Infectious Complications Following Pediatric Ballistic Wounds: A Single Center Review
Amy A. Howk, Mtthew Margol, *Amina M. Bhatia
Emory University, Children's Healthcare of Atlanta, Atlanta, GA
Background (issue): As of 2020 firearm injuries are the leading cause of death for children in the United States. There is a paucity of data regarding injury patterns, clinical course, operative interventions, and postoperative infections in pediatric patients with firearm injuries. The purpose of this study was to evaluate clinical characteristics and risk factors for infection secondary to ballistic injuries at our pediatric level I trauma center.
Methods: We performed a retrospective review of our trauma registry identifying patients that were admitted for management of a firearm injury from January 2016 to November 2021. Demographic and clinical data were collected. Patients with a postoperative surgical site infection were compared to those without infectious complication.
Findings: There were 226 patients identified that met study criteria. Median age was 11 (IQR 5, 14) years. Most patients were male (78%) and black (81%). The most common injury locations were extremity (50%), cranium (19%), and thoracoabdominal (7%). Fifty-seven (25%) patients required operative intervention. Nine (15%) operative patients developed a surgical site infection (SSI). There were 4 abdominal, 3 cranial, and 2 extremity SSI. The ISS was higher (median 20 vs 11, p=0.04) and initial temperature was lower (median 36.6 C vs 37 C, p=0.03) in the group that developed SSI. Most (89%) patients that developed SSI received a course of postoperative antibiotics. There were 16 different combinations of antibiotics administered. Sepsis was more common in patients with SSI (56% vs 4%, p=0.003). There were no differences in other major complications.
Conclusions (implications for practice): Infectious complications following pediatric ballistic injuries that require operative intervention are not uncommon. Preoperative clinical factors including ISS and initial temperature correlated with increased risk. Antibiotic management varied widely. Establishment of a management protocol could mitigate septic complications in this population.
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