The Medical School, University of Liverpool, United Kingdom.
Injury. 2012 Dec;43(12):2088-93. doi: 10.1016/j.injury.2012.03.020. Epub 2012 Apr 12.
Media reports portray a growing problem of gun and stab assaults amongst UK children. Recent legislative changes aim to increase integration between services and protect children better. Child victims of gun or stab assaults are at increased risk of reinjury and are therefore vital targets for interventions shown to be effective at preventing violent injury. There is currently a paucity of data with which to inform public debate, guide policy and develop prevention strategies. We therefore aimed to provide contemporary data on the epidemiology and clinical outcomes for intentional gun and stab injuries in children, using a large UK city as a model environment and also to ascertain whether interventions to prevent violent injury are currently in routine use in a sample of UK urban paediatric EDs.
A retrospective case series analysis was performed of children (<16 years) attending Emergency Departments (EDs) in a typical major UK city with high levels of deprivation. In addition, we undertook a qualitative survey of a sample of UK urban paediatric EDs regarding their use of violent injury prevention strategies in children.
Contrary to media reports and data from London, rates of gun and stab assault remained unchanged through the study (2003-2008). Although tragic fatal injury can occur, the majority of injuries were minor, with most children not requiring admission. Of those admitted, a minority needed surgery (mainly wound debridement and closure). Socioeconomically deprived, adolescent boys appear to be particularly at risk, with attacks at weekends and in public spaces beyond home and school being more common. Interventions to prevent violent reinjury are not currently employed in paediatric EDs in the 15 most populated urban areas of the UK.
Patient safety literature emphasises the need to identify near miss events. Media reports of tragic child deaths due to gunshot and stabbing are actually accompanied by large numbers of minor wounds that we should see as near miss events. Measures shown to reduce reinjury in these high-risk groups could now be pursued in the UK for patient safety and child protection purposes.
媒体报道描绘了英国儿童枪支和刺伤袭击事件日益严重的问题。最近的立法改革旨在加强服务的整合，更好地保护儿童。枪支或刺伤袭击的儿童受害者再次受伤的风险增加，因此是预防暴力伤害的有效干预措施的重要目标。目前，用于为公共辩论提供信息、指导政策和制定预防策略的数据非常有限。因此，我们旨在使用英国一个大城市作为模型环境，提供关于儿童蓄意枪支和刺伤伤害的流行病学和临床结果的当代数据，并确定预防暴力伤害的干预措施目前是否在英国城市儿科 ED 中常规使用。
对在一个贫困程度较高的典型英国大城市急诊部就诊的儿童（<16 岁）进行了回顾性病例系列分析。此外，我们对英国城市儿科 ED 的样本进行了一项关于其在儿童中使用暴力伤害预防策略的定性调查。
与媒体报道和伦敦的数据相反，枪支和刺伤袭击的发生率在研究期间保持不变（2003-2008 年）。尽管可能发生悲惨的致命伤害，但大多数伤害都是轻微的，大多数儿童无需住院。在需要住院的儿童中，少数需要手术（主要是清创和缝合伤口）。社会经济上处于不利地位的青少年男孩似乎特别容易受到攻击，周末和家庭和学校以外的公共场所发生的攻击更为常见。预防暴力再伤害的干预措施目前并未在英国 15 个人口最多的城市的儿科 ED 中使用。
患者安全文献强调需要确定接近错失事件。由于枪击和刺伤导致儿童死亡的悲惨媒体报道实际上伴随着大量我们应视为接近错失事件的轻微伤口。现在可以为患者安全和儿童保护目的在英国实施这些高风险群体中减少再受伤的措施。
