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Pediatric nonpowder firearm injuries: outcomes in an urban pediatric setting
P V Scribano1, M Nance, P Reilly
1Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Nonpowder firearm injuries are common in children, with most being minor. However, serious injuries can occur, emphasizing the need for education and safety regulations.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Public Health
Background:
- Nonpowder firearms cause approximately 32,000 injuries annually, with over 60% affecting children.
- While case reports exist, comprehensive series on pediatric nonpowder firearm injuries are lacking.
- This study examines an 11-year experience in an urban pediatric emergency department.
Purpose of the Study:
- To evaluate the circumstances, injury spectrum, and outcomes of nonpowder firearm injuries in children.
- To identify risk factors and injury patterns associated with nonpowder firearms in a pediatric population.
Main Methods:
- Retrospective, descriptive case series of children (≤18 years) treated from 1983-1994.
- Data sources included hospital databases, NEISS, and trauma registry.
- Medical records were reviewed for demographics, injury circumstances, site, type, treatment, and outcomes.
Main Results:
- 166 children treated for nonpowder firearm injuries; mean age 12 years, 71% male.
- Injuries occurred most frequently to extremities/buttocks (39%) and head/neck (33%).
- Serious injuries included intracranial hemorrhage and cardiac laceration; 7% sustained functional deficits, often ocular.
Conclusions:
- Most nonpowder firearm injuries are minor and treatable with local wound care.
- The potential for severe injury necessitates awareness and preventative measures.
- Recommendations include parent/child education and consideration of stricter regulations and safety instruction.
Background:
Approximately 32 000 nonpowder firearm injuries are reported annually with more than 60% occurring in the pediatric population. Case reports of serious and fatal injuries have been described; however, no large inclusive series have been published. We reviewed an 11-year experience of an urban pediatric emergency department to evaluate the circumstances, spectrum of injuries, and outcomes attributable to nonpowder firearms.
Methods:
A retrospective, descriptive case series of all children 18 years of age or younger evaluated at an urban children's hospital from January 1983 through December 1994 were eligible for study. Patients were identified using a computerized database, the National Electronic Injury Surveillance System, and the trauma registry in the department of surgery. Medical records were reviewed to collect demographic information, circumstances of injury, anatomic site and type of injury, treatment, and outcomes for nonpowder firearm injuries.
Results:
One hundred eighty patients were identified, and a complete data set was available for 166 (92%). The mean age was 12 +/- 3.7 years, 24% of children were <10 years old, and 71% of the children were male. Three patients returned with a second nonpowder firearm injury during the study period. Forty-nine percent of injuries were intentional and 44% of all injuries occurred during the summer and early fall months. The most common sites of injury were the extremity/buttocks (39%), head and neck (33%), thorax (13%), and eye (8%). Serious injuries included intracranial hemorrhage, cardiac right ventricle laceration, hyphema, and abdominal visceral injury (liver laceration, pancreatic laceration, intestinal perforation). The majority of wounds required local wound care, and the children (74%) were discharged from the emergency department. Of the patients admitted to the hospital (27%), 45% required operative intervention. There were no deaths. Seven percent (12/166) of patients sustained some functional deficit with 42% (5/12) the result of an ocular injury.
Conclusion:
The majority of nonpowder firearm injuries are minor; however, the potential for serious injury should not be underestimated. Minor injuries can be treated with local wound care and tetanus prophylaxis, and patients can be discharged from the emergency department. Education of parents and children to the potential risks associated with these weapons is essential. Stricter regulations regarding ownership of nonpowder firearms and mandatory safety instruction should be considered.