Firearm Injury Among Children and Adolescents in Nigerian Civilian Trauma Setting: Prevalence, Pattern, and Implications for Prevention

Firearm injury in children and adolescents and the morbidity associated with it is an appreciable burden in resource-limited settings, though it is under-reported. This study aimed to determine its prevalence and pattern in Nigerian civilian trauma setting. We undertook a retrospective study of all the patients with firearm injury aged 19 years or under who visited the Emergency Department (ED) of two tertiary hospitals in Nigeria over a period of 15 years. Of the 46,734 children and adolescents seen in the ED, firearm injury was the reason for the visit in 56 of them, giving a prevalence of 1.2 per 1000 ED attendance (95% CI: 0.9-1.6). The male-to-female ratio was 1.8:1, and the mean age was 13.98 +/- 5.6 years. The preponderance of firearm injury was in the rural areas, during the dry season, at home, and in the daytime. Armed robbery (20, 35.7%) and communal clash (7, 12.5%) were the two topmost incidents leading to gunshot wounds. Armed robbery-related gunshot occurred mostly on the roads and at nighttime and involved predominantly 15-19-year-olds. Lower extremity was the topmost anatomical region involved. The majority (67%) had no pre-hospital care; the mean and median injury-hospital arrival interval respectively was 352 hrs and 4.2 hrs. Wound infection was the topmost complication. The mean hospital length of stay was 22.6 days. One (1.8%) of the patients died on the third day of hospital admission. Educational campaigns for prevention intensified during the dry season should highlight the risk of firearm injury to this age group and emphasize the importance of proper supervision and guidance of vulnerable children and adolescents. Improving the rates of pre-hospital care and early presentation of victims to the hospital should be considered in tertiary injury prevention strategies.