Wounding patterns in pediatric firearm fatalities: identifying potentially preventable deaths Julia 1Donald
1 Haft ,
Bailey Roberts
2 MD ,
2 MD ,
Douglas James Charlotte L Kvasnovsky MD MPH 2 2 Prince MD , Chethan Sathya MD MSc
2 PhD ,
Jose
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Cohen Children’s Medical Center at Northwell Health/Zucker-Hofstra School of Medicine
Background
Suicide: Given the high rates of death on scene and therefore lack of intervention after the gunshot, the most effective method of intervention for these cases is prevention. • Both age groups could benefit from education surrounding gun storage in the home because the majority of suicides occurred at home. • Resources should be focused on adolescents age 13-18 and children who may be at higher risk of suicide due to mental health diagnosis or concerns for changes in mood.
• Injury is the leading cause of death in children aged 1-18 years, with injury by firearms exceeded only by motor vehicle collisions1. • The rate of pediatric firearm mortalities in the United States (US) is 14-36 times higher than the rate in other high-income countries2,3, making this an important public health crisis in the US. • The circumstances surrounding firearm injury vary by age group4 • Younger children are often bystanders in familial disputes5 • Older children are more likely to be involved in incidents related to crime, gangs or drugs4
Hypothesis
Table 1: Demographic data stratified by cause of death and age group. Handguns were the most commonly used firearm in all cases. ≤ 12 age group: Victims of suicide were older than victims of homicide and unintentional injury. Location of injury was more likely to be at home. 13-18 age group: Victims of unintentional injury are younger than suicide and homicide victims. Location of injury was more likely to be out of the home.
Our study aims to identify wounding patterns of firearm related deaths in the pediatric population in the United States. Understanding wound patterns will help guide initiatives to improve public health strategies and pre-hospital care.
Methods Database: The National Violent Death Reporting System (NVDRS), curated by the Center for Disease Control and Prevention Cohort: All victims with a firearm as the primary weapon type from the years 2005-2017 age 18 years and younger (8,527) • victims were divided into two age groups • 0-12 years • 13-18 years • Of the 8,527 victims, 4,728 of these were homicides, 3,180 were suicides and 619 were unintentional firearm injuries. Analysis: Data was analyzed using GraphPad Prism version 8.0.0. Chi squared analysis was used for categorical variables and one way ANOVA for continuous variables were performed to compare groups. Categories were combined if n<5. A p value of <0.05 was considered statistically significant.
Conclusions
Results
Figure 1: Wounding pattern stratified by cause of death and age group. In both age groups wounding patterns were correlated with cause of death (p<0.0001)*. The patterns of wounding in the children 12 and under followed those of the adolescents, with both groups showing mostly head/neck wounds in suicide, homicide, and unintentional injuries. *in the ≤ 12 age group the Chi-square value may not be valid because not all values are >0 and over 20% of the values are < 5
Figure 7: Independent CRISPR knockout of CDK4 or CDK6 does not cause dropout in most breast cancer cell lines studied.
Table 2: Location of death stratified by cause of death and age group. In both age groups suicide and homicide victims are more likely to be found dead on scene. ≤ 12 age group: Victims of unintentional injury were more likely to die in the emergency department (n=117, 41.3%, p=0.01). Victims of homicide were more likely to die on scene when compared to adolescents. 13-18 age group: Victims of unintentional injury were more likely to be dead on scene compared to ≤ 12 (n=157, 46.7%, p=0.04). Victims of homicide were more likely to die in the emergency department compared to young children.
Homicide: The wounding patterns, location of injury, and location of death varied by age group. Therefore, prevention strategies should differ by age. • Children 12 and under are more likely to sustain less survivable injuries and would benefit from a primary prevention strategy focused on weapons in the home. • Prevention strategies in adolescents should be focused on weapons in the community, as most of their injuries occurred outside the home. They may also benefit from pre and inhospital interventions as they are more likely to die in the emergency department. Unintentional: Younger children are more susceptible to unintentional injuries, but they are more deadly in the adolescent population. • Intervention for the younger age group should be focused on firearm storage at home as it is the most likely site of incidence. • Adolescent intervention should be focused on safe gun handling and carrying within the community because most of these injuries occurred away from the home.
Resources 1. 2. 3. 4. 5.
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