BACKGROUND: Although firearms account for less than 5 % of all pediatric injuries, they have the highest associated case fatality rate. METHODS: The registry at a Level-1 trauma center was used to identify firearm injuries (<18 years of age) from 1991 to 2011. Descriptive statistics and risk-adjusted multivariate analyses (MVA) were performed. RESULTS: Overall, 1085 patients were identified. Immediate operations were performed in 33 % (n = 358) of patients with most having abdominal surgery (n = 214). Survival was 86 %, but higher for African Americans (OR = 1.92) than for Hispanics (p = 0.006). African Americans were more likely to sustain extremity (OR = 2.26) and less head (OR = 0.36) injuries than Hispanics (p < 0.001). Analysis by injury location showed that head (OR = 14.1) had the highest associated mortality. Other significant predictors included multiple major injury (defined by Abbreviated Injury Scale) with central nervous system involvement (OR = 7.30) and single injuries to the chest (OR = 2.68). These findings were compared to abdominal injuries as the baseline (p < 0.02). MVA demonstrated that Caucasian children had higher mortality (OR = 6.12) vs. Hispanics (p = 0.031). Children admitted with initial pH ≤ 7.15 (OR = 14.8), initial hematocrit ≤30 (OR = 3.24), or Injury Severity Score (ISS) > 15 (OR = 1.08) had higher mortality rates (p < 0.05). CONCLUSION: Independent significant indicators of mortality include low initial pH or hematocrit, Caucasian race, high ISS, and those who sustain head injuries.
BACKGROUND: Although firearms account for less than 5 % of all pediatric injuries, they have the highest associated case fatality rate. METHODS: The registry at a Level-1 trauma center was used to identify firearm injuries (<18 years of age) from 1991 to 2011. Descriptive statistics and risk-adjusted multivariate analyses (MVA) were performed. RESULTS: Overall, 1085 patients were identified. Immediate operations were performed in 33 % (n = 358) of patients with most having abdominal surgery (n = 214). Survival was 86 %, but higher for African Americans (OR = 1.92) than for Hispanics (p = 0.006). African Americans were more likely to sustain extremity (OR = 2.26) and less head (OR = 0.36) injuries than Hispanics (p < 0.001). Analysis by injury location showed that head (OR = 14.1) had the highest associated mortality. Other significant predictors included multiple major injury (defined by Abbreviated Injury Scale) with central nervous system involvement (OR = 7.30) and single injuries to the chest (OR = 2.68). These findings were compared to abdominal injuries as the baseline (p < 0.02). MVA demonstrated that Caucasian children had higher mortality (OR = 6.12) vs. Hispanics (p = 0.031). Children admitted with initial pH ≤ 7.15 (OR = 14.8), initial hematocrit ≤30 (OR = 3.24), or Injury Severity Score (ISS) > 15 (OR = 1.08) had higher mortality rates (p < 0.05). CONCLUSION: Independent significant indicators of mortality include low initial pH or hematocrit, Caucasian race, high ISS, and those who sustain head injuries.
Authors: Siu W Lam; Luke P H Leenen; Wouter W van Solinge; Falco Hietbrink; Albert Huisman Journal: Clin Chem Lab Med Date: 2011-01-31 Impact factor: 3.694
Authors: Dylan Pannell; Jeffery Poynter; Paul W Wales; Homer Tien; Avery B Nathens; David Shellington Journal: Can J Surg Date: 2015-06 Impact factor: 2.089
Authors: Tina L Cheng; Sara Johnson; Joseph L Wright; Amari Sokoya Pearson-Fields; Ruth Brenner; Donald Schwarz; Regina O'Donnell; Peter C Scheidt Journal: Acad Emerg Med Date: 2006-04-11 Impact factor: 3.451
Authors: Matthew E Kutcher; Benjamin M Howard; Jason L Sperry; Alan E Hubbard; Anna L Decker; Joseph Cuschieri; Joseph P Minei; Ernest E Moore; Bernard H Brownstein; Ronald V Maier; Mitchell Jay Cohen Journal: J Trauma Acute Care Surg Date: 2015-03 Impact factor: 3.313
Authors: Brent Whittaker; Sarah C Christiaans; Jessica L Altice; Mike K Chen; Alfred A Bartolucci; Charity J Morgan; Jeffrey D Kerby; Jean-François Pittet Journal: Shock Date: 2013-05 Impact factor: 3.454
Authors: Ruhee Shah; Alessandra Della Porta; Sherman Leung; Margaret Samuels-Kalow; Elizabeth M Schoenfeld; Lynne D Richardson; Michelle P Lin Journal: West J Emerg Med Date: 2021-10-27