Penetrating chest injuries in the firearm era

Journal of the American College of Surgeons, 1998

Background: The TRISS methodology (composite index of the Revised Trauma Score and the Injury Severity Score) has become widely used by trauma centers to assess quality of care. The American College of Surgeons recommends including negative TRISS fallouts (fatally injured patients predicted to survive by the TRISS methodology) as a filter to select patients for peer review. The purpose of this study was to analyze the TRISS fallouts among patients with lethal abdominal gunshot wounds admitted to a level I trauma center.

Turkish Journal of Trauma and Emergency Surgery, 2015

BACKGROUND: This study aimed to evaluate injury patterns of patients admitted to the emergency department with gunshot wounds, results of imaging studies, treatment modalities, outcomes, mortality ratios, and complications. METHODS: A retrospective descriptive study was carried out including a total number of one hundred and forty-two patients admitted to Hacettepe University Emergency Department with gunshot injuries between January 1, 1999 and December 31, 2013. The Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and theTrauma and Injury Severity Score (TRISS) probability of survival for penetrating trauma were calculated for all patients. RESULTS: Among the one hundred and forty-two patients in the study, one hundred and twenty-eight (90.1%) were male. Mean age was 36 years. On admission, the average GCS score was 13, mean RTS was 6.64, median ISS was 5 and median TRISS probability for survival was 99.4% for penetrating trauma. Fluid was detected in three (13%) patients in FAST, whereas intra-abdominal solid organ injury and bowel injury were detected in 11 (58%) patients in abdominal CT. The pneumothorax, hemothorax and lung injuries were detected in 10 (40%) patients, whereas hemothorax was detected only in one patient with thoracic injury by chest X-ray. Twenty four (16.9%) patients died; eighteen patients (75%) had isolated severe intracranial injuries, two (8.3%) had thoracic injuries with head and neck injuries, and four (16.7%) patients had intra-abdominal organ injuries (one with concomitant head injury). Ten patients were brought to the ED in cardiopulmonary arrest. In dead patients, GCS, RTS and TRISS were significantly lower, and ISS were significantly higher than in surviving patients. Twenty three (95.8%) patients were in critical injury level (ISS 25-75, actually ISS >50) in the exitus group. CONCLUSION: Mortality rates in gunshot wound patients with cranial injuries are very high. Spontaneous return is not seen in patients brought to the ED in arrest state. Bullets can cause internal organ injuries which can be greater than expected. In thoracoabdominal gunshot wound injuries, conventional X-ray and bedside FAST can be ineffective in detecting the whole extent of intrathoracic and intra-abdominal injuries. Thus, thoracic and abdominal CT should be planned early for hemodynamically stable patients in order to eliminate causes of fatality and make a timely and correct diagnosis. ISS, RTS and GCS are useful in predicting prognosis and mortality. Especially in patients with ISS scores >50, the mortality rate can be as high as 96%.

EC Gastroenterology and Digestive System, 2018

Abstract Keywords: Abdomen; Open Trauma; Blunt Trauma; Etiology; Shock; Stability; Surgery Introduction: Closed and isolated abdominal injuries occur infrequently during an accident and when they do occur they do not always require immediate surgical intervention. Material and Method: An observational, retrospective and cross-sectional study of patients with abdominal trauma was conducted over a period of four years. Inclusion criteria: all open and closed abdominal traumas of any age, of both sexes and by any etiology. Exclusion criteria: polytraumatized patients, cranioencephalic trauma and orthopedic trauma without abdominal involvement. Results: During the study period, 38 cases of abdominal trauma were collected. Upon admission, 5 patients were reported in shock and 33 were stable. 28 cases with open abdominal trauma and 10 with closed abdominal trauma. 29 cases were exclusively abdominal and 9 cases were thoracoabdominal. 3 tomographies and 6 ultrasounds were taken, 1 case was self-inflicted lesion. Isolated abdominal injuries occur infrequently during an accident and when they do occur they do not always require immediate surgical intervention. Currently, there is a tendency to preserve organs and in some countries, surgeons are rarely faced with these situations, but not in countries with social problems or high marginalization, so that surgeons in these countries should be able to interpret correctly the mechanisms of the lesions, adequately estimate the signs and symptoms and the physical examination, the radiological findings and establish whether the patient requires surgical intervention [1]. Introduction On the other hand, evaluation systems such as the ATLS have not been validated with rigorous randomized controlled studies before and after the trauma and their value leaves doubts about their effectiveness despite having been established in almost all the world but continues to be used as a tool in the absence of another system or even when its validity is undoubtedly demonstrated [2-5]. In Mexico, general surgeons continue to be very important in general hospitals due to the resolutive capacity they have to attend, in addition to the conventional surgical resolution conditions, traumatic disorders normally healthy and/or with other comorbidities, i.e. a patient that we did not previously know and that we must attend to abdominal and/or thoracic injuries regardless of age or gender. Discussion: Abdominal trauma is divided into open and closed and because their diagnosis is different, the decision to operate or not to operate and the time to operate vary from case to case. In one study they found that the main cause of trauma was due to motor vehicles and falls and its main presentation was closed abdominal trauma. In our study, the main presentation was open trauma and the main cause was caused by a knife. Another study found that the main cause was the injury by firearm, which is not our case since we only had 2 cases in the last year.

