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Ballistic Trauma in Children

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Abstract

The natural inquisitiveness and vulnerability of early life predispose children to penetrating injury; varying in severity from a minor laceration or foreign body penetration to life-threatening impalement, stab wound, or missile injury. Ballistic injuries, defined as injuries caused by thrown or projected missiles, comprise an important proportion of pediatric penetrating injury. Penetrating injuries are responsible for approximately 15% of pediatric trauma deaths in developed countries.1 Injury patterns differ widely between different communities, socioeconomic groups, cities, countries, and cultures. Such injuries are also more common during times of revolution or sociopolitical change.

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References

  1. Vane D, Shedd FG, Grosfeld JL, et al. An analysis of pediatric Trauma deaths in Indiana. J Pediatr Surg. 1990;9:955-960.

    Article  Google Scholar 

  2. From the Centers for Disease Control. Unintentional firearm-related fatalities among children, teenagers – United States, 1982–1988. JAMA. 1992;268:451-452.

    Article  Google Scholar 

  3. Unintentional firearm-related fatalities among children and teenagers – United States, z1982–1988. MMWR Morb Mortal Wkly Rep. 1992 Jun;41(25):442-5, 451.

    Google Scholar 

  4. Cummings P, Grossman DC, Rivara FP, Koepsell TD. State gun safe storage laws and child mortality due to firearms. JAMA. 1997;278:1084-1086.

    Article  PubMed  CAS  Google Scholar 

  5. Powell EC, Tanz RR. Child and adolescent injury and death from urban firearm assaults: Association with age, race, and poverty. Inj Prev. 1999;5:41-47.

    Article  PubMed  CAS  Google Scholar 

  6. Nance ML, Stafford PW, Schwab CW. Firearm injury among urban youth during the last decade: An escalation in violence. J Pediatr Surg. 1997;32:949-952.

    Article  PubMed  CAS  Google Scholar 

  7. Copeland AR. Childhood firearms fatalities: The Metropolitan Dade County experience. South Med J. 1991;84:175-178.

    Article  PubMed  CAS  Google Scholar 

  8. Rates of homicide. Suicide, and firearm-related death among children – 26 industrialized countries. MMWR Morb Mortal Wkly Rep. 1997;46:101-115.

    Google Scholar 

  9. Krug EG, Dahlberg LL, Powell KE. Childhood homicide, suicide, and firearm deaths: an international comparison. World Health Stat Q. 1996;49:230-235.

    PubMed  CAS  Google Scholar 

  10. Patterson PJ, Holguin AH. Firearm-related deaths among children in Texas: 1984–1988. Tex Med. 1990;86:92-97.

    PubMed  CAS  Google Scholar 

  11. Dowd MD, Knapp JF, Fitzmaurice LS. Pediatric firearm injuries, Kansas City, 1992: A population-based study. Pediatrics. 1994;94:867-873.

    PubMed  CAS  Google Scholar 

  12. Wigton A. Firearm-related injuries and deaths among children and adolescents in Cape Town – 1992–1996. S Afr Med J. 1999;89:407-410.

    PubMed  CAS  Google Scholar 

  13. Hadley GP, Mars MS. Gunshot injuries in infants and children in KwaZulu-Natal – an emerging epidemic? Afr Med J. 1998;88:444-447.

    CAS  Google Scholar 

  14. Scribano PV, Nance M, Reilly P, Sing RF, Selbst SM. Pediatric nonpowder firearm injuries: outcomes in an urban pediatric setting. Pediatrics. 1997;100:E5.

    Article  PubMed  CAS  Google Scholar 

  15. Bratton SL, Dowd MD, Brogan TV, Hegenbarth MA. Serious and fatal air gun injuries: more than meets the eye. Pediatrics. 1997;100:609-612.

    Article  PubMed  CAS  Google Scholar 

  16. Bhattacharyya N, Bethel CA, Caniano DA, Pillai SB, Deppe S, Cooney DR. The childhood air gun: serious injuries and surgical interventions. Pediatr Emerg Care. 1998;14:188-190.

    Article  PubMed  CAS  Google Scholar 

  17. Nance ML, Sing RF, Branas CC, Schwab CW. Shotgun wounds in children. Not just accidents. Arch Surg. 1997;132:58-62.

    PubMed  CAS  Google Scholar 

  18. Ivatury RR, Nallathambi MN, Roberge RJ. Penetrating thoracic injuries: In field stabilisation vs prompt transport. J Trauma. 1987;27:1066-1072.

