TIME TO DEFINITIVE SURGERY IN PEDIATRIC PATIENTS LESS THAN 18 YEARS WITH GUNSHOT WOUNDS
Teresa Evans, Keren Guiab, Faran Bokhari
Cook County Hospital, Chicago, IL
Introduction: The purpose of this study is to determine if time to emergent abdominal procedure has an impact on the survival of pediatric patients with gunshot wounds.
Methods: The NTDB was analyzed for patients aged <18 from 2007-2015 who sustained a gunshot wound and required an abdominal operation. Regression analysis was performed to determine if time to abdominal procedure had an impact on survival.
Results: Of 522 patients included, 457 (87.5%) were male and 90.9% were older than 10 years of age with 78.4% 15-18 years, and 12.5% 10-14 years. Overall 365 (69.9%) patients had an ISS >16, and 186 (35.6%) had an ISS > 25. (90.4%) had a GCS of 14-15. 72 (13.8%) presented in shock. 21 (4.0%) required a resuscitative thoracotomy. The median time to abdominal procedure was 0.72 hours (43.2 min). The median hospital LOS, ICU LOS, and vent days were 12, 5, and 2, respectively. Overall, 502 (96.2%) survived.
Bivariate analysis for patients 15 revealed that ISS >25 (OR 3.532, p=0.008), increased HR (17.180 bpm, p=0.007), and the need for an ED thoracotomy (OR 4.745 p=0.020) were significantly associated with mortality. Logistic regression for patients 15 suggested increased time to procedure (OR 0.096, p=0.032), and increased ISS (OR 1.117, p=0.022) were associated with mortality. The odds of was increased 10.416 for every hour delay.
Conclusion: In pediatric patients 15 who sustain gunshot wounds in which abdominal procedure is necessary, increased ISS is a significant predictor for mortality, and even a slight delay may be associated with higher mortality.
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