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Characterization of Upper and Lower Extremity Firearm Injuries in the Pediatric Population: A Single Institutional Experience Update
Jeremiah M Taylor, BS1, Rebecca Lynn DeSanti, MD2, Abra Shen, MD2, Thais Calderon, MD3, Yusha Liu, MD2, Christopher S. Crowe, MD4, Kari A Keys, MD3 and Jeffrey B Friedrich, MD, MC, FACS3, (1)David Geffen School of Medicine at UCLA, Los Angeles, CA, (2)University of Washington, Harborview Medical Center, Seattle, WA, (3)University of Washington, Seattle, WA, (4)Mayo Clinic, Rochester, MN

The rising availability of firearms and escalating violence rates, particularly in urban environments, have made firearm injuries a major public health concern. Ballistics often result in traumatic injuries to both upper and lower extremities, having significant long-term impacts, especially in children.

A 15-year retrospective chart review at Harborview Medical Center was performed. Data was collected from the Harborview Trauma Registry and electronic medical record via an Institute of Translational Health Sciences Bioinformatics Grant. Inclusion criteria comprised patients younger than 18 years old who presented with extremity firearm injuries. Demographics, injury patterns, and surgical management were examined, with categorical variables reported as percentages, and continuous variables reported as means and standard deviations.

Over the 15-year data collection period, extremity injuries made up 17.6% (128/726) of all pediatric firearm injuries. Our study exclusively analyzed these extremity injuries. The mean age was 15.1 years old and 82% of patients were male. Approximately 41% were Black/African American, 26% were Caucasian, and 9% were Hispanic/Latino. The majority of patients had Medicaid insurance (67%), while fewer were covered under private insurance (14%) or HMO/PPO (3.1%). Approximately 36% of patients were directly admitted to our Level 1 Trauma Center, while the remainder were transferred from an outside medical facility. 43% had upper extremity injuries, 49% lower extremity injuries, and 8% sustained both. The majority of firearm injuries were secondary to assault (81%), with fewer related to accidental discharge of a firearm (17%) or police (2%). 58% of patients required surgical management of any type for their injury. Open fractures were present in 61%, vascular injury in 22%, and nerve injury in 5% of patients. Of the definitive reconstructive surgeries, 9 involved delayed primary closure, 3 involved local tissue advancement, 2 involved Integra followed subsequently by a skin graft, and 2 involved free flaps (gracilis and a skin graft). Approximately 5% of patients had required amputation to an extremity. 22% of children were readmitted to the hospital within 90 days of their initial injury.

Gunshot wounds represent a preventable cause of injury, which are of even greater public health concern in the pediatric population. In this study, a majority of patients required bony fixation, while a smaller, but still sizable number required vascular, nerve or reconstructive repair, and over half required surgical management for their ballistic extremity injury. Thus, subsequent disability after firearm injury in pediatric patients is considerable and deserving of further analysis.

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