Pediatric Gunshot Wound Recidivism: Identification of At-Risk Youth

BACKGROUND:

Although penetrating injury is the most common reason for pediatric trauma recidivism, there is a paucity of literature specifically looking at this population. The objective of this study was to identify those in the pediatric community at the highest levels of risk for suffering GSW on multiple occasions.

METHODS:

A retrospective review querying our urban level 1 trauma database was performed. Patients aged 0-18 sustaining GSW from 2000 to 2011 were selected. This was further refined to include those who returned to the hospital for another firearm injury. Demographic data, including age of initial and subsequent presentation, gender, race, zip code, home address, and disposition were compiled.

RESULTS:

Over the 12 year study period 896 pediatric patients were discharged from the hospital after initial firearm injury with subsequent 8.8 % recidivism rate. All recidivists were male with and 86% were 16-18 at the time of first injury. The subsequent incident occurs within the first year, two years, or three years 32%, 53% and 66% of the time respectively. 9 individuals in our study group suffered GSW on three separate occasions with a mortality rate of 22%. Regarding the domicile, 53 % of the patients were located in a 3 square mile area containing four public high schools.

CONCLUSION:

Utilizing demographic data we have been able to identify a at-risk population where there is a greater than a one in twelve chance of getting shot multiple times. Utilization of this type of demographic data can help target those at highest risk by allocating resources that can have the greatest impact on this societal burden.

LEVEL OF EVIDENCE:

Level 3 Prognostic.

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By:  Gibson P1, Ippolito JA, Shaath MK, Campbell C, Fox AD, Ahmed I.

• 1From Rutgers-NJMS University Hospital, Newark, New Jersey. 
• J Trauma Acute Care Surg. 2016 Mar 30.

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Ecologic Factors Relating to Firearm Injuries and Gun Violence in Chicago

Highlights

• Ecologic variables related to firearm-related injuries and crime were explored.
• The Illinois Trauma Registry and the Chicago Police Department's CLEAR were analyzed.
• Weekday, daily temperature, and rain are associated with firearm injuries and crime.
• Snow was not found to be associated with either firearm-related injuries or crime.

Background

Firearm violence is a major burden on Chicago with greater than 1500 gunshot injuries occurring annually. Identifying ecologic variables related to the incidence of firearm-related injuries and crime could prove useful for developing new strategies for reducing gun-related injuries.

Methods

The Illinois Trauma Registry (ITSR) and the Chicago Police Department's CLEAR (Citizen Law Enforcement Analysis and Reporting) dataset were retrospectively analyzed to investigate group-level factors potentially related to the incidence of gun-related injuries and crime in Chicago from 1999 through 2012. Multivariate linear regression was used to evaluate the effects of day of the week, daily maximum temperature, precipitation, and snow on the incidence of firearm-related injuries and crime.

Results

A total of 18,655 gunshot wounds occurred during the study period (ITSR, 1999–2009). There were 156,866 acts of gun violence identified in the CLEAR dataset (2002–2012). Day of the week, daily maximum temperature, and precipitation were associated with differential risks of gun injury and violence. Rain decreased firearm-related injuries by 9.80% [RR: 0.902, 95% CI: 0.854–0.950] and crime by 7.00% [RR: 0.930, 95% CI: 0.910–0.950]. Gunshot wounds were 33% [RR: 1.33, 95% CI: 1.29–1.37] more frequent on Fridays and Saturdays and gun crime was 18% [RR: 1.18, 95% CI: 1.16–1.20] more common on these days. Snow was not associated with firearm-related injuries or crime.

Conclusions

Day of the week, daily maximum temperature, and rain are associated with the incidence of firearm-related injuries and crime. Understanding the effects of these variables may allow for the development of predictive models and for risk-adjusting injury and crime data.

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By:  Kieltyka J1, Kucybala K2, Crandall M3.

• 1Department of Emergency Medicine, Northwestern University, United States. Electronic address: j-kieltyka@northwestern.edu.
• 2Northwestern University, Feinberg School of Medicine, United States.
• 3Department of Surgery, University of Florida - Jacksonville, United States. 
• J Forensic Leg Med. 2016 Jan;37:87-90. doi: 10.1016/j.jflm.2015.11.003. Epub 2015 Nov 29.

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Homicide in Greenland 1985-2010

PURPOSE:

Homicide in Greenland has not often been investigated. The latest published study documented a dramatic rise in the homicide rate from around 1/100,000 inhabitants to more than 23/100,000 inhabitants from 1946 to 1984. The aim of our study was to characterize homicides in Greenland from 1985 to 2010 and to compare trends during this period with those in previous studies and with homicide characteristics in Denmark, northern Europe, and other Arctic regions.

METHODS:

We identified a total of 281 homicides by legal definition and 194 by medical definition, the latter from the years 1990 to 2010. We procured case files for a total of 129 victims (71 male, 58 female) and 117 perpetrators (85 male, 32 female).

RESULTS:

We identified an overall decrease in the homicide rate during our study period. The decrease in the medical homicide rate was significant (p = 0.007). The homicide rate ranged from 25/100,000 inhabitants to 13/100,000 inhabitants when results were grouped within 5-year periods. There were significantly more male perpetrators (p < 0.001) and among female perpetrators there were significantly more male victims (p < 0.001). Sharp force and gunshot-related killings dominated homicide methods (41 and 29 % respectively), with sharp force deaths increasing throughout the investigation period. Altercations were the main motive (49 %). Alcohol-related homicides decreased in our study period.

CONCLUSIONS:

While the Greenlandic homicide rate has decreased, it is markedly higher compared to that seen in Denmark and northern Europe. However, it resembles the rate seen in the rest of the Arctic. Liberal gun laws do not affect the proportion of gun-related killings. Despite the high homicide rate, women account for almost half the victims.

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By:  Christensen MR1,2, Thomsen AH3, Høyer CB3, Gregersen M3, Banner J4,3.

• 1Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's Vej 11, 2100, Copenhagen E, Denmark. mrchristensen81@gmail.com.
• 2Department of Forensic Medicine, Section of Forensic Pathology, Aarhus University, Palle Juul-Jensen Boulevard 99, 8200, Aarhus N, Denmark. mrchristensen81@gmail.com.
• 3Department of Forensic Medicine, Section of Forensic Pathology, Aarhus University, Palle Juul-Jensen Boulevard 99, 8200, Aarhus N, Denmark.
• 4Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Frederik V's Vej 11, 2100, Copenhagen E, Denmark. 

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