Using Geomapping to Shine Light on Youth Violence in North Philadelphia

Background: Trauma and suicide, including those caused by firearms, are among the top five causes of death in pediatric population in the United States. We evaluated the presentations of all patients with GSWs to an urban pediatric Level 1 trauma emergency department (ED) in North Philadelphia over a seven-year period to characterize demographics, clinical outcomes, the motivation of injuries, and predominantly affected neighborhoods.

Methods: We conducted a retrospective analysis of all patients who presented to our ED between January 1, 2013 and May 31, 2020 for evaluation of GSW. We recorded demographic information, incident location, incident motivation (if known), initiation of trauma protocol, injury sequelae, and disposition at the end of hospital stay. Location data was then analyzed with Arc GIS to identify neighborhoods with high concentration of GSW victims via geo-mapping.

Results: 227 patients charts were evaluated over a 7 year period. Patient age ranged from 2 to 58 years (mean 15 yrs, mode 16 yrs), and 79.7% were male. Patients were 53% Black, 20% Hispanic, 6% White, 1% Asian, and 19% “Other Race”. Trauma protocol was initiated in the ED for 75% of patients.
Predominant motivations were “bystanders of shooting” (44.6%), unknown motivation (37.5%), drug-related violence (8.9%), accidental injury (8%) and interpersonal conflict (6.25%). Other motivations included suicide, police-related injuries and interpartner violence. Of those injured as bystanders, the average age was 13.6 years. 33.3% of victims were shot at their home address. Of those who presented with a gunshot wound, 50.2% were discharged from the ED, 30.6% were admitted to the general floor before being discharged home, and 10.5% were admitted to the ICU before discharge home. 47.1% of victims required follow up with Orthopedics or General Surgery after discharge. Five percent of patients died in the ED or ICU. Geomaps showed the distribution of home addresses for gunshot wound victims (see Figure 1 and 2).

Conclusion: These findings represent the first demographic characterization of pediatric GSW injuries in North Philadelphia. Findings underscore a low mean victim age, a predominance of Black and Hispanic victims, and an appreciable number of victims who were bystanders or in their own homes at the time of their injury. A high proportion of those victims endured injury requiring hospitalization but a significant minority endured death. Mapping confirms that the victims of gun violence who present to St Christopher’s Hospital for Children are from the surrounding neighborhoods and highlights the prevalence of on-going gun violence in local neighborhoods in general. This study offers evidence to support urgent and increased prevention strategies to reduce ongoing firearm violence. It also can inform hospital-based and community-based interventions run at this stand-alone children’s hospital.