Wake Forest University, Winston-Salem, North Carolina; Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
Department of Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida.
J Surg Res. 2024 Oct;302:64-70. doi: 10.1016/j.jss.2024.07.038. Epub 2024 Aug 1.
Pediatric firearm injury prevention research in younger age groups is limited. This study evaluated a large multicenter cohort of younger children with firearm injuries, focusing on injury patterns and surgical resource utilization.
Children ≤15 y old sustaining firearm injuries between 2016 and 2021 and treated at 10 pediatric trauma centers in Florida were included. Individual cases were reviewed for demographics, shooting details, injury patterns, resource utilization, and outcomes. Patients were grouped by age into preschool (0-5 y), elementary school (6-10 y), middle school (11-13 y), and early high school (14-15 y). Multivariable logistic regression was used to identify predictors of death and critical resource utilization.
A total of 489 children (80 preschool, 76 elementary school, 92 middle school, and 241 early high school) met inclusion criteria. Demographics, injury patterns, and resource utilization were similar across age groups. Assault and self-harm increased with age. Self-harm was implicated in 5% of cases but accounted for 18% of deaths. Hand surgery (i.e., below-elbow) procedures were common at 8%. Overall mortality was 10%, but markedly higher for self-harm injuries (47%). On multivariable regression, age and demographics were not predictive of death or critical resource utilization, but self-harm intent was a strong independent risk factor for both.
This study suggests that given the age distribution and disproportionately high impact of self-harm injuries, behavioral health resources should be available to children at the middle school level or earlier. Hand surgery may represent an overlooked but frequently utilized resource to mitigate injury impact and optimize long-term function.
针对年龄较小的儿童的儿科枪支伤害预防研究有限。本研究评估了佛罗里达州 10 个儿科创伤中心收治的大量年龄较小的儿童枪支伤害病例，重点关注伤害模式和手术资源利用情况。
纳入 2016 年至 2021 年期间因枪支受伤且年龄在 15 岁以下的 10 名佛罗里达州儿科创伤中心的患儿。回顾性分析了每位患儿的人口统计学资料、枪击详情、损伤模式、资源利用情况和结局。根据年龄将患儿分为学龄前（0-5 岁）、小学（6-10 岁）、初中（11-13 岁）和高中早期（14-15 岁）。采用多变量逻辑回归分析确定死亡和关键资源利用的预测因素。
共纳入 489 例患儿（80 例学龄前、76 例小学、92 例初中和 241 例高中早期）。年龄组间的人口统计学资料、损伤模式和资源利用情况相似。年龄越大，发生攻击和自伤的比例越高。自伤占比 5%，但导致 18%的死亡。手部手术（即肘下）较为常见，占 8%。总死亡率为 10%，但自伤所致死亡率显著更高（47%）。多变量回归分析显示，年龄和人口统计学资料不是死亡或关键资源利用的预测因素，但自伤意图是两者的独立强风险因素。
本研究表明，鉴于自伤损伤的年龄分布和不成比例的高影响，应在初中或更早阶段为儿童提供行为健康资源。手部手术可能代表一种被忽视但经常使用的资源，可以减轻损伤影响并优化长期功能。
