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Background: Although firearms account for less than 5 % of all pediatric injuries, they have the highest associated case fatality rate., Methods: The registry at a Level-1 trauma center was used to identify firearm injuries (<18 years of age) from 1991 to 2011. Descriptive statistics and risk-adjusted multivariate analyses (MVA) were performed., Results: Overall, 1085 patients were identified. Immediate operations were performed in 33 % (n = 358) of patients with most having abdominal surgery (n = 214). Survival was 86 %, but higher for African Americans (OR = 1.92) than for Hispanics (p = 0.006). African Americans were more likely to sustain extremity (OR = 2.26) and less head (OR = 0.36) injuries than Hispanics (p < 0.001). Analysis by injury location showed that head (OR = 14.1) had the highest associated mortality. Other significant predictors included multiple major injury (defined by Abbreviated Injury Scale) with central nervous system involvement (OR = 7.30) and single injuries to the chest (OR = 2.68). These findings were compared to abdominal injuries as the baseline (p < 0.02). MVA demonstrated that Caucasian children had higher mortality (OR = 6.12) vs. Hispanics (p = 0.031). Children admitted with initial pH ≤ 7.15 (OR = 14.8), initial hematocrit ≤30 (OR = 3.24), or Injury Severity Score (ISS) > 15 (OR = 1.08) had higher mortality rates (p < 0.05)., Conclusion: Independent significant indicators of mortality include low initial pH or hematocrit, Caucasian race, high ISS, and those who sustain head injuries.

Purpose: Initial hematocrit (Hct) is generally not considered a marker of acute blood loss because it is assumed that physiologic response of fluid conservation to hemorrhage is delayed. We challenged this idea by theorizing that admission Hct correlates with conventional signs of shock and predicts the use of blood transfusion during resuscitation of pediatric trauma patients., Methods: Data from 1928 pediatric admissions (<18 years) at a Level I trauma center (2000-2012) were compared using standard statistical analyses and logistic regression modeling to identify factors associated with blood transfusion during initial trauma resuscitation., Results: Overall mortality rate was 3.5%, with a transfusion rate of 10.7%. Factors significantly associated with transfusion were initial Hct, Glasgow Coma Score, base deficit, and injury severity score (all p<0.001). Initial Hct is a stronger predictor for transfusion (area under receiver operator curve (AUC: 0.728) compared to age-specific tachycardia (AUC: 0.689), age-specific hypotension (AUC: 0.673), and altered mental status (AUC: 0.654)). On multivariate analysis, initial Hct was an independent predictor (OR [95% CI]: 2.94 [1.56, 5.52]) along with hypotension (6.37 [2.95, 13.8]), base deficit (4.14 [1.38, 12.4]), and tachycardia (3.07 [1.62, 5.81])., Conclusions: Initial Hct correlates significantly with conventional signs of shock and is a strong independent predictor for blood transfusion with better predictability than other clinical factors., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Pediatric gunshot wounds remain an important cause of morbidity and mortality in the United States. Recent experience in the urban pediatric population has not been extensively documented., Methods: A retrospective review of the trauma registry identified all pediatric (age 0-16 y) gunshot wound injuries between October 1991 and August 2011. We evaluated demographic, injury location, disposition, and outcome data. We applied descriptive statistics and χ(2) with significance level set to P ≤ 0.05., Results: We treated 740 patients at our trauma center. Patients tended to be male (82%) and African American (72%), and most frequently were shot in the abdomen, back, or pelvic regions (26%). Patients with head or neck injuries experienced the highest mortality rate (35%), whereas the mortality rate overall was 12.7%. A total of 23% of patients were discharged directly, but 32% required an operation. We grouped data into five equal time periods, demonstrating that after decreasing through the 1990s, pediatric gunshot wounds presenting to our hospital are steadily increasing., Conclusions: We identified certain demographic and temporal trends regarding pediatric gunshot wounds, and the overall number of injuries appears to be increasing., (Copyright © 2013 Elsevier Inc. All rights reserved.)