W. A. Young1, C. S. Muratore1, F. I. Luks1, W. G. Cioffi2, D. S. Heffernan2 1Hasbro Children’s Hospital, Rhode Island Hospital And Alpert Medical School Of Brown University,Division Of Pediatric Surgery,Providence, RHODE ISLAND, USA 2Rhode Island Hospital And Alpert Medical School Of Brown University,Division Of Trauma And Acute Care Surgery,Providence, RHODE ISLAND, USA
Introduction: Adolescent patients are increasingly vulnerable to gang violence and penetrating trauma with lifelong physical and psychosocial consequences. Male and female adolescents experience different societal influences and peer pressures. Socioeconomic disparities have been reported in adult trauma victims. Specifically, we have shown that health care insurance, as a marker of Socioeconomic Status (SES), is associated with worse outcome following traumatic injuries. However, there is a paucity of data among pediatric patients. We reviewed socioeconomic and gender differences with respect to risk factors for, and patterns of, injury in adolescent penetrating trauma patients.
Methods: Retrospective review of adolescent penetrating trauma patients aged 12-18 inclusive over a 5 year period admitted to the states only Level 1 trauma center. Data was collected from the prospectively maintained trauma database for demographics including insurance status, location (street vs. home) and intent of injury, all injuries sustained and Injury Severity Score (ISS). Hospital course included operations, complications, length of stay, mortality and disposition.
Results: Of 158 patients, 80% male, no difference existed between sexes in age (16 vs 16years;p=0.9), or rates of intoxication (95% vs 75%;p=0.32), but males had higher ISS (7.8 vs 3.4;p<0.05), more likely injured on the street (32.8% vs 18%;p<0.01) versus home (33.6% vs 69%;p<0.01), less likely from self-harm (11% vs 56%;p<0.001). No guns were used in either home or street for self-harm/suicide in either gender. Of the injuries occurring in the home, females were more likely to self-harm (78% vs 22%;p<0.001). There was no difference in street-related gunshot injuries between males and females (35% vs 33%;p=0.9). Self-harm was significantly more likely to occur among insured patients (59% vs 11.1%;p<0.001). However, within the insured adolescents, penetrating trauma among females, compared to males, was dramatically more likely to be from self-harm (91.6% vs 24%;p<0.0001). Overall, there were no differences in length of stay, ICU admission or mortality.
Conclusion:
Socioeconomic and social disparities exist among adolescent penetrating trauma victims. Despite perceptions that males predominate gang-related trauma, we have shown that males and females are equally victims of street related gun violence. Despite outreach interventions, gang related violence continues to increase, especially among uninsured (lower SES) adolescents. Our data argues for increased efforts developing activities and alternatives to street violence. However, a distinct pediatric trauma population exists that is potentially neglected by current programs. These are socially isolated, vulnerable female adolescents participating in self-harm at home. This highlights the need for programs to develop coping mechanisms and self-esteem in the pre-teen years to off-set societal pressures in young females.