Pediatric Firearm Injury: Comparing age-Adjusted Shock Indices for Prediction of Emergency Interventions

To characterize pediatric firearm injury (PFI) and identify predictors of outcomes relevant to emergency care interventions.

We conducted a retrospective registry review of pediatric patients (below 18 y) presenting to a single level-1 trauma center located in Seattle, Washington, from 2018 through 2023. PFI patients were compared with the otherwise injured patients by anatomic or physiological severity indices, such as injury severity score (ISS) and 3 types of age-adjusted shock index. The shock indices included shock index pediatric age-adjusted, pediatric shock index, and Advanced Trauma Life Support-based shock index (ATLS-SI). Multivariable logistic regression was performed to identify predictors of the need for transfusion or surgical intervention.

Of 2610 total trauma patients, 230 (8.8%) were injured by firearms with a median age of 16.0 years (interquartile range: 14.0 to 17.0) and a male proportion of 80.4%. When compared with other injury mechanisms, PFI was associated with more frequent vascular injuries (PFI, 19.1% vs. others, 4.3%), transfusions (31.7% vs. 10.2%), and surgical interventions (23.5% vs. 6.7%). Among the age-adjusted shock indices, an elevated value of ATLS-SI showed the highest specificities for both outcomes [transfusion, 91.7% (95% CI: 86.3-95.5); surgical intervention, 83.5% (77.2-88.7)] and the strongest association with transfusion at an adjusted odds ratio of 4.84 (1.94-12.06).

From this single-center experience, PFI patients are typically male adolescents, more frequently sustain major vascular injuries, and are more likely to require transfusion or surgery. An elevated ATLS-SI at emergency department (ED) arrival is specific for and predictive of the need for emergency care interventions.