J. Tashiro1, C. J. Allen2, E. A. Perez1, H. L. Neville1, C. I. Schulman2, J. E. Sola1 1University Of Miami,Division Of Pediatric Surgery, DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA 2University Of Miami,Division Of Trauma And Critical Care, DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA
Introduction:
Although firearms account for less than 5% of all pediatric injuries, they have the highest associated case fatality rate. In the U.S., pediatric hospitalizations and deaths from firearms have continued to increase with most of these injuries occurring in metropolitan settings. We sought to examine factors associated with mortality due to firearm injuries in pediatric patients treated at an urban trauma center.
Methods:
We queried the trauma registry at a large, urban, Level 1 trauma center for all patients aged <18 years evaluated for firearm injuries from 1991-2011. Descriptive statistics and risk-adjusted multivariate analyses (MVA) were used.
Results:
Overall, 1085 patients were identified. The cohort had a median (IQR) age of 16 (2) years, LOS 2.4 (4.3) days, and most were male (86%), black (74%), sustained intentional injuries (93%) and were admitted to hospital (68%). The most commonly injured locations were abdomen (20%), extremities (19%), and chest (15%). Immediate operations were performed in 33% (n=358) of patients with most having abdominal surgery (n=214). Survival was 86% (7% expired in emergency department), but higher for blacks (OR=1.92) than for Hispanics (p=0.006). Blacks were more likely to sustain extremity (OR=2.26) and less head (OR=0.36) injuries than Hispanics (p<0.001), see Table. Analysis by injury location showed that head (OR=14.1) had the highest associated mortality followed by multiple major by Abbreviated Injury Scale (AIS) with central nervous system (7.30), chest (OR=2.68), and multiple major by AIS (OR=2.52) compared to abdomen (p<0.02). Most deaths occurred in patients with head (43%) or chest (21%) gunshot wounds. No fatalities occurred following scalp, face, or extremity injuries. MVA demonstrated that white children were 8.06 times more likely to die from a firearm injury than Hispanics (p=0.013). Children admitted with initial pH ≤ 7.15 (OR=21.8), initial hematocrit ≤ 30 (OR=4.69), or Injury Severity Score (ISS) > 15 (OR=7.73) had higher mortality rates (p<0.006).
Conclusion:
Analysis of pediatric firearm injuries treated at an urban trauma center demonstrates that most patients are male, black, teenagers who are more likely to sustain extremity rather than higher mortality head injuries seen more frequently in whites and Hispanics. On risk-adjusted MVA, white children are more likely to die than Hispanics. Initial pH, hematocrit, and ISS are significant independent predictors of mortality following firearm injury in children.
