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
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 of 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 2 nd nationally in rate of youth killed by gun • violence Larger metropolitan area ranks 9 th • 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
Demographics and Outcomes for all Patients 13.1 ± 0.2 Age (years) Male 215 (84.3% ) Race African American 206 (80.1% ) Caucasian 46 (18.0% ) Other 3 (1.2% ) Deaths 13 (5.1% ) 9.4 ± 1.1 ISS 3.96 ± 0.6 Mean LOS (days) ED Disposition Home 102 (40.0% ) Floor 74 (29.0% ) PICU 29 (11.4% ) OR 43 (16.8% ) Morgue 7 (2.7% ) Location of Shooting Home 107 (41.9% ) Outside 137 (53.7% ) Car 11 (4.3% ) Circumstance of Shooting Assault 165 (64.7% ) Accidental 83 (32.5% ) Suicide 1 (0.4% ) Unclear 3 (1.2% ) 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% ) 10.7 ± 0.5 Age (years) Male 72 (86.7% ) Race African American 40 (48.2% ) Caucasian 41 (49.4% ) Other 2 (2.4% ) Deaths 2 (2.4% ) 7.2 ± 1.4 ISS 3.3 ± 0.8 Mean LOS (days) Location of Shooting Home 68 (81.2% ) Type of Gun Handgun 23 (27.7% ) BB/ Pellet 43 (51.8% ) Shotgun 6 (7.2% ) Rifle 1 (1.2% ) Unspecified 10 (12.0% ) Shooter Self 35 (42.2% ) Friend 19 (22.8% ) Sibling 13 (15.7% ) Non-sibling family member 5 (6.0% ) Other 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 0 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 Total Number Average age ISS Deaths Mean Hospital (years) (% ) within group (% ) LOS (days) (years) 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 0 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 over 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 Department of Surgery Division of Pediatric Surgery
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