Twenty years of pediatric gunshot wounds in our community: Have we made a difference?

Abstract

BACKGROUND/PURPOSE\nPediatric gunshot wounds (GSWs) carry significant incidence, mortality, and cost. We evaluated 20\u202fyears of GSW demographics at this level 1 trauma center and constructed a risk map triangulating areas of high incidence with risk factors.\n\n\nMETHODS\nChildren 0-18\u202fyears 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.\n\n\nRESULTS\nThe cohort (n\u202f=\u202f898) was 86.4% male. Mean age was 15.6\u202f±\u202f3.4\u202fyears. 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\u202f=\u202f0.89). 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\u202f=\u202f18) (OR 1.19, 95% CI 1.15-1.22, p\u202f<\u202f0.001).\n\n\nCONCLUSIONS\nOur impoverished neighborhoods have higher pediatric GSW incidence, unchanged over 20\u202fyears. Alternative community-based prevention efforts should involve neighborhood capacity building and economic strengthening.\n\n\nTYPE OF STUDY\nRetrospective study.\n\n\nLEVEL OF EVIDENCE\nLevel IV.