Despite the Increasing Use of Nonoperative Management of Firearm Trauma, Shotgun Injuries Still Require Aggressive Operative Management

Dozier, Kristopher C.; Miranda, Marvin A.; Kwan, Rita O.; Cureton, Elizabeth L.; Sadjadi, Javid; Victorino, Gregory P.

doi:10.1016/j.jss.2009.04.019

Cited by 10 publications

(7 citation statements)

References 14 publications

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“…SGIs are an uncommon, but ubiquitous and preventable epidemic, which cause not only serious mental and anatomical harm to the victim but also emotionally and financially damage society. This infrequency has generated inexperience in urban trauma centers and has caused for the surgeon not to reason or to belittle the injury mechanism that is so peculiar of SGI, which leads to an inadequate approach and failure to define injuries' general conditions 1,4,6,7 .…”

Section: Discussionmentioning

confidence: 99%

“…As an expected consequence of pellets dispersion or confluence in the victim, which affects large bodily regions or transmits a large amount of energy within a reduced anatomical area [3][4][5]7,8,10,12 , in our study, we found a huge amount of injuries to specific organs and a high average of injured organs per patient (4.8 injuries/patient), which also required the performance of 49 primary procedures (2.3 procedures/patient) and that, in 76%, a mean of 5.3 sequential surgical procedures had to be carried out. The need for multiple surgical interventions has been described in various studies reported in the literature, given the extent of the damage caused by SGI 4,[6][7][8][10][11][12]16,17 . The above factors clearly explain the prognostic indices that were obtained.…”

Section: Discussionmentioning

confidence: 99%

“…Shotgun injuries (SGIs) are a major public health problem, especially in emerging countries 1 . The most affected group has been estimated to be that of males between 20 and 29 years of age, and although these injuries account only for 0.5-2% of total gunshot wounds, they cause a significant rate of disease-related morbidity, consume a large amount of human and material resources for their approach, and are related to a mortality rate that cannot be belittled [2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

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Shotgun injuries: Need for a special point of view

García-Núñez¹,

Guillén-Hernández²,

Hernández-García³

et al. 2023

CIRUE

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Background: Shotgun injuries (SGIs) are infrequent, but due its special ballistics, are related to adverse outcomes. Objective: The objective of the study was to analyze operative and administrative variables, critical for the institution. Methods: Demographics and health care-related variables from SGI patients admitted to Military Central Hospital (Mexico City) between July 2006 and August 2019, were retrospectively studied. Statistics methods used were dispersion measures and relative occurrence frequency. Results: Over a 15-month span, 21 SGI patients were admitted. Mean age was 36.9 ± 13.6 years (range: 14-61) and male gender was dominant (n = 20; 95%). Type II SGIs were the most common injuries (62%; 13/21). Mean hospital length of stay was 37.1 ± 28.7 days (range: 3-109) while stay at . Global rate of morbidity was 82% (17/21) and most frequent complications were infective. Global mortality rate was 24% (5/21). Conclusions: Once SGIs cause prolonged length of stay, high rate of morbidity, and of enormous consuming of material and human resources, primary prevention strategies are convenient for health-care systems compromised to the care of these cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Shotgun injuries: Need for a special point of view

García-Núñez¹,

Guillén-Hernández²,

Hernández-García³

et al. 2023

CIRUE

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“…We do not routinely give more than a single dose of antibiotics, usually a first-generation cephalosporin, except in the case of a fracture [9]. Shotgun injuries and their associated sequelae often require more operations and resource utilization compared to other firearm injuries [10]. Detection requires knowledge of shotgun mechanics as well as a high degree of vigilance in the examination and management of the patient.…”

