Characteristics of Pediatric Patients Undergoing Craniotomy for Gunshot Wound to the Head: An Analysis of the Kids' Inpatient Database (KID)

Introduction: The high prevalence of firearms in the United States has resulted in increased rates of accidental and intentional harm among children. Increased firearm-related pediatric injuries leave lasting impacts both physically and psychologically. This study aims to characterize patients requiring craniotomy for cranial gunshot wounds (GSW).

Methods: We queried the 1997-2019 Kids’ Inpatient Database (KID), which includes patients 20 years and younger, using cranial GSW diagnosis and craniotomy procedural ICD-9 and ICD-10 codes. Demographic and outcome information were analyzed using chi-squared and independent t-tests. A p-value < 0.05 was considered significant.

Results: Our query identified 2990 pediatric cranial GSW cases, with 980 (32.8%) undergoing craniotomy. The proportion of craniotomy patients remained stable over the years (range 28.5-35.6%, p=0.221), as did mortality status post craniotomy (range 43-54.9%, p=0.072). There was a significant difference in likelihood of undergoing craniotomy based on GSW type; 22.8% of intentional, 33.6% of assault, and 40.8% of accidental GSW victims underwent craniotomy (p < 0.001). Medicaid was most common in craniotomy patients (55.6%), while most non-craniotomy patients had private insurance (28.6%). Craniotomy patients had a significantly longer mean length of stay (LOS) (17.09±20.4 versus 4.8±9.52, p< 0.001). 35.9% of craniotomy patients went home and 16.1% suffered mortality whereas 24.9% of medically managed patients went home and 61.2% suffered mortality.

Conclusion : Patients who underwent craniotomy were most likely to be victims of accidental GSWs; they had a longer LOS, were more likely to be discharged home compared to medically managed patients, and less likely to die compared to medically managed patients. This may be due to patient selection prior to surgical intervention. There has been no significant change in the proportion of craniotomies or percent mortality for patients undergoing craniotomy over the years for victims of cranial GSWs. This underpins the dire need to craft preventive measures to safeguard our vulnerable pediatric population.