Mortality and PICU Hospitalization Among Pediatric Gunshot Wound Victims in Chicago.
Mortality and PICU Hospitalization Among Pediatric Gunshot Wound Victims in Chicago.
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DOI：
10.1097/cce.0000000000000626
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发表时间：
2022-03
影响因子：
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通讯作者：
Pinto NP
中科院分区：
文献类型：
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作者：
Rhine MA;Hegermiller EM;Kane JM;Slidell MB;Mayampurath A;McQueen AA;Mbadiwe N;Pinto NP
枪伤是入住 PICU 的儿童发病率较高且死亡率较高的原因。了解入院 PICU 的风险因素是制定预防和干预策略以最大程度减少儿童枪伤 (GSW) 伤害负担的重要一步。本研究的主要目的是描述 GSW 儿童的结局和入住 PICU 的可能性。 2010 年至 2017 年在芝加哥大学科默儿童医院儿科创伤中心对 0-18 岁 GSW 患者进行的回顾性队列研究进行了评估。人口统计和伤害严重程度测量数据来自机构数据库。我们描述了该队列的死亡率和住院特征。我们使用逻辑回归模型来测试 PICU 入院与患者特征之间的关联。在为期 8 年的研究期间，294 名儿童经历了 GSW。我们没有观察到总死亡率随时间变化的趋势，但 GSW 儿童的死亡率高于全因 PICU 死亡率。与 13-16 岁儿童相比，0-6 岁儿童的住院时间更长（5 天 vs 3 天；p = 0.04），并且入住 PICU 的频率更高（83.3% vs 52.9%；p = 0.001）。调整疾病严重程度后，7 岁以下儿童入住 PICU 的可能性是 13-16 岁儿童的四倍（aOR 范围，3.9-4.6）。尽管美国各地儿童枪支死亡率有所下降，但我们队列中的死亡率并没有随着时间的推移而下降，并且高于 PICU 的全因死亡率。患有 GSW 的年龄较小的儿童比年龄较大的儿童住院时间更长，并且更频繁地需要 PICU 护理。我们的研究结果表明，最年轻的枪支相关伤害受害者可能特别容易遭受严重疾病和伤害的长期后遗症。
Firearm injury accounts for significant morbidity with high mortality among children admitted to the PICU. Understanding risk factors for PICU admission is an important step toward developing prevention and intervention strategies to minimize the burden of pediatric gunshot wound (GSW) injury. The primary objective of this study was to characterize outcomes and the likelihood of PICU admission among children with GSWs. Retrospective cohort study of GSW patients 0–18 years old evaluated at the University of Chicago Comer Children’s Hospital Pediatric Trauma Center from 2010 to 2017. Demographic and injury severity measures were acquired from an institutional database. We describe mortality and hospitalization characteristics for the cohort. We used logistic regression models to test the association between PICU admission and patient characteristics. During the 8-year study period, 294 children experienced GSWs. We did not observe trends in overall mortality over time, but mortality for children with GSWs was higher than all-cause PICU mortality. Children 0–6 years old experienced longer hospitalizations compared with children 13–16 years old (5 vs 3 d; p = 0.04) and greater frequency of PICU admission (83.3% vs 52.9%; p = 0.001). Adjusting for severity of illness, children less than 7 years old were four-fold more likely to be admitted to the PICU than children 13–16 years old (aOR range, 3.9–4.6). Despite declines in pediatric firearm mortality across the United States, mortality did not decrease over time in our cohort and was higher than all-cause PICU mortality. Younger children with GSWs experience longer hospitalizations and require PICU care more often than older children. Our findings suggest that the youngest victims of firearm-related injury may be particularly at-risk of the long-term sequelae of critical illness and injury.