FACTORS OF SURVIVAL FOR PEDIATRIC PATIENTS <15 WITH GUNSHOT WOUNDS
Teresa Evans, Keren Guiab, Faran Bokhari
Cook County Hospital, Chicago, IL
Purpose: The purpose of this study was to determine factors associated with survival in pediatric patients <15 years who sustain gunshot wounds.
Methods: Patients <15 years who sustained GSWs were abstracted from the NTDB from 2007-2015 and were stratified based on intent, and regression analysis was performed.
Results: Of the 1420 patients, 55.6% were 12 years old, 76.8% (1090) were male, and 51.1% were African American. 20.1% presented with a severe GCS, and 44.9% had an ISS >15. 16.8% presented in shock. The most common associated injuries included fracture of the spine or trunk (26.3%), injury to the lung (22.3%), liver (16.1%), colon/rectum (14.9%), or small bowel (14.4%). 5.8%. required an ED thoracotomy, 15.4% required a chest procedure, and 46.9% required an abdominal procedure. Complications occurred in 38.6% of patients. The median LOS, and ICU LOS were 6.5 and 2, respectively. Overall, 82.3% survived.
Multivariate analysis revealed that lower GCS [1.2 (CI: 1.15-1.26)], higher ISS [1.036 (OR: 1.017-1.055)], the presence of shock [OR:4.61 (CI: 2.74-7.75)], and tachycardia [OR: 1.616 (CI: 1.058-2.469),] were associated with mortality as were the necessity for thoracotomy [OR: 2.14 (CI: 1.001-4.57)], or injury to the liver [OR:2.33 (CI: 1.29-4.20)]. Mortality was higher among those who were not white [OR: 2.073 (CI: 1.093-3.932) p=0.026).
Conclusion: GSWs continue to be a cause of morbidity, and mortality among pediatric patients, and assault disproportionately affects older children, and African Americans. Low GCS, high ISS, shock, tachycardia, the need for an EDT, and liver injury were associated with mortality.
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