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Is the Highest Level of Trauma Activation Justified for Non-Powder Firearm Injuries?
LeeAnn Wurster, MS, RN, CPNP, Nationwide Children's Hospital, Columbus OH

Purpose: Although non-powder firearms (BB guns, pellet guns, airsoft guns) often cause trivial injuries, patients with these injuries frequently trigger a “level 1” (highest level) trauma activation in the emergency department (ED).  The purpose of this study was to investigate the outcome of patients who were evaluated in the ED for non-powder firearm injuries in order to determine if a level 1 activation is necessary. Methods:  A retrospective review at an ACS level 1 pediatric trauma center was performed between January 2005 and December 2014.  Patients were identified using external cause of injury codes (e-codes).   Data were evaluated for demographic distribution, rates of over triage, injury severity and resource utilization. Results:  Of the 138 non-powder firearm injuries identified, 111 (80%) were activated as level 1 trauma alerts. Of these highest level alerts, 44% were discharged home from the ED.  However, 56% were admitted, including 7% who were admitted to the pediatric intensive care unit (PICU) and 18% who went directly to the operating room (1 ICH, 9 abdominal, 11 eye, and 3 neck, and 1 femoral artery injury). 4% of the total number of patients had an ISS ≥ 15, 5% sustained an intracranial hemorrhage and several patients had multiple injuries. Conclusion:  Over half of the patients who received a highest level trauma activation due to non-powder firearm injuries were admitted, including 25% of patients who went directly to the operating room or required PICU admission.  Thus, highest level trauma activation is justified for patients with these injuries.

Objective: Describe the outcome of patients who were evaluated in the ED for non-powder firearm injuries in order to determine if the highest level activation is necessary.

Objective Content: Review retrospective data over 10 year time period of non-powder firearm injuries. Evaluate data related to demographic distribution, overtriage rates, injury severity and resource utilization.


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