Targeting safety: Exploring trends and risk factors in pediatric head and neck BB gun injuries and hospitalization.

OBJECTIVE: To examine head and neck injuries caused by BB (Ball Bearing) guns treated in US emergency departments among children under 18 to identify trends in injury frequency over time and risk factors associated with severe injuries leading to hospital admission. METHODS: This retrospective study utilized data from the National Electronic Injury Surveillance System (NEISS), a single database, to analyze head and neck injuries caused by BB guns between 1993 and 2019. The analysis explored demographic characteristics and injury patterns, including sex, age, incidence, injury location, hospital type, and disposition. Linear regression was employed to assess trends in the yearly frequency of injuries, while univariate and multivariate binary logistic regression was used to calculate the odds ratios associated with hospitalization. RESULTS: A total of 4041 cases of pediatric head and neck injuries caused by BB guns and treated in US emergency departments were identified. Most patients were male (84 %), with the highest proportion of injuries occurring in the 10-14 age group (49.7 %). The face (35.8 %) and eye (27.4 %) were the most affected injury sites, and 7.5 % of patients required hospital admission. No significant linear trend was observed in injury frequency over the study period. However, children aged four and under had higher odds of hospitalization (OR 2.77, 95 % CI 1.61-4.75) despite a lower incidence of injuries. Injuries to the eye (OR 12.37, 95 % CI 8.31-18.43) and neck (OR 7.58, 95 % CI 4.76-12.06) were strong predictors of hospital admission. CONCLUSION: Pediatric BB gun-related head and neck injuries remain a source of emergency room visits nationally. Younger children are at increased risk of admission to the hospital. Eye and neck injuries were the strongest predictors of hospital admission. Implementing safety precautions for younger children is crucial, as injuries might be more severe in this age group.

[Features of coarse calico damage by hollow-point bullets of ammunitions to a 12-gauge fire smoothbore weapon (12×70) under the conditions of remote shooting distance]. / Osobennosti povrezhdeniya byazevoi tkani ekspansivnymi pulyami patronov k ognestrel'nomu gladkostvol'nomu oruzhiyu 12-go kalibra (12×70) v usloviyakh neblizkoi distantsii vystrela.

The article presents the experimental study results of damaged clothes imitators' (coarse calico) features in consequence of shot by ammunitions with hollow-point bullet from a 12-gauge fire smoothbore weapon (12×70). The generation mechanism of coarse calico damage during wound of underlying biological human body's imitator by bullet and the factors influencing on mentioned process have been clarified using high-speed video recording.

[Impact of projectile incidence angle with obstacle during ricochet on the damage characteristics formed in smoothbore weapon shot]. / Vliyanie ugla vstrechi puli s pregradoi pri rikoshete na kharakteristiku povrezhdenii, obrazuyushchikhsya pri vystrele iz gladkostvol'nogo oruzhiya.

The aim of this study was to establish the degree of projectile incidence angle with obstacle on forensic medical characteristic of gunshot injuries arising from smoothbore weapon fire and bullet ricochet. Based on the comprehensive forensic study results of experimental entry gunshot injuries, statistically significant differences in the following morphological signs were found for two ranges of incidence angle values (10-20° and 30-50°): «Number of MD¼, «Length 1 MD¼, «Length 2 MD¼, «Width 1 MD¼, «Orientation of AD to the conventional clock face relative to MD 1 or to the group of largest MD (max. value)¼. The medians and limits of 99% confidence intervals of these features values were observed depending on the range of incidence angle values. The revealed patterns can be used in expert practice during forensic medical examination of gunshot injuries formed as a result of a projectile ricochet after smoothbore weapon fire, as well as to develop a methodology for conducting a forensic study of this gunshot injury type.

[Variability of input gunshot injuries of clothing fabrics]. / Variabel'nost' vkhodnykh ognestrel'nykh povrezhdenii tkanei odezhdy.

One of the main components of a gunshot injury is the entrance hole. Its characteristic features: round shape, size, the presence of a central tissue defect, abrasion collar (contamination, metallization), are differential diagnostic signs of an entrance gunshot injury. Under the conditions of the conducted experiments, the peculiarities of the variability of the described signs of the entrance holes on the clothing fabrics were studied, depending on the nature of the objects to be subjected and the contact velocity of the firearm projectile. The identified features must be taken into account when examining gunshot injuries, as well as planning and conducting experimental studies with firearms.

