mechanisms and can pose management challenges. These management challenges include initial management of a complex wound; pain and sedation control for wound evaluation and care; ongoing delivery of wound care; and the psychological morbidity associated with traumatic wounds. TRANSLATIONAL RELEVANCEThe heightened awareness of medical cost and impact of hospitalization on the family of the injured child will drive the evolution of wound care to a more effective and efficient strategy. 2 With this strategy in mind, we have instituted a unique model at our institution for the delivery of pediatric wound care that is utilized in traumatic wounds. CLINICAL RELEVANCEBefore introducing this wound care model, we review in greater detail the types and current management of traumatic wounds with a focus on more complex injuries. We discuss the development of our novel approach to caring for these traumatic wounds. This model reduces the cost associated with the number of emergency department and operating room visits as well as the hospital length of stay for our pediatric patients....

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The Long-term Outcome of Retained Foreign Bodies in Pediatric Gunshot Wounds

Cited by 25 publications

References 17 publications

Trends in pediatric firearm-related injuries over the past 10 years at an urban pediatric hospital

Trends in pediatric firearm-related injuries over the past 10 years at an urban pediatric hospital

Retained Bullet Removal in Civilian Pelvis and Extremity Gunshot Injuries: A Systematic Review

Management of Traumatic Wounds and a Novel Approach to Delivering Wound Care in Children

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