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Using intent to get ahead of pediatric cranial firearm injuries
Carlos Theodore Huerta1, Rebecca A Saberi1, Gareth P Gilna1
1DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America.
Insights
Pediatric cranial firearm injuries (PCFI) have a high mortality rate of 43%. Injury intent significantly impacts patient demographics and outcomes, with assault-related PCFI showing the highest readmission rates.
Area of Science:
- Public Health
- Trauma Surgery
- Pediatric Critical Care
Background:
- Pediatric firearm injuries (PFI) represent a significant public health concern.
- Limited understanding exists regarding how injury intent influences outcomes specifically for pediatric cranial firearm injuries (PCFI).
Purpose of the Study:
- To compare the demographics and outcomes of pediatric cranial firearm injuries (PCFI) based on the intent of the injury.
- To identify patterns in PCFI that can inform targeted interventions.
Main Methods:
- Utilized the Nationwide Readmission Database (2010-2014) to identify patients under 18 years old with PCFI.
- Compared demographics and outcomes across injury intents: assault, self-inflicted, and unintentional.
- Employed weighted analyses to generate national estimates for a population-based cohort study.
Main Results:
- Identified 1,365 cases of PCFI, constituting 11% of all PFI.
- Overall PCFI mortality was 43%, substantially higher than the 6% for all PFI.
- Assault was the most common intent (51%), associated with lower-income households and higher unplanned readmission rates (77%).
- Unintentional injuries were more prevalent in younger children (<13 years) and associated with facial fractures.
- Readmission rate within one year was 21%, with the majority being unplanned.
Conclusions:
- Pediatric cranial firearm injuries are linked to considerable morbidity and mortality.
- Demographic characteristics and clinical outcomes of PCFI differ significantly based on injury intent.
- Understanding these intent-specific patterns is crucial for developing effective interventions to reduce PCFI and improve patient outcomes.
Objective:
Pediatric firearm injuries (PFI) are a public health crisis. Little is known about how injury intent may influence the outcome of pediatric cranial firearm injuries (PCFI). The current study sought to compare demographics and outcomes of PCFI based on intent of injury.
Methods:
The Nationwide Readmission Database (2010-2014) was queried to identify patients <18 years old with PCFI. Demographics and outcomes were compared by injury intent (assault, self-inflicted, unintentional), and results were weighted for national estimates to create a population-based cohort study.
Results:
There were 1,365 cases of PCFI identified for an incidence of 11% of all PFI. The majority of patients were male (83 %), >13 years (81 %), and had an injury severity score >15 (79 %). Overall PCFI mortality was 43 %, compared to 6 % for all PFI. Assault was the most common intent (51 %), followed by self-inflicted (25 %), and unintentional (24 %). Assault was more likely to occur in patients from low-income households (61 % vs. 31 % self-inflicted vs. 42 % unintentional), p < 0.001. Unintentional injuries occurred in those <13 years old (40 % vs. 12 % assault vs. 16 % self-inflicted) and more often resulted in facial fracture (19 % vs. 11 % vs. 13 %), all p < 0.001. Readmission rate within the year was 21 %. The majority (56 %) of readmissions were unplanned, and the rate was highest for assault (77 % vs. <1 % self-inflicted vs. 44 % unintentional, p < 0.001).
Conclusions:
PCFI are associated with significant morbidity and mortality. Demographics and outcomes vary by intent of injury; knowledge of these patterns can direct future interventions to reduce injuries and impact outcomes.
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