[Characteristics of the trajectory of projectiles after penetration of biological and non-biological obstacles in shots fired from various types of firearms]. / Kharakteristika traektorii dvizheniya snaryadov posle probitiya biologicheskikh i nebiologicheskikh pregrad pri vystrelakh iz razlichnykh obraztsov ognestrel'nogo oruzhiya.

The purpose of the work was to study the movement trajectory of the projectile after breaking through an obstacle made of various materials installed at various angles to the aiming line when firing from rifled and traumatic weapons. As a result of a series of experimental shots by shells fired from a traumatic pistol «Jorge¼ (9×22 mm RA cartridge with an initial velocity of 300±20 m/s and a bullet weight of 0.7 g) and the Blaser R93 carbine (Norma Jaktmatch 9.3×62 mm hunting cartridge with an initial speed of 765 m/s and a bullet weight of 11 g) it has been found that, when punching both biological simulators and triplex glass located at the angles of 40-60° with respect to the aiming line, a deflection of the firearm from the aiming line is observed.

[Effect of the target type on the characteristics of gunshot injuries resulting from bullet and shrapnel ricochet]. / Vliyanie vida misheni na kharakteristiku ognestrel'nykh povrezhdenii, obrazuyushchikhsya v rezul'tate rikosheta puli i kartechi.

The study objective is to establish the effect of the type of experimental target (biological, non-biological) on the forensic medical characteristics of gunshot injuries resulting from bullet and shrapnel ricochet when fired from a smooth-bore weapon. Differences in the skin and clothing or their imitators render different morphological patterns of the input gunshot injuries. Based on the results of the ballistic experiment, a list of statistically significant differences in the qualitative and quantitative characteristics of the input gunshot injuries to biological and non-biological targets as a result of a ricochet when a bullet is fired from a smooth-bore weapon was compiled. In addition, the characteristics of the input gunshot injuries were established, demonstrating statistically significant differences only in certain combinations of the specified types of bullet and experimental target. The results obtained can be used in medical forensic examinations of gunshot injuries.

Fatal land hunting-related injuries in the Eastern Black Sea region-Turkey.

BACKGROUND: Hunting requires the use of various weapons or tools as professionals according to the characteristics of the creature to be hunted. Deaths during hunting activities may occur as a result of different reasons (firearm wounds, falling from a height, wild animal attack, or natural, etc.). These events' forensic reports are prepared by the physician who performed the first intervention. Identification of wounds, taking measurement photographs of the wounds before treatment, specifying the shape/sizes of foreign bodies in radiological imaging will be beneficial for determining the type of firearm, the number of shots, and the shooting distance. METHODS: The cases that performed autopsy between 2007 and 2016 at The Council of Forensic Medicine Trabzon Group Chairmanship were analyzed, retrospectively. Twenty-six (4.1%) deceased were examined. Crime scene investigation reports, hunting equipment, wound characteristics, and causes of death were investigated. RESULTS: All of our cases consisted of men (92.3%; n=24) with a mean age of 42.5 years (14-81; SD: ± 17.4). It was determined that 42.3% of the incidents occurred in winter, 80.8% (n=21) occurred in the daytime, 69.2% occurred in open areas such as fields, and 26.9% occurred in forested land. It was found that 88.5% of the deaths were caused by shotgun pellet/buckshot injuries, 7.7% (n=2) by falling off a cliff, and 3.8% by wild boar attacks (vascular injury). It was determined that 57.7% of the shots were made from long shooting distance, 19.2% were made from close range, and 11.5% were made from contact distance. It was found that 73.9% of the perpetrators were other hunters and 26.1% were the deceased person himself. It was determined that 42.3% of the injuries occurred in the chest and 38.4% in the head-and-neck region. It was determined that 96.2% of the cases did not undergo first aid intervention even though there were eyewitnesses in approximately ¾ of the cases. Ethyl alcohol was detected in only 3 cases (11.5%). CONCLUSION: It is thought that similar deaths can be prevented to a certain extent thanks to the hunting and medical first aid training to be given by the local governments. Risk control mechanisms must work properly. Besides, it is necessary to ensure that forensic experts can access the results of the proceedings in such cases. It is thought that this will be more beneficial in terms of developing new behavior styles in similar events.