Section: Discussionmentioning

confidence: 99%

A rare case of retained sabot after close-range shotgun injury

et al. 2021

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Background Shotgun injuries are a relatively uncommon type of trauma, and therefore may present a challenge in management for trauma surgeons. This is particularly true in the case of surgeons unfamiliar with the unique characteristics of shotgun wounds and the mechanics of shotguns. In many cases, the shot pellets are the primary source of injury. However, a broad understanding of shotgun mechanics is important in recognizing alternative presentations. This article details a case of sabot (a stabilization device used with certain projectiles) retention after a close-range shotgun injury, reviews underlying shotgun mechanics, and discusses strategies for the detection and mitigation of these injuries. The aim of this case report is to increase awareness of and reduce the potential morbidity of close-range shotgun injuries. Case presentation A middle-aged female presented to the Emergency Department with wounds to her right hip and flank after suffering a shotgun injury. A contrast computed tomography scan demonstrated no evidence of hollow viscous or vascular injury, but was otherwise severely limited by scatter artifact from the numerous embedded pellets. The patient was admitted for wound care and discharged 2 days later with a clean wound bed and no evidence of tissue necrosis. Six days after injury, she reported an “unusual” smell associated with severe pain in her right hip wound. She was evaluated in clinic where examination revealed a retained foreign body, identified to be a shotgun shell sabot, which was removed in clinic. She presented again several days before scheduled follow-up with a persistent foul smell from her wound and was noted to have necrotic tissue at the base and margins of the wound that required hospital readmission for operative debridement and closure with negative pressure wound therapy. The patient had an uncomplicated recovery after surgical debridement. Conclusions Although shotgun sabot penetration and retention are rare, they are associated with significant morbidity. Sabot penetration should be considered if injury narrative, physical examination, or radiographic characteristics indicate a distance from shotgun to patient of less than 2 m. A high degree of suspicion is indicated at less than 1 m.

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“…As a result, the clinical outcomes following PTBI are not favorable in most reports (because they mostly are about gunshots), in a way that a survival rate of 7-15% has been reported after a gunshot to the brain. [8,10,14] e aim of the present study is to report the etiology, radiological, and hospitalization characteristics of patients who were admitted to Rajaee Hospital, a tertiary referral trauma center in southern Iran, with the diagnosis of PTBI during the past 5 years.…”

mentioning

confidence: 99%

Civilian penetrating traumatic brain injury: A 5-year single-center experience

Yousefi¹,

Azami²,

Borazjani³

et al. 2023

Surgical Neurology International

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Background: The aim of this study was to report the demographics and clinical features of patients with penetrating traumatic brain injury (PTBI) during the past 5 years in Rajaee Hospital, a tertiary referral trauma center in Shiraz, southern Iran. Methods: We conducted a 5-year retrospective evaluation of all patients diagnosed with PTBI who were referred to Rajaee Hospital. We retrieved the following items from the hospital’s database and PACS system: patients’ demographics, on-admission Glasgow Coma Scale (GCS), presence of trauma to other organs, duration of the hospital and ICU stay, the neurosurgical interventions, any necessity of tracheostomy, duration of ventilator dependency, the entrance point of the trauma in the skull, type of assault, length of trajectory in the brain parenchyma, the number of remaining objects in the brain, the occurrence of any hemorrhagic phenomenon, the cross of the bullet from the midline or coronal suture, and the presence of the pneumocephalus. Results: A total of 59 patients with a mean age of 28.75 ± 9.40 had PTBI over the 5 years. The mortality rate was 8.5%. Stab wounds, shotguns, gunshots, and airguns were the cause of injury in 33 (56%), 14 (23.7%), 10 (17%), and 2 (3.4%) patients, respectively. The median initial GCS of patients was 15 (3–15). Intracranial hemorrhage was observed in 33 cases, subdural hematoma in 18 cases, intraventricular hemorrhage in eight cases, and subarachnoid hemorrhage in four cases. The mean duration of hospitalization was 10.05 ± 10.75 (ranging from 1 to 62 days). Furthermore, 43 patients experienced ICU admission with mean days of 6.5 ± 5.62 (1–23). The temporal and frontal regions were the most common entrance points, in 23 and 19 patients, respectively. Conclusion: The incidence of PTBI is relatively low in our center, possibly due to the prohibition of possession or using warm weapons in Iran. Further, multicenter studies with larger sample sizes are needed to determine prognostic factors associated with worse clinical outcomes after PTBI.

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Despite the Increasing Use of Nonoperative Management of Firearm Trauma, Shotgun Injuries Still Require Aggressive Operative Management

Cited by 10 publications

References 14 publications

Shotgun injuries: Need for a special point of view

Shotgun injuries: Need for a special point of view

A rare case of retained sabot after close-range shotgun injury

Civilian penetrating traumatic brain injury: A 5-year single-center experience

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