2010

Background: Gun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities. Methods: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed. Results: Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity. With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference. The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.

Scholars Report, 2018

sUMMAry Introduction: Patients with open or penetrating abdominal trauma are usually subjected to exploratory laparotomy, however, in selected cases, many surgeons decide not to operate and keep their patients under observation since this expectant attitude has avoided unnecessary laparotomies throughout the world. Material and Method: An observational, retrospective and cross-sectional study of open abdominal trauma was conducted over a period of four years. Inclusion criteria: all open abdominal traumas of any age, of both sexes and by any etiology. Exclusion criteria: closed abdominal trauma, multiple trauma patients, cranioencephalic trauma and orthopedic trauma without abdominal involvement. Results: During the study period, 38 cases of abdominal trauma were collected, of which 26 were open. Seventeen male and nine female cases. At admission, two patients were reported in shock and 24 were stable. Twenty-two cases were exclusively abdominal and four cases were thoraco-abdominal. Twenty-two cases were by the knife; two cases per firearm; two cases per rods. Three patients required a transfer to the ICU (splenectomy, iliac artery injury, and packaging). There were no deaths. Discussion: The decision to intervene surgically depends on whether the patient is stable or unstable, in the first case there is time to do the necessary studies, in the second the patient should be laparotomized to control the bleeding that causes the patient's state of shock. In our hospital, we have a shock unit and this helps greatly for the primary care of the injured and its evaluation by surgery.

South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 2020

BACKGROUND This project reviews our experience with managing pancreatic trauma from 2012 to 2018. METHODS All patients over the age of 15 years with a pancreatic injury during the period December 2012-December 2018 were retrieved from the Hybrid Electronic Medical Registry at Grey's Hospital and reviewed. RESULTS During the study period 161 patients sustained a pancreatic injury. The mechanism of trauma was penetrating in 86 patients (53%) and blunt in 75 (47%). The blunt mechanisms included MVA in 27, PVA in 15, falls in four and assaults in the remaining 29. There were 52 stab wounds and 34 gunshot wounds of the pancreas. A total of 26 patients (16%) were shocked on presentation with a systolic blood pressure of 90 mm Hg or less. The median injury severity score was 16. There were 90 patients with American Association for the Surgery of Trauma (AAST) grade I injury to the pancreas, 36 AAST grade II, 27 AAST grade III, 7 AAST grade IV and a single AAST grade V. Fifty-four patie...

World Journal of Surgery, 2001

Thoracic and thoracoabdominal penetrating wounds are frequently encountered in urban medical centers in the United States. This study was undertaken to determine the clinical characteristics and inhospital outcome of these injuries. This was a longitudinal, nonblinded study using the established standard of care of patients with penetrating chest trauma. It consists of an analysis of a consecutive series of 3049 patients treated at one trauma center between April 1972 and March 1996. There were 1347 stab wounds and 1702 gunshot wounds. Antibiotic prophylaxis was administered to patients who underwent laparotomy or thoracotomy or who had lung contusion with hemoptysis (41.6%, 1296/ 3049). Of 3049 patients, 196 had cardiac injuries. All of them underwent thoracotomy, and the mortality was 21.9%. In contrast, among 2853 patients without cardiac injuries, only 257 (9%) required thoracotomy; the mortality in this group was 1.5%. Patients with thoracoabdominal injuries (899/3049) had a mortality of 4.3% compared to 2.1% among those who had isolated chest injuries. The overall mortality was 2.8%. Of 1702 patients with gunshot wounds, 85 (5%) sustained transaxial injuries, with an overall mortality of 36.5%. The complication rate among the survivors was 6% with only 2.5% being infectious. We conclude that the mortality for noncardiac penetrating injuries of the chest is low. The presence of associated abdominal injuries increases the mortality twofold. More than one-third of the patients with transaxial wounds die. Gunshot wounds of the heart result in higher mortality than stab wounds to the heart. The infection rate is low.