[Morphology features of gunshot injuries in occupants of a car]. / Osobennosti morfologii ognestrel'nykh povrezhdenii u lyudei, nakhodyashchikhsya v salone avtomobilya.

The article presents a case of fatal gunshot wounds in occupants of a car. The wounds occurred after the passage of gunfire projectiles through a vehicle's triplex glass barrier and had certain features that distinguished them from the common wounds due to the characteristics of the barrier. As part of the solution of the expert questions, the following up-to-date research methods were applied: scanning electron microscopy, energy-dispersive analysis, and computerized three-dimensional reconstruction of the incident circumstances. These research methods provided a clear-cut solution for the situational tasks set by the investigator and served as tools for assessment of the mechanism of bodies injury.

Rising incidence of interpersonal violence in Pennsylvania during COVID-19 stay-at home order.

BACKGROUND: The coronavirus disease 2019 pandemic and associated policies have had important downstream consequences for individuals, communities, and the healthcare system, and they appear to have been accompanied by rising interpersonal violence. The objective of this study was to evaluate the incidence of injuries owing to interpersonal violence after implementation of a statewide stay-at-home order in Pennsylvania in March 2020. METHODS: Using the Pennsylvania Trauma Outcome Study registry, we conducted a retrospective cohort study of patients with gunshot wounds, stab wounds, and blunt assault-related injuries attributable to interpersonal violence treated at Pennsylvania trauma centers from March 16 to July 31 of 2018, 2019, and 2020. RESULTS: There were fewer total trauma admissions in 2020 (17,489) vs 2018 (19,290) and 2019 (19,561). Gunshot wounds increased in 2020 to 737 vs 647 for 2019 and 565 for 2018 (P = .028), whereas blunt assault injuries decreased (P = .03). In all time periods, interpersonal violence primarily impacted urban counties. African American men were predominantly affected by gunshot wounds and stab wounds, whereas Caucasian men were predominantly affected by blunt assault injuries. There were more patients with substance abuse disorders and positive drug screens during coronavirus disease than in comparison periods: (stab wound population 52.3% vs 33.9% vs 45.9%, coronavirus disease era vs 2018 vs 2019, respectively P = .0001), (blunt assault injury population 41.4% vs 33.1% vs 33.5%, coronavirus disease era vs 2018 vs 2019, respectively P < .0001). There was no correlation between the incidence of interpersonal violence and coronavirus disease 2019 rates at the county level. CONCLUSION: The implementation of a stay-at-home order was accompanied by rising incidence of gunshot and stab wound injuries in Pennsylvania. Preparedness for future resurgences of coronavirus disease 2019 and other pandemics calls for plans to address injury prevention, recidivism, and access to mental health and substance abuse prevention services.

Treatment of Peripheral Nerve Injuries in Syria's War Victims: Experience from a Northern Israeli Hospital.

BACKGROUND: The collapse of the Syrian healthcare system during the civil war led numerous citizens to cross the Syrian-Israeli border to seek medical care. OBJECTIVES: To describe the epidemiology of peripheral nerve injuries (PNIs) sustained in war, their management, and short-term outcomes. METHODS: A retrospective case series study was conducted on 45 consecutive patients aged 25.7 ± 9.3 years. These patients were referred to the hand surgery unit of the department of orthopedic surgery and traumatology at Galilee Medical Center between December 2014 and June 2018. Median time between injury and presentation was 60 days. Injury pattern, additional injuries, surgical findings and management, complications, and length of hospital stay were extracted from medical records. RESULTS: Most injuries were blast (55.6%) followed by gunshot injuries (37.8%). There were 9 brachial plexus injuries, 9 sciatic nerve injuries, and 38 PNIs distal to the plexus: specifically 20 ulnar, 11 median, and 7 radial nerve injuries. In the latter group, neurotmesis or axonotmesis was found in 29 nerves. Coaptation was possible in 21 nerves necessitating cable grafting in 19. A tendon transfer was performed for 13 peripheral nerves, occasionally supplementing the nerve repair. The patients returned to their country after discharge, average follow-up was 53.6 ± 49.6 days. CONCLUSIONS: For nerve injuries sustained in war, early surgical treatment and providing adequate soft tissue conditions is recommended. Tendon transfers are useful to regain early function.

Empowering the affected: Informing community-based solutions through interviews with survivors of interpersonal firearm violence-Perspectives of survivors of firearm injuries.

