Citation

Theodorou CM, Beyer CA, Vanover MA, Brown IE, Salcedo ES, Farmer DL, Hirose S, Beres AL. J. Pediatr. Surg. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Elsevier Publishing)

DOI

10.1016/j.jpedsurg.2021.12.031

PMID

unavailable

Abstract

Highlights

• Firearm violence and motor vehicle collisions are two common causes of injury among children and adolescents
• Firearm violence is significantly more lethal than motor vehicle collisions, with a case fatality rate nearly 50 times that of motor vehicle collisions

Introduction
: Firearms and motor vehicle collisions (MVC) are leading causes of mortality in children. We hypothesized that firearm injuries would have a higher mortality than MVCs in children and a higher level of resource utilization

Methods: Trauma patients <18 years old at a Level 1 pediatric trauma center sustaining gunshot wounds (GSW) or MVCs 2009-2019 were included. Primary outcome was mortality. Secondary outcome was immediate surgery. The California Department of Public Health's Overall Injury Surveillance tool was queried for patients <18 with GSW or MVC 2006-2015 to compare statewide case fatality rates (CFRs), and analyze proportions of GSWs by intent: assault, self-inflicted, and unintentional.

Results: Of 13,840 pediatric trauma patients at our institution, 295 GSWs (2.1%) and 4467 MVCs (32.3%) were included. Mortality was higher for GSWs (7.5% vs. 0.8%, p<0.0001). GSW patients were more likely to require immediate surgery (34.4% vs. 11.2%, p<0.0001). On multivariable analysis, GSW patients were 7.8-times more likely to die than MVC patients (OR 7.83, 95% CI 3.68-16.66, p<0.0001), adjusted for age, sex, and injury severity. Statewide, there were 10,790 pediatric GSWs with 1586 deaths (CFR 14.7%) vs. 710 deaths in 261,363 children in MVCs (CFR 0.3%, p<0.0001). The GSW CFR rose (13.4% to 16.5%, p=0.05) while the MVC CFR decreased (0.5% to 0.2%, p<0.0001) in 2015 vs. 2006.

Conclusion: Firearm violence in pediatric patients is significantly more lethal than MVCs and is resource intensive. The case fatality rate for pediatric firearm violence is rising. Resources must be directed at preventing pediatric firearm injuries.

Level of Evidence: Prognosis study, Level II

Language: en

Keywords

CDPH: California Department of Public Health; CFR: case fatality rate; ED: emergency department; firearm violence; ICU: intensive care unit; injury prevention Abbreviations GSW: gunshot wound; LOS: length of stay; mortality; motor vehicle collisions; MVC: motor vehicle collision; Pediatric Age-Adjusted; pediatric trauma; SIPA: Shock Index