IOA 2022

Pediatric Firearm Injuries in Israel: A 10-year, Single-center, Descriptive Study

Alan Katz 1 Ruth Fan 1 Natan Silver 1 Ehud Lebel 1 Alon Schwartz 2 Amos Peyser 1
1Orthopedic Surgery, Shaare-Zedek Medical Center Affiliated with the Hebrew University School of Medicine, Israel
2General Surgery, Shaare-Zedek Medical Center Affiliated with the Hebrew University School of Medicine, Israel

Background:
Injury resulting from firearms is a prominent public health issue associated with significant morbidity, mortality, and cost. Gunshot wounds (GSW) are a leading cause of injury-related death among children worldwide. This study describes pediatric GSW in Israel over the past decade, evaluating demographic and injury characteristics, as well as hospital treatment.

Methods:
A single-center, retrospective analysis was performed on patients evaluated between 2011 and 2021. All patients aged under 18 and treated for firearm injury were included. Details of their injury and management were collected.

Results:
41 patients were included with mean age 13.9 years (range 2.5-17.9). Male gender was predominant (90.2%) and most patients were of Arab ethnicity (66%). Injuries were intentional in 44% of cases. The type of firearm was unknown in 34% of the cases, an air-gun was used in 34%, and a rifle or handgun was used in the remaining cases. Limb injuries were most common (46%), followed by head & neck injuries (37%), then trunk injuries (29%). Most children (88%) had normal GCS on arrival. Life-saving procedures were performed in the emergency department in 17%, with 51% of all patients requiring surgery. 22% of patients received blood-products. All patients required hospital admission, 24% were admitted to the intensive care unit. Average length of admission was 7.4 days. One patient died (2%) and 29% suffered long-term sequelae, 30% of which were neurological in nature. 20% of all cases required more than one surgical procedure. Increased age and intentional injuries were both associated with longer admission and increased risk of permanent damage.

Conclusion:
To our knowledge this is the first description specifically of pediatric firearm injuries in the Israeli population. An understanding of these diverse injuries can lead to better management and help give doctors, patients and relatives realistic expectations about prognosis.