    Article  PubMed  CAS  Google Scholar 

  19. Paul TR, Marias M, Pons PT, Pons KA, Moore EE. Adult vs paediatric prehospital trauma care. Is there a difference? J Trauma. 1999;47:455-459.

    Article  PubMed  CAS  Google Scholar 

  20. Gaffney P, Johnson G. Paediatric prehospital trauma care. Trauma. 1999;1:279-284.

    Google Scholar 

  21. Bickell WH, Wall MJ Jr, Pepe PE, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331:1105-1109.

    Article  PubMed  CAS  Google Scholar 

  22. Bickell WH, Barrett SM, Romine Jenkins M, Hull SS Jr, Kinasewitz GT. Resuscitation of canine hemorrhagic hypotension with large-volume isotonic crystalloid: impact on lung water, venous admixture, and systemic arterial oxygen saturation. Am J Emerg Med. 1994;12:36-42.

    Article  PubMed  CAS  Google Scholar 

  23. Bickell WH, Bruttig SP, Millnamow GA, O’Benar J, Wade CE. Use of hypertonic saline/dextran versus lactated Ringer’s solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine. Ann Emerg Med. 1992;21:1077-1085.

    Article  PubMed  CAS  Google Scholar 

  24. Bickell WH. Are victims of injury sometimes victimized by attempts at fluid resuscitation? Ann Emerg Med. 1993;22:225-226.

    Article  PubMed  CAS  Google Scholar 

  25. Wright JL, Patterson MD. Resuscitating the pediatric patient. Emerg Med Clin North Am. 1996;14:219-231.

    Article  PubMed  CAS  Google Scholar 

  26. Sarnaik AP, Kopec J, Moylan P, Alvarez D, Canady A. Role of aggressive intracranial pressure control in management of pediatric craniocerebral gunshot wounds with unfavorable features. J Trauma. 1989;29(10):1434-1437.

    Article  PubMed  CAS  Google Scholar 

  27. Hall JR, Reyes HM, Meller JL. Penetrating zone-II neck injuries in children. J Trauma. 1991;31(12):1614-1617.

    Article  PubMed  CAS  Google Scholar 

  28. Mitchell RB, Pereira KD, Younis RT, Lazar RH. The management of asymptomatic firearm injuries in children. J R Coll Surg Edinb. 1997;42(6):418-419.

    PubMed  CAS  Google Scholar 

  29. Cooper A, Barlow B, Di Scala C, String D. Mortality and truncal injury: the pediatric perspective. J Pediatr Surg. 1994;29:33-38.

    Article  PubMed  CAS  Google Scholar 

  30. Mineo TC, Ambrogi V, Cristino B, Pompeo E, Pistolese C. Changing indications for thoracotomy in blunt chest trauma after the advent of videothoracoscopy. J Trauma. 1999;47:1088-1091.

    Article  PubMed  CAS  Google Scholar 

  31. Chen MK, Schropp KP, Lobe TE. The use of minimal access surgery in pediatric trauma: a preliminary report. J Laparoendosc Surg. 1995;5:295-301.

    Article  PubMed  CAS  Google Scholar 

  32. Pitcher GJ. Fiber-endoscopic thoracoscopy for diaphragmatic injury in children. Semin Pediatr Surg. 2001;10:17-19.

    Article  PubMed  CAS  Google Scholar 

  33. Powell RW, Gill EA, Jurkovich GJ, Ramenovsky ML. Resuscitative thoracotomy in children and adolescents. Am J Surg. 1988;54:188-191.

    CAS  Google Scholar 

  34. Rothenberg SS, Moore EE, Moore FA, Baxter BT, Moore JB, Cleveland HC. Emergency department thoracotomy in children – a critical analysis. J Trauma. 1989;29:1322-1325.

    Article  PubMed  CAS  Google Scholar 

  35. Beaver BL, Moore VL, Peclet M, Haller JA, Smialek J, Hill JL. Efficacy of emergency room thoracotomy in paediatric trauma. J Pediatr Surg. 1987;22:19-23.

    Article  PubMed  CAS  Google Scholar 

  36. Sheikh AA, Culbertson CB. Emergency department thoracotomy in children: rationale for selective application. J Trauma. 1993;34:323-328.

