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Pediatric firearm incidents

it’s time to decrease on-scene mortality

Friedman, Jessica, MD1; Hoof, Marcus, BS1; Smith, Alison, MD PhD1; Tatum, Danielle, PhD2; Ibraheem, Kareem, MD1; Guidry, Chrissy, DO1; Schroll, Rebecca, MD1; Duchesne, Juan, MD1; McGrew, Patrick, MD1

Journal of Trauma and Acute Care Surgery: February 7, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/TA.0000000000002210
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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 utilized the National Emergency Medical Services Information Systems database (NEMSIS) to characterize patterns of on-scene mortality in order to identify patients who may benefit from changes to prehospital care practices.

Methods NEMSIS was searched for all pediatric firearm incidents from 2010-2015. 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 Chi Squared test for categorical variables. A linear regression model was used to calculate independent predictors of mortality.

Results 16808 patients were identified, with a mortality rate of 6.1%. Most mortalities suffered cardiac arrest on-scene; 72.6% of these were prior to 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. Non-compressible injuries together accounted for 25.8% of injuries and 23.5% of mortalities.

Conclusions 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. Non-compressible 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 IV

Study type economic/decision

1Tulane University School of Medicine, Department of Surgery, New Orleans, LA

2Our Lady of the Lake Regional Medical Center, Baton Rouge, LA

Corresponding author: Jessica Friedman, MD, Tulane School of Medicine, 1430 Tulane Ave, Dept. of Surgery, SL-22, New Orleans, LA 70112. Email: jfried7@tulane.edu. Phone: 504-988-2306. Fax: 504-988-3683

Conflicts of interest: No conflicts of interest are declared.

This manuscript 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.