A Single-Center Retrospective Review of Gun Violence in the - - PowerPoint PPT Presentation

A Single-Center Retrospective Review of Gun Violence in the Pediatric Population

Pam ela M. Choi, M.D.; Charles Hong, M.D.; Martin S. Keller, M.D.

Department of Surgery Division of Pediatric Surgery

Department of Surgery Division of Pediatric Surgery

Disclosures

 I have no relevant financial relationships with the manufacturer of any commercial product or provider of commercial services discussed in this CME activity.  I do not intend to discuss an unapproved/ investigative use

• f any commercial product/ device in my presentation.

Department of Surgery Division of Pediatric Surgery

Gun Violence

• Gun-related violence remains a significant public health

concern in the pediatric population

• St Louis City ranks 2nd nationally in rate of youth killed by gun

violence

• Larger metropolitan area ranks 9th
• Numerous efforts have been enacted to address this

problem

• Distribution of free gun locks
• Outpatient violence intervention program started at our institution in

2011

• Injury Free Coalition for Kids
• Citywide involvement with other level-1 trauma centers to reach out

to the community regarding gun violence

• Media spots
• Presentations to Legislature
• Charities/ Rallies
• Midnight to 5am curfew for minor < 17 years in St Louis City

Department of Surgery Division of Pediatric Surgery

Purpose

• We sought to help improve preventative interventions by

examining recent epidemiology and outcomes of pediatric gunshot wounds managed at our institution.

Department of Surgery Division of Pediatric Surgery

Methods

• Retrospective review of children (aged < 16 years) at a

Level-1 Pediatric Trauma Center from 2008-2013 injured by gunshot wounds

• State designated Level-1 in Missouri and Illinois
• American College of Surgeons Verified
• We extracted demographics of patients, timing and

location of shooting, circumstances of shooting, type of firearm, mortality, injury severity, length of stay, and recidivism.

Department of Surgery Division of Pediatric Surgery

Results

• 255 pediatric gunshot victims over 5 years

Year Percent of Traum a Registry 2008-2009 6.2% 2009-2010 5.3% 2010-2011 2.9% 2011-2012 2.2% 2012-2013 2.6%

Department of Surgery Division of Pediatric Surgery

Age (years) 13.1 ± 0.2 Male 215 (84.3% ) Race African American Caucasian Other 206 (80.1% ) 46 (18.0% ) 3 (1.2% ) Deaths 13 (5.1% ) ISS 9.4 ± 1.1 Mean LOS (days) 3.96 ± 0.6 ED Disposition Home Floor PICU OR Morgue 102 (40.0% ) 74 (29.0% ) 29 (11.4% ) 43 (16.8% ) 7 (2.7% ) Location of Shooting Home Outside Car 107 (41.9% ) 137 (53.7% ) 11 (4.3% ) Circumstance of Shooting Assault Accidental Suicide Unclear 165 (64.7% ) 83 (32.5% ) 1 (0.4% ) 3 (1.2% )

Demographics and Outcomes for all Patients

Department of Surgery Division of Pediatric Surgery

Pediatric GSW Victims per Year

Department of Surgery Division of Pediatric Surgery

Demographics and outcomes for accidental gunshot wound victims

Total accidental 83 (32.5% ) Age (years) 10.7 ± 0.5 Male 72 (86.7% ) Race African American Caucasian Other 40 (48.2% ) 41 (49.4% ) 2 (2.4% ) Deaths 2 (2.4% ) ISS 7.2 ± 1.4 Mean LOS (days) 3.3 ± 0.8 Location of Shooting Home 68 (81.2% ) Type of Gun Handgun BB/ Pellet Shotgun Rifle Unspecified 23 (27.7% ) 43 (51.8% ) 6 (7.2% ) 1 (1.2% ) 10 (12.0% ) Shooter Self Friend Sibling Non-sibling family member Other 35 (42.2% ) 19 (22.8% ) 13 (15.7% ) 5 (6.0% ) 11 (13.3% )

Department of Surgery Division of Pediatric Surgery

Shootings by time of day and trauma activation status

Time of day Stat Minor Consult Other Total (% ) 0000-0600 16 15 8 3 42 (16.5% ) 0600-1200 10 6 3 19 (7.5% ) 1200-1800 24 23 6 3 56 (22.0% ) 1800-0000 78 31 22 7 138 (54.1% ) Total (% ) 128 (50.2% ) 75 (29.4% ) 39 (15.3% ) 13 (5.1% )

Department of Surgery Division of Pediatric Surgery

Outcomes for gunshot wound victims by age

Age (years) Total Number (% ) Average age within group (years) ISS Deaths (% ) Mean Hospital LOS (days) 14-16 169 (66.3% ) 15.3 8.4 8 (4.7% ) 3.3 10-13 42 (16.5% ) 12.2 11.4 3 (7.1% ) 5.7 5-9 26 (10.2% ) 7.2 6.2 3.7 0-4 18 (7.1% ) 2.5 18.4 2 (11.1% ) 6.9

Department of Surgery Division of Pediatric Surgery

Discussion

• Accidental shootings have been stable
• Shootings result in a significant hospital resource utilization
• Most commonly occurred between 6 PM to 12 AM (54.1% ) and a

significant proportion led to a trauma stat activation (50.2% )

• City-instituted curfew limited

Department of Surgery Division of Pediatric Surgery

Limitations of Study

• Retrospective, observational/ epidemiologic study
• Single Center
• Recidivism- going to adult hospitals?
• Data incomplete?
• Presently collaborating with other Level-1 Pediatric Trauma Center

in St Louis

Department of Surgery Division of Pediatric Surgery

Conclusions/ Future Directions

• More work is needed in reducing the number of accidental

shootings within the home, which have remained stable

• ver the past 5 years.
• Our data shows decreasing numbers of gun victims,

suggesting successful preventative efforts.

• Recent surge of shootings
• 2014- 32 gunshot victims over 8 months (3.5% of registry)
• Gun sales have increased in response to pending Ferguson verdict

Department of Surgery Division of Pediatric Surgery

Thank You!

• Acknowledgements
• Charles Hong, MD
• Martin Keller, MD
• St Louis Children’s Hospital Trauma Registry

Pam Choi General Surgery Resident Campus Box 8109 660 South Euclid Ave

• St. Louis, MO 63110

(314) 362-8028 choip@wustl.edu