Division of Acute Care Surgery, Department of Surgery, College of Medicine, Johns Hopkins University, Baltimore, MD.
Division of Pediatric Trauma, Department of Surgery, College of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
Ann Surg. 2020 Oct;272(4):556-561. doi: 10.1097/SLA.0000000000004390.
To evaluate racial disparities among White and Black pediatric firearm injury patients on a national level.
Pediatric firearm-related morbidity and mortality are rising in the United States. There is a paucity of data examining racial disparities in those patients.
The Pediatric Trauma Quality Improvement Program (2017) was queried for pediatric (age ≤17 years) patients admitted with firearm injuries. Patients were stratified by race: White and Black. Injury characteristics were assessed. Outcomes were mortality, hospital length of stay, and discharge disposition. Hierarchical regression models were performed to determine predictors of mortality and longer hospital stays.
A total of 3717 pediatric firearm injury patients were identified: Blacks (67.0%) and Whites (33.0%). The majority of patients were male (84.2%). The most common injury intent in both groups was assault (77.3% in Blacks vs in 45.4% Whites; P<0.001), followed by unintentional (21.1% vs 35.4%; P<0.001), and suicide (1.0% vs 14.0%; P<0.001). The highest fatality rate was in suicide injuries (62.6%). On univariate analysis, White children had higher mortality (17.5% vs 9.8%; P<0.001), longer hospital stay [3 (1-7) vs 2 (1-5) days; P = 0.021], and more psychiatric hospital admissions (1.3% vs 0.1%; P<0.001). On multivariate analysis, suicide intent was found to be an independent predictor of mortality (aOR 2.67; 95% CI 1.35-5.29) and longer hospital stay (β + 4.13; P<0.001), while White race was not.
Assault is the leading intent of injury in both Black and White children, but White children suffer more from suicide injuries that are associated with worse outcomes.
Level III Prognostic.
在全国范围内评估白人和黑人儿科火器伤害患者之间的种族差异。
美国儿科与火器相关的发病率和死亡率正在上升。关于这些患者的种族差异的数据很少。
查询小儿创伤质量改进计划（2017 年）中因火器受伤入院的儿科（年龄≤17 岁）患者。患者按种族分层：白人及黑人。评估了损伤特征。结局为死亡率、住院时间及出院去向。进行分层回归模型以确定死亡率和住院时间延长的预测因素。
共确定了 3717 名儿科火器伤害患者：黑人（67.0%）和白人（33.0%）。大多数患者为男性（84.2%）。两组中最常见的受伤意图都是攻击（黑人占 77.3%，白人占 45.4%；P<0.001），其次是意外（黑人占 21.1%，白人占 35.4%；P<0.001）和自杀（黑人占 1.0%，白人占 14.0%；P<0.001）。自杀性伤害的死亡率最高（62.6%）。单变量分析显示，白人儿童死亡率更高（17.5%比 9.8%；P<0.001），住院时间更长[3（1-7）比 2（1-5）天；P=0.021]，且更多被送往精神病院[1.3%比 0.1%；P<0.001]。多变量分析显示，自杀意图是死亡率（比值比 2.67；95%置信区间 1.35-5.29）和住院时间延长（β+4.13；P<0.001）的独立预测因素，而白种人不是。
攻击是黑人和白人儿童受伤的主要原因，但白人儿童遭受更多自杀性伤害，导致预后更差。
三级预后。
