Civilian gunshot wounds (GSWs) involving the skeletal spine and spinal cord in pediatric patients are fortunately rare. Nevertheless, their presentation mandates judicious evaluation, and their clinical outcomes remain poorly defined. Thus, the authors aimed to characterize the clinical course of this traumatic presentation in the pediatric population based on their institutional experience.
A retrospective review of a level I trauma center database was performed for the period 2011–2021. Clinical data were included for patients aged ≤ 18 years who had presented with radiographic and clinical evidence of a GSW to the spine and had at least one documented follow-up at least 6 months after injury. The primary outcomes of the study were the categorization of gunshot injuries and the results of neurological and functional examinations.
A total of 13 patients satisfied the study selection criteria. The mean patient age was 15.7 ± 1.6 years, and all presentations were assault in nature. Most of the patients were male (n = 12, 92%) in gender, Black in race (n = 11, 85%), and from zip codes with a median household income below the local county average (n = 10, 77%). All patients presented with a minimum Glasgow Coma Scale score of 14. Examination at presentation revealed American Spinal Injury Association Impairment Scale (AIS) grade A in 3 cases (23%), grade B in 2 (15%), grade C in 1 (8%), grade D in 2 (15%), and grade E in 5 (38%). Gunshot injury involved all regions of the spine, most commonly the cervical and thoracic spine (n = 6 for each, 46%). In terms of skeletal injury, the most common injuries were to the facet (n = 10, 77%) and the pedicle (n = 8, 62%), with evidence of intracanal injury in 9 patients (69%). Neurosurgical intervention was pursued in 1 patient (8%). Overall, 7 patients (54%) experienced a complication during admission, and the median length of hospitalization was 12 days (range 1–88 days) without any mortality events. Within 90 days from discharge, 2 patients (15%) were readmitted to the hospital for further care. The mean follow-up was 28.9 months (range 6–74 months), by which only 1 patient (8%) had an improved AIS examination; all other patients remained at their initial AIS grade.
Pediatric GSWs involving the spine are typically nonfatal presentations, and their long-term functional outlook appears contingent on clinical examination findings at initial presentation. Although neurosurgical intervention is not necessary in most cases, judicious evaluation of radiographic and clinical examinations by a neurosurgical team is strongly recommended to optimize recovery.
AIS = American Spinal Injury Association Impairment Scale; GCS = Glasgow Coma Scale; GSW = gunshot wound; ICU = intensive care unit; LOS = length of stay; mRS = modified Rankin Scale.
TaylorJS, MadhavanS, HanRW, ChandlerJM, TenakoonL, ChaoS. Financial burden of pediatric firearm-related injury admissions in the United States. PLoS One. 2021;16(6):e0252821.3416134110.1371/journal.pone.0252821)| false
WatersRL, AdkinsRH. The effects of removal of bullet fragments retained in the spinal canal. A collaborative study by the National Spinal Cord Injury Model Systems. Spine (Phila Pa 1976). 1991;16(8):934-939.
WatersRL, AdkinsRH. The effects of removal of bullet fragments retained in the spinal canal. A collaborative study by the National Spinal Cord Injury Model Systems. Spine (Phila Pa 1976). 1991;16(8):934-939.)| false
GohBC, StrianoBM, CrawfordAM, et al.Surgical intervention is associated with improvements in the ASIA Impairment Scale in gunshot-induced spinal injuries of the thoracic and lumbar spine. Clin Spine Surg. 2022;35(7):323–327.
GohBC, StrianoBM, CrawfordAM, Surgical intervention is associated with improvements in the ASIA Impairment Scale in gunshot-induced spinal injuries of the thoracic and lumbar spine. Clin Spine Surg. 2022;35(7):323–327.3527672010.1097/BSD.0000000000001308)| false
DwornikJJ, O’NealML, GaneyTM, Slater-HaaseAS, OgdenJA, WagnerCE. Metallic dissolution of a civil war bullet embedded in a sternum. Am J Forensic Med Pathol. 1996;17(2):130–135.10.1097/00000433-199606000-00009)| false
JanuaryAM, ZebrackiK, ChlanKM, VogelLC. Symptoms of depression over time in adults with pediatric-onset spinal cord injury. Arch Phys Med Rehabil. 2014;95(3):447–454.2431632710.1016/j.apmr.2013.11.011)| false