Evaluation of prognosis in refugee children with high kinetic energy penetrating thoracic gunshot wounds

Aim: Civil wars cause the death of many innocent children, and penetrating thoracic firearm injury (PTFI) is a leading cause of morbidity and mortality in children in war environments.The aim of this study was to evaluate child casualties admitted to the emergency department with PTFI that occurred on the battlefield.Material and Methods: Our study was conducted by reviewing the files of pediatric patients with PTFI under the age of 18 who were transferred from Syria to the first response hospital on the Syrian border of Turkey due to the Syrian civil war between January 2016 and December 2019.Results: Our study included 28 (84.4%)boys and 5 (15.2%) girls.The cause of injury was a bullet in 5 cases, shrapnel in 28 cases and hemothorax (33.3%) was the most common thoracic injury.It was found that a longer time from injury to presentation to the emergency department (p=0.012,p<0.001), injury with a bullet (p=0.013,p=0.017), the presence of shock at the time of presentation (p<0.001,p=0.001) and an increase in the amount of erythrocyte suspensions given (p<0.001)significantly increased the development of complications and mortality.It was also found that mortality and morbidity were significantly higher in PTFI child casualties with low pediatric trauma score (PTS) (p<0.001).Discussion: Penetrating thoracic injuries in children are still associated with high mortality and morbidity.Rapid transfer of these patients to the hospital, and effective, multidisciplinary resuscitation and aggressive thoracotomy interventions when necessary will reduce mortality in these patients.