A Six Year Retrospective Review Of Pediatric Firearm Injuries

Monday, October 28, 2013: 1:15 PM
Plaza International Ballroom E-F (Hyatt Regency Orlando, formerly the Peabody)
Phyllis Hendry, MD1, Andrea Suen, MD1, Colleen J. Kalynych, MSH, EdD1 and Julia Paul, RN, MSN2, (1)University of Florida College of Medicine/Jacksonville, Jacksonville, FL, (2)Shands Jacksonville, Jacksonville, FL

Purpose

Pediatric firearm injuries are an increasing source of morbidity and mortality. Epidemiologic trends assist in determining effective prevention strategies and address disparities. The study site is an urban state designated Level I trauma center (TC) and receiving area for children with firearm injuries.  Firearm injuries in adolescents are common; however, younger children are not well studied.  Study purpose was to determine trends in pediatric firearm injuries to develop prevention strategies and prospective statewide study model. Aims were to describe epidemiology of firearm injuries in patients 0-18 years old (y/o) presenting to a pediatric TC and emergency department (ED) and perform case study of patients ≤ 14 y/o for determining shooting characteristics and patterns.

Methods

Part I abstracted data from the hospital’s trauma registry. Inclusion criteria were patients 0-18 y/o presenting to study site January 2005 to December 2010 with firearm injury and registry inclusion. Exclusions were incomplete records or ≥ 19 y/o.  Demographic data was extracted and injury site, arrival mode, disposition.   Part II included detailed retrospective review of patients ≤14 y/o including TC and hospital medical records, rescue and crime scene reports. Data abstracted from 0-14 group included shooting details (gun type, shooter characteristics) and treatment information (procedures, discharge diagnoses, medical and social history).   Data was entered in RedCap™ (Research Electronic Data Capture) for statistical analysis with further analysis pending upon review of crime scene records.

Results

Trauma database query resulted in 456 patients (0-18 y/o), including 78 patients ≤ 14 y/o. Medical and rescue records were obtained for 70 of 78 patients. In the 0-18 y/o group 86% were male versus 72% in 0-14 y/o. Eighty percent African American (0-18y/o); 64% in 0-14 y/o group. Death in 7.5% (0-18 y/o) and 9% (0-14 y/o).  Mode of arrival: 21% (0-18 y/o) arrived via private car or walk-in compared to 11% (0-14 y/o). Disposition was discharged to home in 80% of both categories.

The ≤ 14 y/o group revealed average time of presentation as 1657. Common procedures: irrigation and dressing (26%), intubation (21%) and blood transfusion (14%). Shooter relationship was unknown person (69%); known persons (30%)- sibling (6%), friend (7%), parent/other family (4%) and other relationships (13%). Mental, medical or developmental disabilities were documented in 17%. Common injury sites were extremities (37%), trunk (27%), head (10%), and neck (6%). Types of firearms included 64% unknown.  Only 13% documented child protective services notification. 

Conclusion

In light of recent national firearm tragedies, there is renewed interest in firearm safety and prevention.  Preliminary results from this study suggest firearm injuries differ in younger victims compared to adolescents.  Emergency records often lack important shooting details necessary in developing effective crime and prevention strategies. Barriers included difficulty in matching law enforcement, rescue, and hospital records and missing data.