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Pediatric firearm incidents

It is time to decrease on-scene mortality

Friedman, Jessica, MD; Hoof, Marcus, BS; Smith, Alison, MD, PhD; Tatum, Danielle, PhD; Ibraheem, Kareem, MD; Guidry, Chrissy, DO; Schroll, Rebecca, MD; Duchesne, Juan, MD; McGrew, Patrick, MD

Journal of Trauma and Acute Care Surgery: May 2019 - Volume 86 - Issue 5 - p 791–796
doi: 10.1097/TA.0000000000002210
Editor's Choice

BACKGROUND Previous epidemiological studies on pediatric firearm mortality have focused on overall mortality rather than on-scene mortality. Despite advances in trauma care, the number of potentially preventable deaths remains high. This study used the National Emergency Medical Services Information Systems database to characterize patterns of on-scene mortality in order to identify patients who may benefit from changes to prehospital care practices.

METHODS National Emergency Medical Services Information Systems database was searched for all pediatric firearm incidents from 2010 to 2015. Data on demographics, anatomic location of injury, intent and location of incident, and on-scene mortality were analyzed using Student’s t test for continuous variables and χ2 test for categorical variables. A linear regression model was used to calculate independent predictors of mortality.

RESULTS Sixteen thousand eight hundred eight patients were identified, with a mortality rate of 6.1%. Most mortalities suffered cardiac arrest on-scene; 72.6% of these were prior to Emergency Medical Services (EMS) arrival, which carried a significantly higher mortality rate than arrest after EMS arrival. No difference was seen in anatomic location of injury in those who arrested before and after EMS arrival. Compressible injuries were most common with the lowest mortality. Noncompressible injuries together accounted for 25.8% of injuries and 23.5% of mortalities.

CONCLUSION To our knowledge, this is the largest study of on-scene mortality in pediatric firearm injury. Cardiac arrest prior to EMS arrival was a considerable source of on-scene mortality; significantly more of these patients died than those who arrested after EMS arrival. The mortality of compressible injuries was very low, implying that use of compression and tourniquets have been effective in stopping life-threatening extremity bleeding. Noncompressible injury mortality could be decreased with education of bystanders and more aggressive on-scene intervention. Through the evaluation of on-scene mortality specifically, this study offers insight into potential areas of focus to improve prehospital care of pediatric gunshot victims.

LEVEL OF EVIDENCE Therapeutic/Care management, level IV.

From the Department of Surgery (J.F., M.H., A.S., K.I., C.G., R.S., J.D., P.M.), Tulane University School of Medicine, New Orleans; and Our Lady of the Lake Regional Medical Center (D.T.), Baton Rouge, LA.

Address for reprints: Jessica Friedman, MD, Tulane School of Medicine, 1430 Tulane Ave, Dept. of Surgery, SL-22, New Orleans, LA 70112; email:

This article will be presented at the AAST Annual Conference in September 2018 Section XVA - (Oral) Session XVA: Papers 21–29: Parallel Session.

© 2019 Lippincott Williams & Wilkins, Inc.