THE INCREASING BURDEN OF PEDIATRIC FIREARM INJURIES ON THE EMERGENCY DEPARTMENT

Introduction: Surveillance of injuries is necessary in order to develo p preventive strategies, The purpose of this study was to examine pedi atric gunshot wounds over a seven-year period for changes in frequency , site of injury, and demographic variables. Methods: The medical char ts of all pediatric patients (age <19 years) who presented to the two urban emergency departments (EDs) in Baton Rouge, Louisiana between Ja nuary 1, 1987, and December 31, 1993, were retrospectively reviewed. D ata included age, date and time of presentation, site(s) of injury, di sposition, operative procedure, and hospital stay. Results were strati fied into age <1 year, 1-4 years, 5-9 years, 10-14 years, and 15-19 ye ars. Results: During the study period there were 465 pediatric firearm injuries seen in the two urban EDs. Of all patients, 302 (65%) were m ale, and the proportion remained unchanged during the study period. Th e incidence of firearm injury rose from 3.0/1000 pediatric ED patients in 1987 and 5.9 in 1993 (P < 0.05). Mean age rose from 12.2 +/- 2.1 y ears to 15.1 +/- 1.6 years (P < 0.05), and admission percentage rose f rom 7 to 46% (P < 0.05) between 1987 and 1993. The proportion of firea rm injuries in the age group 15 to 19 years rose from 52% in 1987 and 82% in 1993 (P < 0.05). Operative procedures were required by 56 (12%) and intensive care admission by nine (2%); this did not change signif icantly over the study period. Thirty-three (7%) of all victims died. The most common sites of injury in decreasing order of frequency were extremity (60%), head/neck (14%), chest/back (13%), abdomen/flank (7%) , and pelvis/buttocks (6%); they did not vary by age group. A signific antly greater proportion of pediatric firearm injuries presented betwe en 5 PM and 5 AM (65%), on Friday (24%) or Sunday (20%), and during th e three summer months (29%) or December (11%). Conclusions: The freque ncy of pediatric gunshot wounds presenting to urban EDs has increased significantly since 1987. These findings confirm previous studies conc erning site of injury as well. as time, date, and month of presentatio n and suggest targeting preventative measures at the 15- to 19-year ag e group.