    Article  PubMed  CAS  Google Scholar 

  37. Inci I, Ozcelic C, Nizam O, Eren N, Ozgen G. Penetrating chest injuries in children: a review of 94 cases. J Pediatr Surg. 1996;31:673-676.

    Article  PubMed  CAS  Google Scholar 

  38. Nance ML, Sing RF, Reilly PM, Templeton JM, Schwab CW. Thoracic gunshot wounds in children under 17 years of age. J Pediatr Surg. 1996;31:931-935.

    Article  PubMed  CAS  Google Scholar 

  39. Peterson R, Tepas JJ 3rd, Edwards FH, Kissoon N, Pieper P, Ceithaml EL. Pediatric and adult thoracic trauma: Age-related impact on presentation and outcome. Ann Thorac Surg. 1994;58:14-18.

    Article  PubMed  CAS  Google Scholar 

  40. Bains MS, Gisnberg RJ, Jones WG 2nd, et al. The clamshell incision: An improved approach to bilateral pulmonary and mediastinal tumor. Ann Thorac Surg. 1994;58(1):30-33.

    Article  PubMed  CAS  Google Scholar 

  41. Shimizu J, Oda M, Morita K, et al. Evaluation of the clamshell incision for bilateral pulmonary metastases. Int Surg. 1997;82(3):262-265.

    PubMed  CAS  Google Scholar 

  42. Luciani GB, Starnes VA. The clamshell approach for the surgical treatment of complex cardiopulmonary pathology in infants and children. Eur J Cardiothorac Surg. 1997;11(2):298-306.

    Article  PubMed  CAS  Google Scholar 

  43. Shorr RM, Gottlieb MM, Webb K, Ishiguro L, Berne TV. Selective management of abdominal stab wounds: importance of the physical examination. Arch Surg. 1988;123:1141-1145.

    PubMed  CAS  Google Scholar 

  44. Mills RP, Robbs JV. Paediatric arterial injury: management options at the time of injury. J R Coll Surg Edinb. 1991;36:13-17.

    PubMed  CAS  Google Scholar 

  45. Johansen K, Lynch K, Paun M, Copass M. Non-invasive vascular tests reliably exclude occult arterial trauma in injured extremities. J Trauma. 1991;31:515-522.

    Article  PubMed  CAS  Google Scholar 

  46. Gahtan V. The role of emergent arteriography in penetrating limb trauma. Am Surg. 1994;60:123-127.

    PubMed  CAS  Google Scholar 

  47. Weaver FA, Yellin AE, Bauer M, et al. Is arterial proximity a valid indication for arteriography in penetrating extremity trauma? A prospective analysis. Arch Surg. 1990;125:1256-1260.

    PubMed  CAS  Google Scholar 

  48. Reichard KW, Hall JR, Meller JL, Spigos D, Reyes HM. Arteriography in the evaluation of penetrating pediatric extremity injuries. J Pediatr Surg. 1994;29:19-22.

    Article  PubMed  CAS  Google Scholar 

  49. Itani KM, Rothenberg SS, Brandt ML, et al. Emergency center arteriography in the evaluation of suspected peripheral vascular injuries in children. J Pediatr Surg. 1993;28:677-680.

    Article  PubMed  CAS  Google Scholar 

  50. Frykberg ER, Crump JM, Dennis JW, Vines FS, Alexander RH. Nonoperative observation of clinically occult arterial injuries: a prospective evaluation. Surgery. 1991;109:85-96.

    PubMed  CAS  Google Scholar 

  51. Kuo PC, Schroeder RA. The emerging multifaceted roles of nitric oxide. Ann Surg. 1995;221:220-235.

    Article  PubMed  CAS  Google Scholar 

  52. Reichard KW, Reyes HM. Vascular trauma and reconstructive approaches. Semin Pediatr Surg. 1994;3:124-132.

    PubMed  CAS  Google Scholar 

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Correspondence to Graeme Pitcher .

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© 2011 Springer London

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Pitcher, G. (2011). Ballistic Trauma in Children. In: Brooks, A., Clasper, J., Midwinter, M., Hodgetts, T., Mahoney, P. (eds) Ryan's Ballistic Trauma. Springer, London. https://doi.org/10.1007/978-1-84882-124-8_35

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  • DOI: https://doi.org/10.1007/978-1-84882-124-8_35

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