Bayouth Lilly, Lukens-Bull Katryne, Gurien Lori, Tepas Joseph J, Crandall Marie
Department of Surgery, Brody School of Medicine at East Carolina University.
Center for Health Equity and Quality Research, University of Florida College of Medicine Jacksonville.
J Pediatr Surg. 2019 Jan;54(1):160-164. doi: 10.1016/j.jpedsurg.2018.10.003. Epub 2018 Oct 5.
BACKGROUND/PURPOSE: Pediatric gunshot wounds (GSWs) carry significant incidence, mortality, and cost. We evaluated 20 years of GSW demographics at this level 1 trauma center and constructed a risk map triangulating areas of high incidence with risk factors.
Children 0-18 years suffering a GSW between 1996 and 2016 were identified via our trauma registry. Hospital charges, demographic, socioeconomic, and institutional variables were retrospectively reviewed. Multivariable logistic regression identified predictors of mortality. Geographic information system (GIS) mapping of incident location and residence identified areas of higher incidence.
The cohort (n = 898) was 86.4% male. Mean age was 15.6 ± 3.4 years. Median Injury Severity Score (ISS) was 9 (1-75). Procedural and/or operative intervention occurred in 52.9%. Intent included assault (81.5%) and unintentional injury (12.8%). Hospital charges showed significant annual increase. Annual incidence varied without trend (p = 0.89). Mapping revealed significant clustering of GSWs in known lower socioeconomic areas. Yearly and total GSWs were highest in one particular zip code. ISS was a significant predictor of mortality (n = 18) (OR 1.19, 95% CI 1.15-1.22, p < 0.001).
Our impoverished neighborhoods have higher pediatric GSW incidence, unchanged over 20 years. Alternative community-based prevention efforts should involve neighborhood capacity building and economic strengthening.
Retrospective study.
Level IV.
背景/目的：小儿枪伤（GSW）的发生率、死亡率和成本都很高。我们评估了这家一级创伤中心20年的枪伤人口统计学数据，并绘制了一张风险地图，将高发病率地区与风险因素进行三角定位。
通过我们的创伤登记系统确定了1996年至2016年间遭受枪伤的0至18岁儿童。对医院费用、人口统计学、社会经济和机构变量进行了回顾性审查。多变量逻辑回归确定了死亡率的预测因素。对事件发生地点和居住地进行地理信息系统（GIS）绘图，确定了发病率较高的地区。
该队列（n = 898）中男性占86.4%。平均年龄为15.6±3.4岁。中位损伤严重程度评分（ISS）为9（1-75）。52.9%的患者接受了程序和/或手术干预。受伤意图包括袭击（81.5%）和意外伤害（12.8%）。医院费用呈显著年度增长。年发病率无趋势变化（p = 0.89）。绘图显示，已知社会经济水平较低的地区枪伤病例显著聚集。在一个特定的邮政编码区域，每年和总的枪伤病例数最高。ISS是死亡率的显著预测因素（n = 18）（OR 1.19，95%CI 1.15-1.22，p < 0.001）。
我们贫困社区的小儿枪伤发病率较高，20年来没有变化。基于社区的替代预防措施应包括社区能力建设和经济强化。
回顾性研究。
四级。
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