EC Gastroenterology and Digestive System, 2018

Abstract Keywords: Abdomen; Open Trauma; Blunt Trauma; Etiology; Shock; Stability; Surgery Introduction: Closed and isolated abdominal injuries occur infrequently during an accident and when they do occur they do not always require immediate surgical intervention. Material and Method: An observational, retrospective and cross-sectional study of patients with abdominal trauma was conducted over a period of four years. Inclusion criteria: all open and closed abdominal traumas of any age, of both sexes and by any etiology. Exclusion criteria: polytraumatized patients, cranioencephalic trauma and orthopedic trauma without abdominal involvement. Results: During the study period, 38 cases of abdominal trauma were collected. Upon admission, 5 patients were reported in shock and 33 were stable. 28 cases with open abdominal trauma and 10 with closed abdominal trauma. 29 cases were exclusively abdominal and 9 cases were thoracoabdominal. 3 tomographies and 6 ultrasounds were taken, 1 case was self-inflicted lesion. Isolated abdominal injuries occur infrequently during an accident and when they do occur they do not always require immediate surgical intervention. Currently, there is a tendency to preserve organs and in some countries, surgeons are rarely faced with these situations, but not in countries with social problems or high marginalization, so that surgeons in these countries should be able to interpret correctly the mechanisms of the lesions, adequately estimate the signs and symptoms and the physical examination, the radiological findings and establish whether the patient requires surgical intervention [1]. Introduction On the other hand, evaluation systems such as the ATLS have not been validated with rigorous randomized controlled studies before and after the trauma and their value leaves doubts about their effectiveness despite having been established in almost all the world but continues to be used as a tool in the absence of another system or even when its validity is undoubtedly demonstrated [2-5]. In Mexico, general surgeons continue to be very important in general hospitals due to the resolutive capacity they have to attend, in addition to the conventional surgical resolution conditions, traumatic disorders normally healthy and/or with other comorbidities, i.e. a patient that we did not previously know and that we must attend to abdominal and/or thoracic injuries regardless of age or gender. Discussion: Abdominal trauma is divided into open and closed and because their diagnosis is different, the decision to operate or not to operate and the time to operate vary from case to case. In one study they found that the main cause of trauma was due to motor vehicles and falls and its main presentation was closed abdominal trauma. In our study, the main presentation was open trauma and the main cause was caused by a knife. Another study found that the main cause was the injury by firearm, which is not our case since we only had 2 cases in the last year.

The European Research Journal, 2020

Objectives: Thoracic trauma is among the most important causes of mortality in emergency departments. In this study of penetrating stab wounds (PSWs) and gunshot wounds (GSWs) admitted to the emergency department with penetrating thoracic trauma cases clinical findings, emergency treatment approaches and survivals were compared with literature information. Methods: One hundred fifty-two patients who applied to Bakırköy Dr. Sadi Konuk Training and Research Hospital Emergency Department with penetrating thoracic trauma on 1 January 2014 and 31 December 2014 were evaluated retrospectively the patients. SPSS 22.0, NY, USA program was used in the analyzes. Results: Patients administered with PSW were 79.6%, with GSW were 20.4%. Patients in the group GSW were admitted to the emergency department with more serious symptoms than patients in the group PSW (Triage level 2, GSW: 87.1%, PSW: 62.8% and Triage level 3, GSW: 12.9% vs. PSW: 37.2%), (p = 0.010). Hemothorax (25.8%) in PSW patients and pneumothorax (40.5%) in GSW patients was detected more frequently. Surgical treatment was performed in 14.9% of patients with PSW, tube thoracostomy was performed in 24%, and 62.82% were treated with conservative treatment. Surgical treatment was performed in 35.5% of GSW patients and tube thoracostomy was performed in 29%, and 48.4% were treated with conservative treatment (p > 0.05). Conclusion: Despite the lower incidence of GSW than PSW in emergency departments, GSW require more surgical intervention and have a higher mortality rate.

Annals of African Surgery

To describe prevalence, management and factors determining outcomes in patients presenting with gunshot abdominal injuries. Method: We retrospectively analysed all cases of gunshot to the abdomen received at Kenyatta National Hospital from October 2013 to October 2017. Patients' demographic and clinical data were collected from their case notes. Data analysis used Fisher's exact test and binary logistic regression. A p-value of <0.05 was considered statistically significant. Results: A total of 1,588 records of patients with abdominal injuries were analysed. Of these, 209(15.3%) were cases of gunshot to the abdomen. The mean age was 31.5 years; male to female ratio was 8:1. Exploratory laparotomy was the preferred management in 161(77%) patients, selective nonoperative management in 11(5.3). Negative laparotomy rate was 8.7%, inpatient mortality 20% and complication rate 26%. Age, time from injury to admission, assisted breathing on admission, need for transfusion, and number of complications independently predicted mortality. Conclusion: Gunshot abdominal injuries are commonly encountered at our setting and these are associated with significant mortality and development of complications. With careful selection, some patients can be successfully managed non-operatively.