Predictors of mortality in pediatric urban firearm injuries.
BACKGROUND
Although firearms account for less than 5 % of all pediatric injuries, they have the highest associated case fatality rate.


METHODS
The registry at a Level-1 trauma center was used to identify firearm injuries (<18 years of age) from 1991 to 2011. Descriptive statistics and risk-adjusted multivariate analyses (MVA) were performed.


RESULTS
Overall, 1085 patients were identified. Immediate operations were performed in 33 % (n = 358) of patients with most having abdominal surgery (n = 214). Survival was 86 %, but higher for African Americans (OR = 1.92) than for Hispanics (p = 0.006). African Americans were more likely to sustain extremity (OR = 2.26) and less head (OR = 0.36) injuries than Hispanics (p < 0.001). Analysis by injury location showed that head (OR = 14.1) had the highest associated mortality. Other significant predictors included multiple major injury (defined by Abbreviated Injury Scale) with central nervous system involvement (OR = 7.30) and single injuries to the chest (OR = 2.68). These findings were compared to abdominal injuries as the baseline (p < 0.02). MVA demonstrated that Caucasian children had higher mortality (OR = 6.12) vs. Hispanics (p = 0.031). Children admitted with initial pH ≤ 7.15 (OR = 14.8), initial hematocrit ≤30 (OR = 3.24), or Injury Severity Score (ISS) > 15 (OR = 1.08) had higher mortality rates (p < 0.05).


CONCLUSIONS
Independent significant indicators of mortality include low initial pH or hematocrit, Caucasian race, high ISS, and those who sustain head injuries.
University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL, 33136, USA.
Kelly A
KA
Feldman
University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL, 33136, USA.
Jun
J
Tashiro
University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL, 33136, USA.
Casey J
CJ
Allen
University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL, 33136, USA.
Eduardo A
EA
Perez
University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL, 33136, USA.
Holly L
HL
Neville
University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL, 33136, USA.
Carl I
CI
Schulman
University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL, 33136, USA. jsola@med.miami.edu.
Juan E
JE
Sola
D000293:Adolescent; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000401:mortality*
Firearms; Gunshot wounds; Pediatric; Trauma; Urban
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