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Mortality and PICU Hospitalization Among Pediatric Gunshot Wound Victims in Chicago
Maya A Rhine1, Emma M Hegermiller2, Jason M Kane3
1Pritzker School of Medicine, The University of Chicago, Chicago, IL.
Insights
Pediatric firearm injuries are a serious concern. Younger children with gunshot wounds (GSWs) face longer hospital stays and higher intensive care unit admission rates, indicating increased risk.
Area of Science:
- Pediatric Trauma Surgery
- Public Health
- Epidemiology
Background:
- Firearm injuries cause significant morbidity and mortality in children admitted to pediatric intensive care units (PICUs).
- Understanding risk factors for PICU admission is crucial for developing effective prevention and intervention strategies for pediatric gunshot wound (GSW) injuries.
Purpose of the Study:
- To characterize outcomes and identify factors associated with PICU admission in pediatric GSW patients.
- To analyze demographic and injury severity measures in relation to GSW outcomes.
Main Methods:
- A retrospective cohort study was conducted involving GSW patients aged 0-18 years.
- Data were collected from 2010 to 2017 at the University of Chicago Comer Children's Hospital Pediatric Trauma Center.
- Logistic regression models were used to assess the association between PICU admission and patient characteristics.
Main Results:
- Over an 8-year period, 294 children sustained GSWs. Mortality for GSW patients exceeded all-cause PICU mortality.
- Younger children (0-6 years) had longer hospitalizations (5 vs. 3 days) and higher PICU admission rates (83.3% vs. 52.9%) compared to older children (13-16 years).
- Children under 7 years old were four times more likely to be admitted to the PICU than those aged 13-16, even after adjusting for illness severity.
Conclusions:
- Pediatric firearm injury mortality did not decrease over time in the study cohort and remained higher than general PICU mortality.
- Younger children with GSWs experience prolonged hospitalizations and are more frequently admitted to the PICU.
- The youngest victims of firearm injuries are particularly vulnerable to long-term critical illness and injury sequelae.
Abstract:
Firearm injury accounts for significant morbidity with high mortality among children admitted to the PICU. Understanding risk factors for PICU admission is an important step toward developing prevention and intervention strategies to minimize the burden of pediatric gunshot wound (GSW) injury.
Objectives:
The primary objective of this study was to characterize outcomes and the likelihood of PICU admission among children with GSWs.
Design Setting And Participants:
Retrospective cohort study of GSW patients 0-18 years old evaluated at the University of Chicago Comer Children's Hospital Pediatric Trauma Center from 2010 to 2017.
Main Outcomes And Measures:
Demographic and injury severity measures were acquired from an institutional database. We describe mortality and hospitalization characteristics for the cohort. We used logistic regression models to test the association between PICU admission and patient characteristics.
Results:
During the 8-year study period, 294 children experienced GSWs. We did not observe trends in overall mortality over time, but mortality for children with GSWs was higher than all-cause PICU mortality. Children 0-6 years old experienced longer hospitalizations compared with children 13-16 years old (5 vs 3 d; p = 0.04) and greater frequency of PICU admission (83.3% vs 52.9%; p = 0.001). Adjusting for severity of illness, children less than 7 years old were four-fold more likely to be admitted to the PICU than children 13-16 years old (aOR range, 3.9-4.6).
Conclusions And Relevance:
Despite declines in pediatric firearm mortality across the United States, mortality did not decrease over time in our cohort and was higher than all-cause PICU mortality. Younger children with GSWs experience longer hospitalizations and require PICU care more often than older children. Our findings suggest that the youngest victims of firearm-related injury may be particularly at-risk of the long-term sequelae of critical illness and injury.
