Gunshot Injuries in Children

Ninety consecutive patients between 2 and 15 years of age sustaining gunshot wounds were analyzed and a management algorithm evolved. Key management steps included fluid resuscitation in the field by trained paramedical personnel and recognition of the severity of the wound when large-caliber or shotgun injuries were encountered. Arteriograms were most helpful in locating vascular injuries; venograms were inaccurate. Morbidity was directly related to missile size and impact area, and to the number of organs injured. Any hospitalization beyond 2 weeks' duration should have social service, home-bound school service, psychiatry, and physical therapy in consultation. During a 5-year period only two of the 90 patients died secondary to hemorrhagic shock.