BACKGROUND Firearm violence is the leading cause of death and is a major source of morbidity for children in the United States. While gunshot wounds (GSWs) are known to cause lasting psychological repercussions beyond physical injury, these effects are not well documented compared with the physical implications. Our study explores the association between accidental gunshot-related fractures in children and subsequent psychiatric outcomes. QUESTION/PURPOSE Relative to non-GSW-related fractures, do children sustaining an accidental GSW-related fracture experience higher risk of mental illness and psychiatric disorders? METHODS This study utilized the TriNetX US Collaborative Network as it provides comprehensive inpatient and outpatient data, longitudinal follow-up, and complete medical records across different facilities, closely reflecting real-world patient outcomes in orthopaedic practice. We retrospectively evaluated children diagnosed with an accidental GSW-related fracture and compared mental health diagnoses to children who experienced non-GSW-related fractures. Between January 1, 2003, and March 1, 2023, a total of 5071 children in the United States without preexisting anxiety, mood, psychotic, substance use, or insomnia disorders were reported to have experienced an accidental GSW-related fracture. Among these patients, 55% (2773) had a follow-up period of at least 1 year and met the inclusion criteria for the exposure cohort. In the non-GSW-related fracture cohort, a total of 61% (985,070) of children among 1,613,891 without the preexisting aforementioned conditions had a minimum follow-up period of 1 year and met the inclusion criteria. A total of 2769 children were successfully matched in each cohort using a greedy nearest neighbor propensity score-matching algorithm. Matching was based on age, gender, race, fracture location, and BMI, as these characteristics were identified through a regression analysis as potentially associated with psychiatric outcomes (p < 0.01). The mean ± SD age was 15 ± 4 years, and 16% (451) in the GSW cohort were girls. In the non-GSW cohort 17% (474) were girls. With respect to race and ethnicity, 62% (1709 in the GSW cohort; 1679 in the non-GSW cohort) were Black and 14% (384 in the GSW cohort; 386 in the non-GSW cohort) were Hispanic. Outcomes of interest were recorded for up to 3 years after the index event. RESULTS The accidental GSW-related fracture cohort experienced a greater hazard of developing anxiety disorders (HR 3.8 [95% confidence interval (CI) 3.2 to 4.6]; p < 0.001), substance use disorders (HR 3.6 [95% CI 3.0 to 4.2]; p < 0.001), mood disorders (HR 2.4 [95% CI 1.9 to 3.1]; p < 0.001), non-mood psychotic disorders (HR 2.4 [95% CI 1.5 to 3.9]; p < 0.001), and insomnia (HR 1.8 [95% CI 1.4 to 2.3]; p < 0.001). CONCLUSION Orthopaedic surgeons should implement early psychiatric screenings and integrate mental health support for children with gunshot-related fractures to address elevated risk of anxiety disorders, psychotic disorders, mood disorders, substance abuse, and insomnia. Future studies should focus on identifying effective interventions that mitigate these long-term psychological outcomes, with an emphasis on practical, targeted approaches in clinical care. LEVEL OF EVIDENCE Level III, prognostic study.

中文翻译：

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意外枪击相关骨折的儿童患精神疾病和精神疾病的风险是否更大？倾向匹配研究。


背景 枪支暴力是美国儿童死亡的主要原因，也是儿童发病的主要来源。虽然已知枪伤 （GSW） 会引起除身体伤害之外的持久心理影响，但与身体影响相比，这些影响并没有得到很好的记录。我们的研究探讨了儿童意外枪击相关骨折与随后的精神结局之间的关联。问题/目的 相对于非 GSW 相关骨折，意外发生 GSW 相关骨折的儿童患精神疾病和精神疾病的风险是否更高？方法 本研究利用 TriNetX US 协作网络，因为它提供全面的住院和门诊数据、纵向随访和跨不同设施的完整医疗记录，密切反映骨科实践中患者的真实结果。我们回顾性评估了诊断为意外 GSW 相关骨折的儿童，并将心理健康诊断与经历非 GSW 相关骨折的儿童进行了比较。在 2003 年 1 月 1 日至 2023 年 3 月 1 日期间，据报道，美国共有 5071 名既往没有焦虑、情绪、精神病、物质使用或失眠障碍的儿童经历了意外的 GSW 相关骨折。在这些患者中，55% （2773） 的随访期至少为 1 年，并符合暴露队列的纳入标准。在非 GSW 相关骨折队列中，在 1,613,891 名没有上述疾病的儿童中，共有 61% （985,070） 的儿童最短随访期为 1 年，并符合纳入标准。 使用贪婪最近邻倾向得分匹配算法在每个队列中成功匹配了 2769 名儿童。匹配基于年龄、性别、种族、骨折部位和 BMI，因为这些特征是通过回归分析确定的，可能与精神结局相关 （p < 0.01）。SD 的平均年龄为 15 ± 4 岁，GSW 队列中 16% （451） 为女孩。±在非 GSW 队列中，17% （474） 是女孩。在种族和民族方面，62%（GSW 队列中有 1709 人;非 GSW 队列中有 1679 人）是黑人，14%（GSW 队列中有 384 人;非 GSW 队列中有 386 人）是西班牙裔。在指数事件发生后长达 3 年内记录感兴趣的结果。结果 意外 GSW 相关骨折队列发生焦虑障碍的风险更大（HR 3.8 [95% 置信区间 （CI） 3.2 至 4.6];p < 0.001）、物质使用障碍（HR 3.6 [95% CI 3.0 至 4.2];p < 0.001）、情绪障碍（HR 2.4 [95% CI 1.9 至 3.1];p < 0.001）、非情绪精神病（HR 2.4 [95% CI 1.5 至 3.9];p < 0.001）、 和失眠 （HR 1.8 [95% CI 1.4 至 2.3];p < 0.001）。结论 骨科医生应实施早期精神病学筛查，并为枪伤相关骨折患儿提供心理健康支持，以解决焦虑障碍、精神障碍、情绪障碍、药物滥用和失眠风险升高的问题。未来的研究应侧重于确定减轻这些长期心理结果的有效干预措施，重点是临床护理中实用、有针对性的方法。证据级别 III 级，预后研究。