PEDIATRICS Vol. 100 No. 4 October 1997,
p. e5
Copyright ©1997 by the American Academy of Pediatrics
ELECTRONIC ARTICLE:
Pediatric Nonpowder Firearm Injuries: Outcomes in an Urban
Pediatric Setting
,
,
From the * Division of Emergency Medicine, Children's Hospital
of Philadelphia, Philadelphia, Pennsylvania; the
Division of
Trauma and Critical Care, University of Pennsylvania Medical Center,
Philadelphia, Pennsylvania; and the § Division of Trauma, Carolinas
Medical Center, Charlotte, North Carolina.
Background. Approximately 32 000 nonpowder firearm injuries are reported annually with more than 60% occurring in the pediatric population. Case reports of serious and fatal injuries have been described; however, no large inclusive series have been published. We reviewed an 11-year experience of an urban pediatric emergency department to evaluate the circumstances, spectrum of injuries, and outcomes attributable to nonpowder firearms.
Methods. A retrospective, descriptive case series of all children 18 years of age or younger evaluated at an urban children's hospital from January 1983 through December 1994 were eligible for study. Patients were identified using a computerized database, the National Electronic Injury Surveillance System, and the trauma registry in the department of surgery. Medical records were reviewed to collect demographic information, circumstances of injury, anatomic site and type of injury, treatment, and outcomes for nonpowder firearm injuries.
Results. One hundred eighty patients were identified, and a complete data set was available for 166 (92%). The mean age was 12 ± 3.7 years, 24% of children were <10 years old, and 71% of the children were male. Three patients returned with a second nonpowder firearm injury during the study period. Forty-nine percent of injuries were intentional and 44% of all injuries occurred during the summer and early fall months. The most common sites of injury were the extremity/buttocks (39%), head and neck (33%), thorax (13%), and eye (8%). Serious injuries included intracranial hemorrhage, cardiac right ventricle laceration, hyphema, and abdominal visceral injury (liver laceration, pancreatic laceration, intestinal perforation). The majority of wounds required local wound care, and the children (74%) were discharged from the emergency department. Of the patients admitted to the hospital (27%), 45% required operative intervention. There were no deaths. Seven percent (12/166) of patients sustained some functional deficit with 42% (5/12) the result of an ocular injury.
Conclusion. The majority of nonpowder firearm injuries are minor; however, the potential for serious injury should not be underestimated. Minor injuries can be treated with local wound care and tetanus prophylaxis, and patients can be discharged from the emergency department. Education of parents and children to the potential risks associated with these weapons is essential. Stricter regulations regarding ownership of nonpowder firearms and mandatory safety instruction should be considered.
Key words: firearms, wounds, violence, child.Increasingly, attention has been focused on the epidemic of firearm-related injuries in the pediatric population, which carries a mortality rate of 12% to 19%.1 What often escapes mention are the estimated 32 000 injuries attributable to nonpowder firearms (ie, BB gun, pellet gun, and air rifle) which occur each year in the United States.1 The majority of victims (more than three quarters) are under the age of 15. This is particularly disturbing because most states have minimal or no restrictions on the sale and use of these weapons to children. In fact, only 14 states in the United States have legislation governing the sale or possession of these weapons.1
Many case reports of serious and even fatal nonpowder firearm injuries have been published describing ocular, intracranial, abdominal, and thoracic wounds,4 yet there is little data regarding the epidemiology and outcome in a defined population. We reviewed all nonpowder firearm injuries treated at an urban pediatric hospital during an 11-year period to ascertain demographic characteristics, specific injuries, and outcomes.
All nonpowder firearm injuries treated in the Children's Hospital of Philadelphia emergency department were identified for the period 1983 to 1994 using data from the National Electronic Injury Surveillance System (NEISS) under the auspices of the US Consumer Product Safety Commission. NEISS includes data from 91 hospitals that were selected as a representative sample of approximately 6000 hospitals with emergency departments in the United States. Our institution is one of the participating hospitals that provide data to the NEISS and a listing of these patients was provided by them. Additional patients who had been transported by ground or air and diverted from the emergency department were identified using the trauma registry from the department of surgery. This included patients from 1986 through 1994.
2, Student's
t, or Fisher's exact tests were used when appropriate. Odds
ratios with 95% confidence intervals are reported, and a P
value of <.05 was considered statistically significant.
During the 11-year period, 180 patients were identified as having sustained a nonpowder firearm injury (157 via NEISS, 23 via trauma registry). Medical records were reviewed, and a complete data set was available for 166 (92%). These patients formed the study population for all reported data. In a random sample of 15% of charts, reabstraction revealed more than 95% concordance of original abstracted data.
Table 1.
Injuries Caused by Nonpowder Firearms, by Age and Gender
Fig. 1.
