Z.T. O’Connor4, E. Pracht3, A. Green2, C.W. Snyder2 2Johns Hopkins All Children’s Hospital, Division Of Pediatric Surgery, St. Petersburg, FL, USA 3University of South Floirda, College Of Public Health, Tampa, FLORIDA, USA 4University of South Florida, College Of Arts And Science, Tampa, FL, USA
Introduction:
Firearm injuries are rising in Florida among all age groups. Hospitals may have age-based limitations on surgical services that may not align with the state definition of pediatric trauma patients (age ≤ 15). Understanding the surgical needs of patients with firearm injuries at the extremes of age can help optimize hospital readiness and secondary prevention.
Methods:
The Agency for Healthcare Administration database was queried for all patients admitted to a Florida hospital with a firearm injury between 2015-2021. Procedure codes were categorized based on U.S. Agency for Healthcare Research and Quality clinical classifications. Surgical and critical care (intubation, blood transfusion, chest tube placement) procedures were included in analysis. Patients were categorized by age in years: children (0-13), young adolescents (14-15), older adolescents (16-17), adults (18-64), and elderly (65+). Demographics, injury characteristics and procedure types were described and compared by age group. Multivariable logistic regression was used to evaluate the independent effect of age on surgical resource utilization.
Results:
The study included 16,263 firearm injuries, of which 295 (2%) were children, 303 (2%) young adolescents, 824 (5%) older adolescents, and 886 (5%) elderly. Overall mortality was 8%. A majority of patients required either a surgical (72%) or critical care procedure (36%). Neurosurgical procedures were performed in 3% of patients overall, but were highest among children (8%) and young adolescents (7%, p<0.0001). Elderly patients were less likely to have abdominal surgery (17%, p<0.0001), and children were less likely to have orthopedic surgery (29%, p<0.0001). On logistic regression modeling with adjustment for sex, race/ethnicity, insurance, transfer status, shooting intent, firearm type, and injury severity score, children were more likely to undergo a neurosurgical procedure compared to adults (odds ratio 2.37, 95% confidence interval 1.49-3.77). Adjusted rates of intubation and blood transfusion were similar for all age groups.
Conclusion:
In this statewide cohort of firearm injury patients, 72% required surgery and 36% required critical care procedures. Rates of surgical resource utilization varied by age, with children at greatest risk to require neurosurgical procedures. These findings highlight the importance of hospital readiness to deliver immediate critical care resources to all ages, and ensure appropriate surgical resources are available for firearm injury patients at extremes of age.