Ministry of Health

http://newzealand.govt.nz/

    
 ©Copyright
 Published: 28/11/2011

Paediatric Gun Shot Injuries
Adrian Skinner

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Outline

Gun shot injuries in children: a ten year experience
Adrian Skinner
Rangi Dansey
Dean Rex
James Hamill
Department of Paediatric Surgery
Starship Children’s Hospital, Auckland, New Zealand

INTRODUCTION
 NZ has reputation for outdoors lifestyle
 NZ does not have liberal gun laws
 Children are at risk and suffer gun shot injuries

AIM
 Auckland experience
 Injuries
 Outcome

METHODS
 Retrospective review
 10yr period 1996-2005
 Starship Children’s Hospital
 Catchment ~1.5-2 million

RESULTS
N = 30 (1 child every 4 months)
Age
    Median 8.5 years
Gender
    24 male (80%)
Ethnicity
Hospital of first presentation
Weapon
 four .22
 one .270
 one 12 bore shot gun
 one blunt recoil (non-penetrating)
 23 x air rifles

Place of injury
    Home
    Bush
    School
    Sea

Transfer method

Injuries
 66% head and/or neck
 Most serious injuries with large calibre >.22
 Majority injuries superficial
 5 cases projectile in-situ

GCS

Admitting service
All paediatric services:
 Paediatric surgery
 Paediatric orthopaedics
 Paediatric cardiology
 Ophthalmology
 Neurosurgery
 Cardio-thoracic surgery
 Paediatric ENT surgery

Definitive treatment
Operations
 3 required >1 x OR procedure
 5 treated conservatively
 Majority required subcutaneous pellet retrieval only

Operations
 Posterior fossa decompression
 RCA ligation
 Laparotomy, splenectomy, L hemicolectomy, repair stomach lac, stoma formation
 Removal of pellet from heart & close VSD
 Debridement of compound skull injury
 Craniotomy, evacuation of haematoma
 Partial thymectomy & removal of pellet via sternotomy

Delay to OR

Outcome
 8 required PICU
 Hospital stay 1 – 52 days
 One fatality

Follow-up
 Median follow-up 3.5 months

Morbidity
 13 pts (43%) have long term/disabling morbidity
 L CN VII LMN palsy; NG feeds; L hearing loss; L eye lid palsy
 R CN IV palsy; epilepsy
 persistent vitreous haemorrhage
 R hemiparesis, dyphasia
 L brachial plexus injury

Mortality

Airgun versus Others
Head injury 11 5
Operation 19 6
LOS total 92 102
PICU 4 4
Morbidity 4 4
Mortality 0 1

Summary
 Most gunshot injuries from air rifles
 Incidence increasing
 Significant morbidity

Conclusion
Public awareness campaign