Nonpowder firearm injuries by month.
[View Larger Version of this Image (9K GIF file)]
Table 2.
Age-specific Injuries by Anatomic Site
Table 3.
Disposition and Outcome of Children With Nonpowder Firearm Injuries
Table 4.
Disposition Based on Body Part Injury
Nonpowder firearms represent a significant source of injury in the pediatric age group in this country. There are two injury patterns that result from nonpowder firearms: minor, requiring local care in the emergency department with subsequent discharge; and serious, requiring admission to the hospital and frequently operative intervention. Serious injuries occasionally cause long-term functional deficit. Nonpowder firearms can generate muzzle velocities of 200 to 900 foot-pounds per second5; skin penetration requires only 120 foot-pounds per second.6 Fortunately, the majority of these injuries are minor (74% in this series).
Received for publication Jan 16, 1997; accepted May 14, 1997.
Reprint requests to (P.V.S.) Division of Emergency Medicine, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106.
NEISS, National Electronic Injury Surveillance System.
- McNeill AM, Annest JL The ongoing hazard of BB and pellet gun-related injuries in the United States. Ann Emerg Med 1995; 26:187-194[CrossRef][Medline]
-
Annest JL,
Mercy JA,
Gibson DR,
National estimates of nonfatal
firearm-related injuries.
JAMA
1995;
273:1749-1754
[Abstract/Free Full Text] -
American Academy of Pediatrics, Committee on Injury and Poison
Prevention
Firearm injuries affecting the pediatric population.
Pediatrics
1992;
89:788-790
[Abstract/Free Full Text] -
American Academy of Pediatrics, Committee on Accident and Poison and
Prevention (1985 to 1987)
Injuries related to "toy" firearms.
Pediatrics
1987;
79:473-474
[Abstract/Free Full Text] - Sharif KW, McGhee CN, Tomlinson RC Ocular trauma caused by airgun pellets: a ten-year survey. Eye 1990; 4:855-860
- Fernandez LG, Radhakrishnan J, Gordon RT, Thoracic BB injuries in pediatric patients. J Trauma 1995; 38:384-389[Medline]
- Wascher RA, Gwinn BC Air rifle pellet injury to the heart with retrograde caval migration. J Trauma 1995; 38:379-381[Medline]
- Girdler NM Facial airgun wound. J Trauma 1995; 38:390-391[Medline]
-
Suchedina AA,
Watson DC,
Alpert BS,
Cardiac injury from an air
gun pellet: a case report.
Am J Dis Child
1993;
147:262-263
[Abstract/Free Full Text] -
Blocker S,
Coln D,
Chang JH
Serious air rifle injuries in children.
Pediatrics
1982;
69:751-754
[Abstract/Free Full Text] - Nakamura DS, McNamara JJ, Sanderson L, Thoracic air gun injuries in children. Am J Surg 1983; 146:39-42[CrossRef][Medline]
- Myre LE, Black RE Serious air gun injuries in children. Update of injury statistics and presentation of five cases. Pediatr Emerg Care 1987; 3:168-170[CrossRef][Medline]
-
Harris W,
Luterman A,
Curreri PW
BB and pellet guns
toys or deadly
weapons?
J Trauma
1983;
23:566-569[Medline] - Reddick EJ, Carter PL, Bickerstaff L Air gun injuries in children. Ann Emerg Med 1985; 14:1108-1111[CrossRef][Medline]
- Miner ME, Cabrera JA, Ford E, Intracranial penetration due to BB air rifle injuries. Neurosurgery 1986; 19:952-954[Medline]
- Ford EG, Senac MO, McGrath N It may be more significant than you think: BB air rifle injury to a child's head. Pediatr Emerg Care 1990; 6:278-279[CrossRef][Medline]
- Fernandes ET, Wrenn E, Jerkins G, Late urologic complication of an abdominal gunshot wound. J Pediatr Surg 1990; 25:1283-1284[CrossRef][Medline]
- DiMaio VJ Homicidal death by air rifle. J Trauma 1975; 15:1034-1037[Medline]
-
Lawrence SL
Fatal nonpowder firearm wounds: case report and review of
the literature.
Pediatrics
1990;
85:177-181
[Abstract/Free Full Text] -
Christoffel KK,
Tanz R,
Sagerman S,
Childhood injuries caused by
nonpowder firearms.
Am J Dis Child
1984;
138:557-561
[Abstract/Free Full Text] - Powell EC, Sheehan KM, Christoffel KK Firearm violence among youth and public health strategies for prevention. Ann Emerg Med 1996; 28:204-212[CrossRef][Medline]
Pediatrics (ISSN 0031 4005). Copyright ©1997 by the American Academy of Pediatrics
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