title: Gunshot injuries in children served by emergency services.
abstract: OBJECTIVE
  To describe the incidence, injury severity, resource use, mortality, and costs for children with gunshot injuries, compared with other injury mechanisms.
  
  
  METHODS
  This was a population-based, retrospective cohort study (January 1, 2006-December 31, 2008) including all injured children age ≤ 19 years with a 9-1-1 response from 47 emergency medical services agencies transporting to 93 hospitals in 5 regions of the western United States. Outcomes included population-adjusted incidence, injury severity score ≥ 16, major surgery, blood transfusion, mortality, and average per-patient acute care costs.
  
  
  RESULTS
  A total of 49,983 injured children had a 9-1-1 emergency medical services response, including 505 (1.0%) with gunshot injuries (83.2% age 15-19 years, 84.5% male). The population-adjusted annual incidence of gunshot injuries was 7.5 cases/100,000 children, which varied 16-fold between regions. Compared with children who had other mechanisms of injury, those injured by gunshot had the highest proportion of serious injuries (23%, 95% confidence interval [CI] 17.6-28.4), major surgery (32%, 95% CI 26.1-38.5), in-hospital mortality (8.0%, 95% CI 4.7-11.4), and costs ($28,510 per patient, 95% CI 22,193-34,827).
  
  
  CONCLUSIONS
  Despite being less common than other injury mechanisms, gunshot injuries cause a disproportionate burden of adverse outcomes in children, particularly among older adolescent males. Public health, injury prevention, and health policy solutions are needed to reduce gunshot injuries in children.
authors.affiliation: Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, mailcode CR-114, Portland, OR 97239-3098. newgardc@ohsu.edu.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
authors.forename: Brian
authors.initials: B
authors.lastname: Wetzel
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
authors.forename: N Ewen
authors.initials: NE
authors.lastname: Wang
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Kristan
authors.initials: K
authors.lastname: Staudenmayer
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
authors.forename: Erik D
authors.initials: ED
authors.lastname: Barton
authors.forename: Garen
authors.initials: G
authors.lastname: Wintemute
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000639:trends*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
keywords: children; health services; trauma; violence