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Published on: September 21, 2017
National benchmarks for penetrating head injury in U.S. children and adolescents: Mechanism, intent, and disparities
Alexander S Mina1, Jeffrey W Chen1, Keely Wolf2
1Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, 6701 Fannin Street, Houston, TX 77030, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
Insights
Penetrating head injuries in children and adolescents vary by age, with firearms being the leading cause of death. Tailored prevention strategies are crucial for reducing mortality from these injuries.
Area of Science:
- Pediatric Trauma Surgery
- Public Health Epidemiology
- Injury Prevention Science
Background:
- Penetrating head injuries (PPHI) in children and adolescents represent a significant public health concern.
- Existing data on PPHI epidemiology in this age group requires contemporary national benchmarks for effective prevention.
Purpose of the Study:
- To establish current national benchmarks for pediatric and adolescent PPHI.
- To characterize the epidemiology, including age, race/ethnicity, mechanism, and intent.
- To identify independent predictors of mortality for targeted prevention.
Main Methods:
- Retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program (TQIP) database (2019-2023).
- Inclusion of children and adolescents aged 1-17 years with PPHI (firearm, cut/pierce, animal bite).
- Stratification by age groups and analysis of mortality predictors, controlling for injury severity.
Main Results:
- A total of 9,046 PPHI cases were analyzed; 73.8% were male, with 49.9% aged 15-17 years.
- Injury mechanisms and intent varied significantly by age: animal bites in younger children, self-inflicted injuries in early adolescents, and firearm assaults in older adolescents.
- Firearm injuries accounted for 68.5% of cases and 97.7% of deaths; overall mortality was 25.4%, rising with age.
Conclusions:
- Pediatric PPHI presents distinct epidemiologic phenotypes: animal bites (young), self-inflicted firearms (early adolescence), and firearm assaults (older adolescents).
- Firearm-related injuries are the primary driver of mortality in this population.
- National benchmarks support the need for tailored, phenotype-specific prevention strategies over a generalized approach.
Purpose:
To establish contemporary national benchmarks for penetrating head injury (PPHI) in children and adolescents by characterizing its epidemiology, age, race/ethnicity, mechanism, and intent, and to identify independent predictors of mortality, in order to inform age- and mechanism-specific prevention.
Methods:
Retrospective cohort study of children and adolescents aged 1-17 years with PPHI in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database, 2019-2023. PPHI comprised firearm, cut/pierce, and animal-bite mechanisms with documented head-region involvement. Patients were stratified into four developmental age groups (1-4, 5-9, 10-14, 15-17 years). Outcomes included overall (emergency department and in-hospital) mortality, neurosurgical intervention, length of stay, and hospital-acquired infection (HAI). Animal bites were summarized as a separate descriptive subgroup; the multivariable mortality model was restricted to firearm and cut/pierce mechanisms, with a sensitivity analysis varying the head-injury severity threshold.
Results:
Among 9046 children and adolescents with PPHI, 73.8% were male and 49.9% were aged 15-17 years. Mechanism and intent shifted markedly with age: animal bites predominated among children aged 1-4 years (61.3% of that group), whereas firearms accounted for 88.2% of injuries in adolescents aged 15-17 years. Injuries were predominantly unintentional before age 10 (80.9%); self-inflicted injury peaked at ages 10-14 (21.1%); and assault predominated at ages 15-17 (63.4%). Overall mortality was 25.4% and rose from 12.2% in children aged 1-9 years to 31.3% in those aged 10-17 years. Firearms caused 6199 injuries (68.5%) and 97.7% of all deaths. Independent predictors of mortality included firearm mechanism, self-inflicted intent, non-Hispanic Black race, lower Glasgow Coma Scale score, higher Injury Severity Score, and direct (non-transferred) arrival.
Conclusion:
PPHI in U.S. children and adolescents comprises three distinct epidemiologic phenotypes, animal bites in young children, self-inflicted firearm injury peaking in early adolescence, and firearm assault concentrated among older, predominantly non-Hispanic Black adolescents. Firearms drive nearly all mortality. These national benchmarks support tailored, phenotype-specific prevention rather than a single undifferentiated strategy.