BACKGROUND: Firearm violence remains epidemic in the United States, with interpersonal gun violence leading to significant morbidity and mortality. Interpersonal violence has strong associations with social determinants of health, and community-specific solutions are needed to address root causes. We hypothesized that open-ended interviews with survivors of interpersonal firearm violence would identify themes in individual and community-level factors that contribute to ongoing violence. METHODS: Between July 2017 and November 2019, we performed a mixed-methods study in which qualitative and quantitative data were obtained from survivors of interpersonal firearm violence admitted to our urban level I trauma center. Qualitative data were obtained through semistructured, open-ended interviews with survivors. Quantitative data were obtained via survey responses provided to these same individuals. Qualitative and quantitative data were then used to triangulate and strengthen results. RESULTS: During the study period, 51 survivors were enrolled in the study. The most common cause of firearm violence reported by survivors was increased gang and drug activity (n = 40, 78%). The most common solution expressed was to reduce drug and gang lifestyle by offering jobs and educational opportunities to afflicted communities to improve opportunities (n = 35, 69%). Nearly half of the survivors (n = 23, 45%) believe that firearm violence should be dealt with by the affected community itself, and another group of survivors believe that it should be through partnership between the community and trauma centers (n = 19, 37%). CONCLUSION: Interviews with survivors of firearm violence at our urban level I trauma center suggest that drug and gang lifestyle perpetuate ongoing violence and that this would best be overcome by improving access to quality education and job opportunities. To address endemic firearm violence in their communities, trauma centers should identify opportunities to partner in developing programs that provide improved education, job access, and conflict mediation. LEVEL OF EVIDENCE: Prognostic and epidemiological, level I.

The Influence of the Opioid Epidemic on Firearm Violence in Kentucky Counties.

BACKGROUND: The opioid crisis is a major public health emergency. Current data likely underestimate the full impact on mortality due to limitations in reporting and toxicology screening. We explored the relationship between opioid overdose and firearm-associated emergency department visits (ODED & FAED, respectively). METHODS: For the years 2010 to 2017, we analyzed county-level ODED and FAED visits in Kentucky using Office of Health Policy and US Census Bureau data. Firearm death certificate data were analyzed along with high-dose prescriptions from the Kentucky All Schedule Prescription Electronic Reporting records. Socioeconomic variables analyzed included health insurance coverage, race, median household earnings, unemployment rate, and high-school graduation rate. RESULTS: ODED and FAED visits were correlated (Rho = 0.29, P< 0.01) and both increased over the study period, remarkably so after 2013 (P < 0.001). FAED visits were higher in rural compared to metro counties (P < 0.001), while ODED visits were not. In multivariable analysis, FAED visits were associated with ODED visits (Std. B = 0.24, P= 0.001), high-dose prescriptions (0.21, P = 0.008), rural status (0.19, P = 0.012), percentage white race (-0.28, P = 0.012), and percentage high school graduates (-0.68, P < 0.001). Unemployment and earnings were bivariate correlates with FAED visits (Rho = 0.42, P < 0.001 and -0.32, P < 0.001, respectively) but were not significant in the multivariable model. CONCLUSIONS: In addition to recognized nonfatal consequences of the opioid crisis, firearm violence appears to be a corollary impact, particularly in rural counties. Firearm injury prevention efforts should consider the contribution of opioid use and abuse.

Penetrating Trauma Rapid Estimated Disability Scale: Assessing Facial Self-Inflicted Gunshot Wounds.

Objectives: Self-inflicted facial gunshot wounds (GSWs) result in complex but consistent injuries that are often survivable. We suggest a novel method for rapid stratification into groups that may be associated with hospital course and cost after self-inflicted facial GSWs. Methods: This is retrospective review of self-inflicted facial GSWs between January 1, 2009, and December 31, 2018, at a tertiary academic center. Patients were given a penetrating trauma rapid estimated disablity (PRED) score (1-4) based solely on radiologic imaging injury patterns. Clinicopathologic factors were then compared between groups. Results: There were 2 PRED 1 patients (15.1%), 8 PRED 2 patients (29.6%), 5 PRED 3 patients (18.5%), and 12 PRED 4 patients (44.4%). An increased PRED score was statistically associated with increasing mean days in intensive care unit (2.5 PRED 1, 4.2 PRED 2, 6 PRED 3, 11.6 PRED 4, p = 0.001), mean length of hospitalization (5.5 PRED 1, 13.1 PRED 2, 25.6 PRED 3, 39.8 PRED 4, p = 0.007), and mean cost ($) of hospitalization (22,000 PRED 1, 29,000 PRED 2, 37,000 PRED 3, 63,000 PRED 4, p = 0.01). Conclusions and Relevance: The PRED score for self-inflicted GSWs to the face is strongly associated with length of hospital stay and cost of hospitalization.

