I. I. Maizlin1, G. F. Smith1, R. T. Russell1 1University Of Alabama at Birmingham,Pediatric Surgery,Birmingham, Alabama, USA
Introduction: Gunshot wounds (GSWs) are the second most common cause of traumatic pediatric deaths nationwide. Since most evaluations of pediatric GSWs were performed in urban settings, we utilized our institution’s data from a mostly rural catchment area to identify trends in circumstances and clinical outcomes resulting from unintentional pediatric GSWs and determine consequent geographical and age-based foci for most effective intervention.
Methods: A retrospective review of our institution trauma registry identified all pediatric patients (≤18 years old) admitted for unintentional GSWs between January 2000 and December 2015. Patients were stratified into 4 age groups: ≤5 years, 6-9 years, 10-14 years, 15-18 years. Demographics, patterns of injury, and outcomes were analyzed by χ2 and ANOVA. Incidence rates were collated by location and compared to the 2010 US Census data to create geographic representations (“heat maps”) of cases per 100,000 residents throughout the catchment area.
Results: 194 children (79.4% male, 72.0% African American) sustained unintentional GSWs, with mean age of 10.7 ±4.6 years. The most common utilized firearm was a handgun (54.2%), followed by a pellet gun (24.7%) and hunting rifle (5.3%). As compared to the overall national trauma mortality rate of 2.7%, unintentional GSWs in our facility resulted in mortality rate of 4.1%. Mean hospital stay was 4.7 days, with median Injury Severity Score (ISS) of 5 (Range 1-13) and most common injury site being the extremity. Young teenagers (10-14 years) were most likely to experience an unintentional GSW, with rates of injury being more than twice as likely as other age groups. Younger age groups were associated with higher mean ISS at presentation (15.8 vs. 10.8 vs. 9.0 vs. 5.7, p=0.011), though no difference in mortality rates (p=0.898) or length of hospitalization (p=0.449) were observed. The youngest patients were more likely to suffer injuries to head/neck and abdominal cavity, while young teenagers were more commonly shot in the extremities and older teenagers were most likely to experience thoracic trauma. Evaluation of geographic trauma locations (Figure 1), demonstrated that unintentional GSW rates increased as one approached urban centers of population.
Conclusion: We identified demographic and geographic trends regarding pediatric unintentional GSWs. Individuals 10-14 years of age are most likely to be victims of unintentional GSWs, with handguns as likeliest injury mechanism and probability of such traumas increased in the peri-urban areas. Utilizing consequent heat maps of the catchment area, we were able to determine the most effective areas and populations to be targeted for preventative intervention.
