Citation

Miller KR, Benns MV, Nagengast A, Bozeman MC, Nash NA, Franklin GA, Smith JW, Harbrecht BG. J. Am. Coll. Surg. 2017; 225(4): e190.

Copyright

(Copyright © 2017, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2017.07.1045

PMID

unavailable

Abstract

Introduction

Firearm injury remains a significant contributor to morbidity and mortality in the United States. Patients sustaining firearm injuries are a heterogeneous group with varying injury patterns dependent upon the circumstances (unintentional, intentional self-inflicted, intentional assault) surrounding the injury. Unintentional injuries may have significant differences with regard to management and injury patterns.

Methods

Firearm injuries at a Level I trauma center from Jan 2012 to June 2016 were examined. Demographic data and injury patterns were abstracted from the trauma registry and charts. Statistical analysis was performed using chi square and ANOVA.

Results

There were 161 (14%) unintentional injuries of 1131 total firearm injuries with a 2.5% mortality rate, significantly lower than intentional injuries (12.5%, p=.0002) correlating with a lower ISS (8.4 vs 14.4, p=<.0001) and shorter length of stay (4.5 vs 6.7 days, p=.003). The majority of injuries were sustained by handguns in both groups. A significantly greater proportion of unintentional injuries affected extremities with less injuries to the head and thoracoabdominal regions (p<.0001, p<.0001, p<.001). Despite higher ISS and mortality, patients sustaining unintentional injuries underwent operative intervention at a significantly higher rate than intentional injuries (84% vs 64%, p<.0001). Finally, the majority of injuries occurred while cleaning the firearm (35%) followed by injuries sustained while carrying the firearm (19%), inadvertent dropping (16%), loading (12%), and ricochet (2.7%).

Conclusions

Unintentional firearm injuries, despite a lower overall severity of injury, more frequently require operative intervention than intentional firearm injuries and involve distinct injury patterns. These differences should be considered during implementation of injury prevention programs.

Language: en