The increasing burden of pediatric firearm injuries on the emergency department

Abstract

Introduction: Surveillance of injuries is necessary in order to develop preventive strategies. The purpose of this study was to examine pediatric gunshot wounds over a seven-year period for changes in frequency, site of injury, and demographic variables.

Methods: The medical charts of all pediatric patients (age < 19 years) who presented to the two urban emergency departments (EDs) in Baton Rouge, Louisiana between January 1, 1987, and December 31, 1993, were retrospectively reviewed. Data included age, date and time of presentation, site(s) of injury, disposition, operative procedure, and hospital stay. Results were stratified into age < 1 year, 1-4 years, 5-9 years, 10-14 years, and 15-19 years.

Results: During the study period there were 465 pediatric firearm injuries seen in the two urban EDs. Of all patients, 302 (65%) were male, and the proportion remained unchanged during the study period. The incidence of firearm injury rose from 3.0/1000 pediatric ED patients in 1987 and 5.9 in 1993 (P < 0.05). Mean age rose from 12.2 +/- 2.1 years to 15.1 +/- 1.6 years (P < 0.05), and admission percentage rose from 7 to 46% (P < 0.05) between 1987 and 1993. The proportion of firearm injuries in the age group 15 to 19 years rose from 52% in 1987 and 82% in 1993 (P < 0.05). Operative procedures were required by 56 (12%) and intensive care admission by nine (2%); this did not change significantly over the study period. Thirty-three (7%) of all victims died. The most common sites of injury in decreasing order of frequency were extremity (60%), head/neck (14%), chest/back (13%), abdomen/flank (7%), and pelvis/buttocks (6%); they did not vary by age group. A significantly greater proportion of pediatric firearm injuries presented between 5 PM and 5 AM (65%), on Friday (24%) or Sunday (20%), and during the three summer months (29%) or December (11%).

Conclusions: The frequency of pediatric gunshot wounds presenting to urban EDs has increased significantly since 1987. These findings confirm previous studies concerning site of injury as well as time, date, and month of presentation and suggest targeting preventative measures at the 15- to 19-year age group.