The Jarring Reality: Adolescent and Pediatric Gunshot Trauma on the Rise in a Major Urban Institution

Julianna E Winter; Arjun Verma; Bela P Delvadia; Olivia C Lee; McCayn M Familia; William F Sherman

doi:10.5435/JAAOS-D-23-01172

The Jarring Reality: Adolescent and Pediatric Gunshot Trauma on the Rise in a Major Urban Institution

J Am Acad Orthop Surg. 2024 May 10. doi: 10.5435/JAAOS-D-23-01172. Online ahead of print.

Authors

Julianna E Winter¹, Arjun Verma, Bela P Delvadia, Olivia C Lee, McCayn M Familia, William F Sherman

Affiliation

¹ Department of Orthopaedic Surgery, Tulane University, New Orleans, LA (Winter, Verma, and Delvadia); Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA (Lee); and Department of Orthopaedic Surgery, Tulane University, New Orleans, LA (Sherman).

PMID: 38739866
DOI: 10.5435/JAAOS-D-23-01172

Abstract

Introduction: Firearms are the leading cause of death in the pediatric population, and the incidence of firearm injury is on the rise in the United States. The purpose of this study was to examine the incidence of pediatric gunshot wounds (GSWs) in New Orleans from 2012 to 2023 and evaluate factors that contribute to mortality.

Methods: A retrospective analysis of pediatric GSWs was conducted using the trauma database at a Level I trauma center in New Orleans, Louisiana. All patients aged 0 to 18 years with a GSW between January 1, 2012, and January 1, 2023, were evaluated. Demographic data, Injury Severity Score (ISS), hospital length of stay (LOS), discharge disposition, intent of injury, mortality, firearm type, orthopaedic injuries, and related surgical procedures were extracted from the database. Linear regression was used to assess the trend of GSWs over time, and logistic regression was used to identify variables that predicted mortality. Statistical significance was defined as α = 0.05. Geographic information system (GIS) mapping was conducted using the ZIP code location of injury to identify geographic areas with the greatest number of GSWs.

Results: A significant increasing trend was observed in the number of pediatric GSWs when adjusted for changes in population (P = 0.014), and the number of GSWs increased 43.2% over the duration of the study. Higher ISS, shorter length of stay, and self-inflicted intent of injury were notable predictors of mortality. Three hundred fifty-four patients (31.4%) had at least one orthopaedic injury, and of the survivors, 365 patients (35.6%) required at least one surgical procedure in the operating room during their admission.

Discussion: The number of GSWs in the pediatric population in New Orleans presenting at a large level 1 trauma center demonstrated a statistically significant increasing trend over the past 11 years. ISS and self-inflicted intent were predictive of mortality within this pediatric patient population.