THORACIC GUNSHOT WOUNDS IN CHILDREN UNDER 17 YEARS OF AGE

Over the past decade there has been a significant increase in the inci dence of gunshot wounds (GSW) among Americans under 19 years of age. D espite the increase, pediatric GSW have received little attention in t he literature. and no study has focused on pediatric victims of thorac ic GSW. In the present study, the authors performed a retrospective re view of the records of 51 patients under 17 years of age who were trea ted for thoracic GSW at adjoining level I pediatric and adult trauma c enters between July 1987 and June 1995. The primary catchment area for these institutions is a lower socioeconomic, urban tenancy; The study population was 80.4% male and 86.3% black; the mean age was 12.4 year s. The mean injury severity score and trauma score were 13.6 and 13.4, respectively. Although statistically significant differences could no t be demonstrated with this population size, trends were evident when the group was subdivided by age group (less than or equal to 12 years and >12 years of age). The younger group was more likely to require a thoracic operation after injury (35.3% v 23.5%), to have unstable vita l signs (41.2% v 26.5%), to have a higher total abbreviated injury sco re (AIS) for the chest (4.8 v 4.0); however, their total extrathoracic AIS was lower (2.1 v 3.1). The younger group spent more time in the h ospital and in the intensive care unit (7.6 v 4.6 days and 2.0 v 0.9 d ays, respectively). The younger children were more likely to have sust ained injury by unintentional crossfire (35.3% v 14.7%) and were never injured by intentional assault (0% v 47.2%). Overall, 50% of the pati ents required surgery, including 93.8% of the patients who had unstabl e vital signs at the time of arrival. All six deaths (11.8%) owing to the thoracic injury occurred in patients who had mediastinal injury th at required an emergency-department thoracotomy (EDT). The authors con clude that among this predominantly black male population, there are d ifferent trends with respect to treatment, circumstances, and pattern of injury between the younger and older subpopulations. Copyright (C) 1996 by W.B. Saunders Company