Pediatric Gunshot Wounds: A Decade-Long Emergency Department Experience in a High-Risk Region

Öz

Background: Pediatric gunshot wounds (GSWs) remain a significant cause of preventable mortality worldwide, particularly in regions with high violence and low socioeconomic conditions. The Pediatric Trauma Score (PTS) is widely used for trauma severity assessment, yet its prognostic value in firearm-related pediatric injuries remains underexplored. Methods: This retrospective study included patients under 18 years who presented with GSWs to the emergency department of a tertiary care hospital in southeastern Türkiye between 2015 and 2025. Demographic, clinical, and outcome data were collected. The predictive value of PTS for in-hospital mortality was analyzed using ROC curve analysis. Logistic regression was used to identify independent mortality predictors. Results: A total of 200 pediatric GSW cases were evaluated; the median age was 11 years, and 73% were male. The overall mortality rate was 6.5%. All deaths occurred in patients triaged as red zone and requiring emergency interventions. Mortality was significantly associated with low PTS (median: 1 vs. 9, p<0.001), low GCS, head/neck injuries, abdominal-pelvic trauma, intubation, and blood transfusion needs. ROC analysis showed that PTS had high predictive performance (AUC: 0.969) with an optimal cut-off of 5.5. In multivariate analysis, head/neck injuries (OR: 5.327) and abdominal trauma (OR: 3.173) remained significant predictors, while higher PTS was protective (OR: 0.014). Conclusion: Pediatric firearm injuries are associated with substantial mortality. PTS is a strong, practical predictor of outcome and can aid in triage and early intervention strategies. Comprehensive trauma care systems and public health policies are essential to reduce mortality in high-risk pediatric populations.

Anahtar Kelimeler

• Pediatric Trauma
• Gunshot Wounds
• Mortality
• Pediatric Trauma Score
• Emergency Medicine

Pediatrik Ateşli Silah Yaralanmaları: Yüksek Riskli Bir Bölgede On Yıllık Acil Servis Deneyimi

Öz

Amaç: Pediatrik ateşli silah yaralanmaları (ASY), dünya genelinde önlenebilir ölümlerin önemli bir nedeni olmaya devam etmektedir. Bu durum özellikle şiddetin yoğun olduğu ve sosyoekonomik düzeyin düşük olduğu bölgelerde daha belirgin hale gelmektedir. Pediatrik Travma Skoru (PTS), travma şiddetini değerlendirmede yaygın olarak kullanılmakla birlikte, ateşli silah kaynaklı pediatrik yaralanmalarda prognostik değeri yeterince araştırılmamıştır. Yöntemler: Bu retrospektif çalışmaya, 2015–2025 yılları arasında Türkiye'nin güneydoğusunda bir üçüncü basamak hastanenin acil servisine ateşli silah yaralanması nedeniyle başvuran 18 yaş altı hastalar dâhil edilmiştir. Hastalara ait demografik, klinik ve sonuç verileri toplanmıştır. Hastane içi mortaliteyi öngörmede PTS'nin prediktif değeri ROC eğrisi analizi ile değerlendirilmiştir. Mortalitenin bağımsız belirleyicilerini saptamak amacıyla lojistik regresyon analizi yapılmıştır. Bulgular: Toplam 200 pediatrik ASY vakası değerlendirildi; medyan yaş 11, hastaların %73’ü erkekti. Genel mortalite oranı %6,5 olarak saptandı. Tüm mortal vakalar, kırmızı alan triyajı almış ve acil müdahale gerektirmişti. Mortalite ile düşük PTS (medyan: 1 vs. 9, p<0.001), düşük GKS, baş-boyun yaralanmaları, abdominal-pelvik travma, entübasyon ve kan transfüzyonu ihtiyacı arasında anlamlı ilişkiler bulundu. ROC analizi, PTS’nin yüksek prediktif performansa sahip olduğunu gösterdi (AUC: 0.969) ve optimal eşik değeri 5,5 olarak belirlendi. Çok değişkenli analizde, baş-boyun yaralanmaları (OR: 5.327) ve abdominal travma (OR: 3.173) bağımsız mortalite belirleyicisi olarak kalırken, yüksek PTS koruyucu bir faktör olarak öne çıktı (OR: 0.014). Sonuç: Pediatrik ateşli silah yaralanmaları önemli mortalite ile ilişkilidir. PTS, klinik sonuçları öngörmede güçlü ve pratik bir skorlama aracı olup, triyaj ve erken müdahale stratejilerinde kullanılabilir. Yüksek riskli pediatrik popülasyonlarda mortaliteyi azaltmak için kapsamlı travma bakım sistemleri ve etkili halk sağlığı politikaları gereklidir.

Anahtar Kelimeler

• Pediatrik Travma
• Ateşli Silah Yaralanmaları
• Mortalite
• Pediatrik Travma Skoru
• Acil Tıp.

Kaynakça

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