title: Pediatric penetrating trauma: the epidemic continues.
abstract: BACKGROUND
  Pediatric penetrating injuries plague inner cities. Based on our clinical observations, we hypothesized that pediatric penetrating trauma (PPT) is increasing with the major increase occurring in communities with lower socioeconomic status.
  
  
  METHODS
  We retrospectively reviewed the trauma databases between 2000 and 2009 of the three major trauma centers in Alameda and San Francisco counties. Patients with PPT aged 16 years or younger were included. Demographics, Injury Severity Score, probability of survival, and length of hospital stay were collected. Median family incomes (MFI) were obtained from US Census data.
  
  
  RESULTS
  We identified 598 patients with PPT: 432 gunshot wounds (GSWs), 141 stabbings, and 25 other. The rate of PPT increased by 138% from 2000 to 2009 (p = 0.003). The mean (SEM) age of the patients was 13.8 (0.1) years, which did not change during the study period (p = 0.12). The incidence of single GSW to the head increased from 3% to 7% (p = 0.01) and carried a 63% mortality rate. Blacks and Hispanics sustained 82.5% of PPT. The MFI of PPT victims was $39,209. PPT was more prevalent in zip codes with an MFI below the Bay Area MFI of $68,954, (mean [SEM], 8.0 [1.5] victims per zip code below MFI vs. 1.9 [0.3] victims per zip code above MFI; p = < 0.001).
  
  
  CONCLUSIONS
  PPT in the Bay Area increased during the last decade, and the increased PPT was associated with lower MFIs. Black and Hispanic children experienced the greatest proportion of penetrating injuries and had the lowest MFIs. The prevalence of single GSW to the head is increasing, which may suggest a deliberate attempt to fatally injure these children.
  
  
  METHODS
  Prognostic study, level II.
authors.affiliation: Department of Surgery, Alameda County Medical Center, University of California San Francisco - East Bay, Oakland, California, USA.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Schecter
authors.forename: James
authors.initials: J
authors.lastname: Betts
authors.forename: William P
authors.initials: WP
authors.lastname: Schecter
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Victorino
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000704:Analysis of Variance; D002140:California / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016014:Linear Models; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015999:Multivariate Analysis; D011203:Poverty; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014951:Wounds, Stab / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy