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Pediatric gunshot wounds to the head and neck
S E Kountakis1, J J Rafie, B Ghorayeb
1Department of Otolaryngology-Head and Neck Surgery, The University of Texas, USA.
Insights
Pediatric gunshot wounds to the head and neck are common and often fatal. Most injuries are preventable, with intracranial involvement leading to high fatality rates even from low-energy weapons.
Area of Science:
- Pediatric Trauma Surgery
- Forensic Pathology
- Public Health
Background:
- Pediatric head and neck gunshot wounds (GSWs) present a significant public health concern.
- These injuries result in high mortality rates, profound family devastation, and substantial healthcare costs.
Purpose of the Study:
- To retrospectively analyze pediatric cases of head and neck GSWs treated at a Level I trauma center.
- To identify patterns, mechanisms, and outcomes associated with these injuries in children.
Main Methods:
- Retrospective review of pediatric GSW cases (July 1990-July 1993) at a Level I trauma center.
- Inclusion criteria: patients aged 3-17 years with GSWs exclusively to the head and neck region.
- Data collected on demographics, weapon type, injury location, circumstances, and outcomes.
Main Results:
- 32 pediatric head and neck GSW cases identified; 26 male, 6 female, ages 3-17.
- Cranial cavity involvement occurred in 13 cases, resulting in 9 deaths and 1 institutionalization.
- Common circumstances included home shootings (11 cases) and incidents involving play (12 cases); 14 shooters were known to victims, 7 were self-inflicted.
Conclusions:
- Pediatric head and neck GSWs are frequently preventable injuries.
- High fatality rates are often linked to intracranial involvement, even with low-energy projectiles.
- Interventions aimed at prevention and improved trauma care are critical for this vulnerable population.
Abstract:
Gunshot wounds to the head and neck in the pediatric population have become alarmingly common. They often result in death of the victim, devastate families, and inflict a considerable financial burden to hospitals and society. We present a retrospective study of cases treated at a level I trauma center in Houston, Texas, from July 1990 to July 1993. We identified 115 cases of gunshot wounds in children, 32 of which were exclusively confined to the head and neck region. There were 26 male and 6 female patients. Ages ranged from 3 to 17 years. The cranial cavity was involved in 13 cases, leading to 9 deaths and 1 institutionalization. The shootings took place at home in 11 cases, and they involved play in 12 cases. The shooter was known to 14 of the victims, and the wounds were self-inflicted in 7 cases. The most common type of weapon was the .22 caliber pistol, which caused four of the deaths. Two of our cases involved BB air rifles, one of which mandated a craniotomy for the evacuation of an epidural hematoma. Our findings indicate that gunshot wounds to head and neck in children are in most instances preventable and result in high fatality rates because of common intracranial involvement, even when low-energy missiles are used.