New York State and the Nation: Trends in Firearm Purchases and Firearm Violence During the COVID-19 Pandemic.

BACKGROUND: The impacts of social stressors on violence during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We hypothesized that firearm purchases and violence would increase surrounding the pandemic. This study determined the impact of COVID-19 and shelter-in-place (SIP) orders on firearm purchases and incidents in the United States (US) and New York State (NYS). METHODS: Scatterplots reflected trends in firearm purchases, incidents, and deaths over a 16-month period (January 2019 to April 2020). Bivariate comparisons of SIP and non-SIP jurisdictions before and after SIP (February 2020 vs. April 2020) and April 2020 vs. April 2019 were performed with the Mann-Whitney U test. RESULTS: The incidence of COVID-19 in the US increased between February and April 2020 from 24 to 1 067 660 and in NYS from 0 to 304 372. When comparing February to March to April in the US, firearm purchases increased 33.6% then decreased 22.0%, whereas firearm incidents increased 12.2% then again increased by 3.6% and firearm deaths increased 23.8% then decreased in April by 3.8%. In NYS, comparing February to March to April 2020, firearm purchases increased 87.6% then decreased 54.8%, firearm incidents increased 110.1% then decreased 30.8%, and firearm deaths increased 57.1% then again increased by 6.1%. In both SIP and non-SIP jurisdictions, April 2020 firearm purchases, incidents, deaths, and injuries were similar to April 2019 and February 2020 (all P = NS). DISCUSSION: Coronavirus disease 2019-related stressors may have triggered an increase in firearm purchases nationally and within NYS in March 2020. Firearm incidents also increased in NYS. SIP orders had no effect on firearm purchases and firearm violence.

Selective Nonoperative Management of Abdominal Shotgun Wounds.

BACKGROUND: Selective nonoperative management (SNOM) of abdominal gunshot wounds (GSWs) has not been specifically examined after shotgun injuries. Because of the unpredictable nature of shotgun pellets, it is unclear if SNOM after shotgun wounds is safe. The study objective was to examine outcomes after SNOM for shotgun wounds to the abdomen. METHODS: Patients with isolated abdominal shotgun wounds were identified from the National Trauma Data Bank (2007-2017). Transfers, arrival without signs of life, death in the emergency department, severe (Abbreviated Injury Scale ≥3) extra-abdominal injuries, abdominal Abbreviated Injury Scale = 6, and missing data were exclusion criteria. Patients with abdominal handgun wounds (GSWs) were used for comparison. Study groups of shotgun-injured patients were defined by management strategy: operative management (OM) (exploratory laparotomy ≤4h) versus SNOM (no exploratory laparotomy ≤4h). Outcomes were compared by mechanism of injury (shotgun versus GSW) and management strategy (OM versus SNOM) using univariate and multivariate analyses. RESULTS: After exclusions, 1425 patients injured by abdominal shotgun wounds were included. Shotgun-injured patients underwent SNOM more frequently than GSW patients (42% versus 34%, P < 0.001). On multivariate analysis, injury by shotgun was independently associated with SNOM (OR 1.443, P = 0.040). Shotgun injuries were significantly more likely to fail SNOM (OR 2.401, P = 0.018). Failure of SNOM occurred earlier among shotgun-than GSW-injured patients (15 versus 24h, P = 0.011). SNOM after shotgun injury was associated with lower mortality than OM, even when patients failed SNOM (P < 0.001). Complications were uniformly higher after OM than SNOM, even when SNOM failed (P < 0.05). CONCLUSIONS: SNOM was utilized more commonly after shotgun wounds than GSWs. However, SNOM was more likely to fail after shotgun injury and tended to occur earlier after admission. SNOM after shotgun injury was associated with improved mortality and decreased complication rates when compared with OM, even when patients failed SNOM. SNOM appears to be a safe and beneficial management strategy after shotgun wounds to the abdomen.