Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
J Adolesc Health. 2021 May;68(5):978-984. doi: 10.1016/j.jadohealth.2020.09.004. Epub 2020 Oct 14.
To determine the incidence and outcomes of firearm injuries in adolescents and the effect of trauma center (TC) designation on their mortality.
The National Trauma Data Bank (2010-2016) was queried for all encounters involving adolescents aged 13-16 years with firearm injuries. Multivariable logistic regression was employed to determine the association of covariates with mortality (α = .05). Propensity score matching was also used to explore the relationship between TC designation and mortality.
A total of 9,029 adolescents met inclusion criteria. Patients aged 15 and 16 years compromised 77.8% of the cohort and were more often male (87.9% vs. 80.6%, p < .001), black (63.8% vs. 56.1%, p < .001), injured in the abdomen (25.4% vs. 22.4%, p = .007) or extremities (62.3% vs. 56.7%, p < .001), and incurred severe injuries (54.5% vs. 50.9%, p = .004) versus 13- and 14-year-old patients. Younger patients were more often injured in the head/neck (23.8% vs. 20.5%, p = .001). Multivariable logistic regression demonstrated no difference in mortality between age groups. Poor neurologic presentation, severe injury, abdominal, chest, and head injuries were all associated with an increased odds of death. Odds of mortality were 2.88 times higher at adult TCs compared to pediatric TCs (CI: 1.55-5.36, p = .001). However, using a 1:1 propensity score matching model, no difference in mortality was found between TC types (p = NS).
Variability exists in outcomes for adolescents after firearm injuries. Understanding and identifying the potential differences between pediatric and adult TCs managing adolescent firearm victims may improve survival in all treatment venues, but these data support patients being treated at the closest available TC.
确定青少年中枪支伤害的发生率和结果，以及创伤中心（TC）指定对其死亡率的影响。
从 2010 年至 2016 年的国家创伤数据库中查询所有涉及 13-16 岁青少年枪支伤害的患者。采用多变量逻辑回归来确定死亡率的协变量相关性（α=0.05）。还使用倾向评分匹配来探索 TC 指定与死亡率之间的关系。
共有 9029 名青少年符合纳入标准。15 岁和 16 岁的患者占队列的 77.8%，且更常为男性（87.9%比 80.6%，p<.001）、黑人（63.8%比 56.1%，p<.001）、腹部（25.4%比 22.4%，p=0.007）或四肢（62.3%比 56.7%，p<.001）受伤，且伤势严重（54.5%比 50.9%，p=0.004），而 13 岁和 14 岁的患者则不然。年轻患者更常头部/颈部受伤（23.8%比 20.5%，p=0.001）。多变量逻辑回归显示，各年龄组之间的死亡率无差异。神经功能不良、严重损伤、腹部、胸部和头部损伤均与死亡风险增加相关。与儿科 TC 相比，成人 TC 的死亡率高 2.88 倍（95%CI：1.55-5.36，p=0.001）。但是，使用 1:1 倾向评分匹配模型，TC 类型之间的死亡率无差异（p=NS）。
青少年枪支伤害后的结果存在差异。了解和识别儿科和成人 TC 管理青少年枪支受害者之间的潜在差异，可能会提高所有治疗场所的生存率，但这些数据支持在最近的 TC 接受治疗。
