儿童非颅内致命性火器伤：对治疗的启示

Nonintracranial fatal firearm injuries in children: implications for treatment.

作者信息

Nance Michael L, Branas Charles C, Stafford Perry W, Richmond Therese, Schwab C William

机构信息

Department of Surgery, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.

出版信息

J Trauma. 2003 Oct;55(4):631-5. doi: 10.1097/01.TA.0000035090.99483.0A.

DOI:10.1097/01.TA.0000035090.99483.0A

PMID:14566115

Abstract

BACKGROUND

Understanding the injury characteristics of nonintracranial fatal (NIF) gunshot wounds in children treated in a statewide trauma system will help guide effective treatment strategies.

METHODS

This study was a retrospective analysis of children fatally injured with firearms. The review included demographic information, firearm injury characteristics, and outcome. The setting included trauma centers participating in a statewide trauma registry. Patients were all children (age < 18 years) treated in trauma centers for NIF gunshot wounds from January 1988 through December 2000. The main outcome measures were characteristics of fatal firearm injuries in children.

RESULTS

Over the 13-year period, there were 1,954 children with firearm injuries including 368 (18.8%) children with fatal wounds. Of the fatally wounded children, 177 (48.1%) had no intracranial injury. The NIF injury population was 90.4% male, with a mean age of 14.9 years (range, <1-17 years) and an Injury Severity Score of 38.2 (range, 9-75). Over 95% of deaths in this group occurred within 24 hours of admission. Although injuries to the thorax were most common (78.5%), 48.6% of the NIF cohort had injuries to multiple body regions, including 31% with injuries in both the abdomen and thorax. Compared with all children wounded by firearms, NIF firearm injury patients had, on average, more body regions injured (1.6 vs. 1.1, p < 0.001) and a greater total number of injuries (6.0 vs. 3.5, p < 0.001). Patients with an NIF injury were more likely to suffer a major vascular injury (54.8% vs. 13.8%, p < 0.001), lung injury (56.5% vs. 12.9%, p < 0.001), or cardiac injury (44.6% vs. 4.6%, p < 0.001) than all children with a firearm injury.

CONCLUSION

Most children who arrive at trauma centers alive and subsequently die from NIF firearm injuries do so rapidly from major vascular and thoracic injury. Almost half of these children have injuries to multiple body regions, further complicating management. Innovative, aggressive treatment approaches should be sought to improve survival in this extremely injured cohort of children.

摘要

背景

了解在全州创伤系统中接受治疗的儿童非颅内致命性（NIF）枪伤的损伤特征，将有助于指导有效的治疗策略。

方法

本研究是对因枪支造成致命伤害的儿童进行的回顾性分析。该回顾包括人口统计学信息、枪支损伤特征及结果。研究地点包括参与全州创伤登记系统的创伤中心。患者为1988年1月至2000年12月期间在创伤中心接受治疗的所有NIF枪伤儿童（年龄<18岁）。主要结局指标为儿童致命性枪支损伤的特征。

结果

在这13年期间，有1954名儿童遭受枪支伤害，其中368名（18.8%）儿童为致命伤。在致命伤儿童中，177名（48.1%）无颅内损伤。NIF损伤人群中男性占90.4%，平均年龄14.9岁（范围：<1 - 17岁），损伤严重度评分为38.2（范围：9 - 75）。该组中超过95%的死亡发生在入院后24小时内。尽管胸部损伤最为常见（78.5%），但48.6%的NIF队列患儿有多个身体部位受伤, 其中31%的患儿腹部和胸部均受伤。与所有受枪支伤害的儿童相比，NIF枪伤患者平均受伤的身体部位更多（1.6个 vs. 1.1个，p < 0.001），总受伤数量更多（6.0处 vs. 3.5处，p < 0.001）。与所有受枪支伤害的儿童相比，NIF损伤患者更有可能遭受大血管损伤（54.8% vs. 13.8%，p < 0.001）、肺部损伤（56.5% vs. 12.9%，p < 0.001）或心脏损伤（44.6% vs. 4.6%，p < 0.001）。