SHOTGUN WOUNDS IN CHILDREN - NOT JUST ACCIDENTS

Objective: To characterize the demographic characteristics of shotgun wounds in children and adolescents across various regions within a sta te. Design: Retrospective case study. Setting: Accredited trauma cente rs in Pennsylvania. Patients: All patients less than 18 years old who sustained shotgun wounds. Data Collection: Patient data were collected from the Pennsylvania Trauma Systems Foundation statewide trauma regi stry for January 1987 through December 1994. Data reviewed included ag e, race, sex region, nature of injury, assailant, location of incident , length of slay in the hospital and intensive care unit, Injury Sever ity Score, organs injured, death, and discharge disposition. Results: Over 8 years there were 95 shotgun wounds in patients with a mean+/-SD age of 14.0+/-3.7 years; the male-to-female ratio was 5.8:1. The inci dence of shotgun wounds in urban areas increased threefold during the second half of the study; the incidence in nonurban regions was unchan ged. Eighteen deaths (19%) occurred, 17 (94%) within 24 hours and 10 ( 56%) because of intracranial injury. Overall, unintentional shotgun wo unds were most common (n=46 [48%]), followed by assaults (n=37 [39%]) and suicides (n=8 [8%]). The highest per capita incidence of shotgun w ounds occurred in urban areas, typically the result of an assault (n=3 0 [73%]). In nonurban areas, shotgun wounds were usually unintentional (n=36 [67%]); 34 (63%) occurred in the home. In contrast, in urban ar eas, 26 shotgun wounds (63%) occurred on the street. Overall, 14 fatal shotgun wounds (78%) occurred in the home. Operative intervention was required for 57 patients (60%). Ultimately, 67 patients (71%) were di scharged to home. Conclusions: In urban areas, shotgun wounds are incr easing in incidence, often occur on the street, and often result from assault. In nonurban areas, shotgun wounds are usually unintentional, often occur in the home, and are more often lethal than shotgun wounds in urban areas. Multiple-organ injury, surgery, and lengthy hospital stays are common.