Shotgun wounds in children. Not just accidents
M. L. Nance, R. F. Sing, C. C. Branas and C. W. Schwab
Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, USA.
OBJECTIVE: To characterize the demographic characteristics of shotgun
wounds in children and adolescents across various regions within a state.
DESIGN: Retrospective case study. SETTING: Accredited trauma centers in
Pennsylvania. PATIENTS: All patients less than 18 years old who sustained
shotgun wounds. DATA COLLECTION: Patient data were collected from the
Pennsylvania Trauma Systems Foundation statewide trauma registry for
January 1987 through December 1994. Data reviewed included age, race, sex,
region, nature of injury, assailant, location of incident, length of stay
in the hospital and intensive care unit, Injury Severity Score, organs
injured, death, and discharge disposition. RESULTS: Over 8 years there were
95 shotgun wounds in patients with a mean +/- SD age of 14.0 +/- 3.7 years;
the male-to-female ratio was 5.8:1. The incidence of shotgun wounds in
urban areas increased threefold during the second half of the study; the
incidence in nonurban regions was unchanged. Eighteen deaths (19%)
occurred, 17 (94%) within 24 hours and 10 (56%) because of intracranial
injury. Overall, unintentional shotgun wounds were most common (n = 46
[48%]), followed by assaults (n = 37 [39%]) and suicides (n = 8 [8%]). The
highest per capita incidence of shotgun wounds occurred in urban areas,
typically the result of an assault (n = 30 [73%]). In nonurban areas,
shotgun wounds were usually unintentional (n = 36 [67%]); 34 (63%) occurred
in the home. In contrast, in urban areas, 26 shotgun wounds (63%) occurred
on the street. Overall, 14 fatal shotgun wounds (78%) occurred in the home.
Operative intervention was required for 57 patients (60%). Ultimately, 67
patients (71%) were discharged to home. CONCLUSIONS: In urban areas,
shotgun wounds are increasing in incidence, often occur on the street, and
often result from assault. In nonurban areas, shotgun wounds are usually
unintentional, often occur in the home, and are more often lethal than
shotgun wounds in urban areas. Multiple-organ injury, surgery, and lengthy
hospital stays are common.
