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Shotgun wounds in children. Not just accidents
M L Nance1, R F Sing, C C Branas
1Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, USA.
Insights
Shotgun wounds in children and adolescents are increasing in urban areas, often from assault. Nonurban shotgun injuries are typically unintentional, more lethal, and occur in the home.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Forensic Pathology
Background:
- Shotgun wounds in pediatric populations present unique challenges in trauma care.
- Understanding demographic patterns is crucial for targeted prevention strategies.
Purpose of the Study:
- To characterize the demographic features of pediatric and adolescent shotgun injuries across different regions.
- To analyze injury patterns, causes, and outcomes in relation to geographic location.
Main Methods:
- Retrospective case study utilizing data from the Pennsylvania Trauma Systems Foundation statewide trauma registry (1987-1994).
- Inclusion criteria: patients under 18 years old with shotgun wounds.
- Data points included demographics, injury nature, location, severity, and outcomes.
Main Results:
- 95 cases of pediatric shotgun wounds were analyzed (mean age 14.0 years, male:female ratio 5.8:1).
- Urban incidence of shotgun wounds increased threefold, primarily due to assaults occurring on the street.
- Nonurban injuries were predominantly unintentional, occurred in the home, and had higher fatality rates (19% overall, 78% in-home).
Conclusions:
- Urban pediatric shotgun wounds are rising, linked to assaults and street incidents.
- Nonurban injuries are often unintentional home incidents and more frequently fatal.
- Significant morbidity necessitates operative intervention and prolonged hospitalization.
Objective:
To characterize the demographic characteristics of shotgun wounds in children and adolescents across various regions within a state.
Design:
Retrospective case study.
Setting:
Accredited trauma centers in Pennsylvania.
Patients:
All patients less than 18 years old who sustained shotgun wounds.
Data Collection:
Patient data were collected from the Pennsylvania Trauma Systems Foundation statewide trauma registry for January 1987 through December 1994. Data reviewed included age, race, sex, region, nature of injury, assailant, location of incident, length of stay in the hospital and intensive care unit, Injury Severity Score, organs injured, death, and discharge disposition.
Results:
Over 8 years there were 95 shotgun wounds in patients with a mean +/- SD age of 14.0 +/- 3.7 years; the male-to-female ratio was 5.8:1. The incidence of shotgun wounds in urban areas increased threefold during the second half of the study; the incidence in nonurban regions was unchanged. Eighteen deaths (19%) occurred, 17 (94%) within 24 hours and 10 (56%) because of intracranial injury. Overall, unintentional shotgun wounds were most common (n = 46 [48%]), followed by assaults (n = 37 [39%]) and suicides (n = 8 [8%]). The highest per capita incidence of shotgun wounds occurred in urban areas, typically the result of an assault (n = 30 [73%]). In nonurban areas, shotgun wounds were usually unintentional (n = 36 [67%]); 34 (63%) occurred in the home. In contrast, in urban areas, 26 shotgun wounds (63%) occurred on the street. Overall, 14 fatal shotgun wounds (78%) occurred in the home. Operative intervention was required for 57 patients (60%). Ultimately, 67 patients (71%) were discharged to home.
Conclusions:
In urban areas, shotgun wounds are increasing in incidence, often occur on the street, and often result from assault. In nonurban areas, shotgun wounds are usually unintentional, often occur in the home, and are more often lethal than shotgun wounds in urban areas. Multiple-organ injury, surgery, and lengthy hospital stays are common.