Shotgun wounds in children. Not just accidents

Causes of accidents in children aged 0–14 years and risk factors related to the family environment

A case-control study to determine the causes of accidents in children aged 0-14 years and to analyse family environment risk factors was carried out. The variables analysed in the children were age, gender, mechanism and type of accidental injury, number of siblings, birth order of the injured child, history of sibling injury and family type. Variables analysed in the parents were mother's age, history of alcoholism, maternal and paternal education level, time mother spent at home with the child, presence or absence of parents at the time of the accident and parents' occupations. The most important risk factors were gender, time mother spends at home, level of maternal education, paternal alcoholism, birth order, more than five siblings and previous injury to a sibling.

Pediatric trauma deaths are predominated by severe head injuries during spring and summer

Background

Trauma is the most prevalent cause of death in the young. Insight into cause and time of fatal pediatric and adolescent trauma is important for planning trauma care and preventive measures. Our aim was to analyze cause, severity, mode and seasonal aspects of fatal pediatric trauma.

Methods

Review of all consecutive autopsies for pediatric fatal trauma during a 10-year period within a defined population.

Results

Of all pediatric trauma deaths (n = 36), 70% were males, with the gender increasing with age. Median age was 13 years (range 2–17). Blunt trauma predominated (by road traffic accidents) with most (n = 15; 42%) being "soft" victims, such as pedestrians/bicyclist and, 13 (36%) drivers or passengers in motor vehicles.

Penetrating trauma caused only 3 deaths. Prehospital deaths (58%) predominated. 15 children (all intubated) reached hospital alive and had severely deranged vital parameters: 8 were hypotensive (SBP < 90 mmHg), 13 were in respiratory distress, and 14 had GCS < 8 on arrival. Emergency procedures were initiated (i.e. neurosurgical decompression, abdominal surgery or pelvic fixation for hemorrhage) in 12 patients. Probability of survival (Ps) was < 33% in over 75% of the fatalities. A bimodal death pattern was evident; the initial peak by CNS injuries and exsanguinations, the latter peak by CNS alone. Most fatalities occurred during spring (53%) or summertime (25%).

Conclusion

Fatal pediatric trauma occurs most frequently in boys during spring/summer, associated with severe head injuries and low probability of survival. Preventive measures appear mandated in order to reduce this mortality in this age group.

Firearm injury among urban youth during the last decade: an escalation in violence

PURPOSE

To better characterize firearm violence in urban youth, the authors investigated the circumstances and outcome of shootings among youths under 17 years of age.

METHODS

A retrospective case review was undertaken of all patients under 17 years of age treated for a gunshot wound at two adjoining level I Trauma Centers (adult and pediatric) administering to a predominantly lower socioeconomic population from January 1986 to December 1995. Demographics, injury severity, circumstances, and outcome of injury were analyzed.

RESULTS

323 youths were wounded by firearms. The mean age was 12.8 years, and 82.3% were boys. There was a 110% increase in frequency of wounding noted during the second half of study (219 v 104), predominantly in the adolescent subset (160% increase for age greater than 12 years v 30% increase for age 12 years and under). The mean injury severity score and trauma score were 9.3 and 14.4, respectively. Violent circumstances (assault, crossfire, drive-by shooting, suicide) accounted for 60.4% of injuries and more than doubled over the study period (26.7% of total in the first 2 years [n = 4], 68.8% in the last 2 years [n = 55]). Unintentional injuries (self nonsuicide, family, friend) accounted for 26.3% of the injuries and declined in relative frequency over the study period (46.7% of total in the first 2 years [n = 7], 20.0% in the last 2 years [n = 16]). Black boys had the highest wounding incidence (9.2/1,000 population), were most commonly injured by assault (29.0%), and had a higher mean number of wounds (1.8). White boys had a lower wounding incidence (3.1/1,000 population), were more often injured unintentionally by a friend (41.2%), and had a lower mean number of wounds (1.3), none as a result of violence. Girls had a wounding incidence of less than 2/1,000 and were most commonly injured in crossfire (40.7%). Ten percent of shootings were fatal. The assailant was known to the victim in 52.8% of children less than 6 years of age, but only 24.7% of children over 12 years of age.

CONCLUSIONS

The incidence of gunshot wounds in the youth of this urban population has increased substantially over the past decade. Adolescent black boys were the most frequent victims of these shootings. There has been a disproportionate growth in violent circumstances surrounding the shootings.