Epidemiology of Upper Extremity Firearm Injuries among Major Trauma Hospitals in the United States

Hooper, Rachel C.; Shauver, Melissa J.; Chou, Ching-Han; Chen, Jung-Shen; Chung, Kevin C.

doi:10.1097/prs.0000000000008220

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Similar to national data showing non-Hispanic Black or African American male patients under 44 years had the largest increase in firearm homicide rate from 2019 to 2020, 21 our study supports this trend by demonstrating this same demographic also accounts for an overwhelming portion of nonfatal firearm injury to the UE. Our findings are also consistent with comparable studies showing an average age under 35 years and male predominance, 8,17,22–24 which reflects the disproportionately greater burden borne by this vulnerable population. Moreover, these injuries also generate significant economic challenges.…”

Section: Discussionsupporting

confidence: 93%

The Epidemiology, Management, and Outcomes of Civilian Gunshot Wounds to the Upper Extremity at an Urban Trauma Center

Muss,

Hu,

Bauder

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Gunshot wounds (GSWs) create significant morbidity in the United States. Upper extremity (UE) GSWs are at high risk of combined injuries involving multiple organ systems and may require variable treatment strategies. This study details the epidemiology, management, and outcomes of civilian UE GSWs at an urban level 1 trauma center. Methods: Using the University of Pennsylvania Trauma Registry, all adult patients with UE GSWs from 2015 to 2020 who were at least 6-months postinjury were studied for demographics, injury pattern, operative details, and postoperative outcomes. Fisher exact and Wilcoxon rank sum tests were used to determine differences in treatment modalities and outcomes. Results: In 360 patients, the most common victim was young (x̄ = 29.5 y old), African American (89.4%), male (94.2%), and had multiple GSWs (70.3%). Soft tissue-only trauma (47.8%) and fractures (44.7%) predominated. Presence of fracture was independently predictive of neurologic, vascular, and tendinous injuries (P < 0.001). Most soft tissue-only injuries were managed nonoperatively (162/173), whereas fractures frequently required operative intervention (115 of 161, P < 0.001). Despite a prevalence of comminuted (84.6%) and open (43.6%) fractures, hardware complications (7.5%) and wound infection (1.1%) occurred infrequently. Conclusions: Civilian GSWs to the UE with only soft tissue involvement can often be managed conservatively with antibiotic administration, bedside washout, and local wound care. Even with combined injuries and open fractures, single-stage operative debridement and fracture care with primary or secondary closure often prevail. As civilian ballistic trauma becomes more frequent in the United States, these data help inform patient expectations and guide management.

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Section: Discussionsupporting

confidence: 93%

The Epidemiology, Management, and Outcomes of Civilian Gunshot Wounds to the Upper Extremity at an Urban Trauma Center

Muss,

Hu,

Bauder

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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“…Gunshot wound injuries involving the extremity account for an estimated 70% of unintentional and 45% of intentional firearm injuries, and are the most common site of nonfatal GSWs with approximately 48 254 isolated UE firearm injuries reported in the United States from 2007 to 2017. 3,28,29 Despite the high number of these injuries, the incidence of infection associated with UE GSWs is unclear, and prophylactic antibiotic administration practices vary considerably. While little is known specifically about isolated UE GSWs, a 2016 survey completed by 220 members of the Orthopaedic Trauma Association found that 86% of surgeons routinely prescribe antibiotics for all ballistic fractures, most commonly a first-generation cephalosporin (76%).…”

Section: Discussionmentioning

confidence: 99%

“…1 Of the nearly 240 000 nonfatal civilian firearm injuries in the United States per year, 49% to 67% involve the extremities with 24% to 34% of all firearm injuries involving the upper extremity (UE). 2,3 Risk of infection related to these injuries is unclear. 4,5 Despite current literature reporting a low overall rate of infection, prophylactic antibiotic administration practices after isolated UE gunshot wounds (GSWs) vary widely.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Prophylaxis and Infectious Complications in Isolated Gunshot Wounds to the Upper Extremity

Brown

Payne

Handel

et al. 2023

Hand (New York, N,Y.)

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Background: Prophylactic antibiotics are variably prescribed after isolated upper extremity gunshot wounds (UE GSWs). The risk of infection and factors influencing prescribing practice remain poorly understood, and clinical practice guidelines are lacking. Methods: Adults with isolated UE GSWs over a 10-year period were included. Medical records were reviewed for demographic and injury variables, comorbidities, surgical treatments, antibiotic administration, infectious complications, and follow-up duration. Infection rate was calculated. Bivariate and multivariable linear regression analyses were used to identify patient-related and injury-related factors predictive of prophylactic antibiotic prescription. Results: A total of 281 patients were eligible for inclusion. Prophylactic antibiotics were prescribed at discharge for 111 patients (40%). Multivariable analysis revealed that patients with more distal injuries and ballistic fractures were significantly more likely to receive prophylactic antibiotics. Of patients with at least 30-day postinjury follow-up, 6% developed infections. Conclusion: Prophylactic antibiotic administration after UE GSWs was inconsistent but more common in patients with ballistic fractures and injuries in the hand. The overall incidence of infection was found to lie between 3% and 6%. The rate of infection in the antibiotic prophylaxis (2%-6%) group was similar to that in the no-antibiotic (5%-7%) group, suggesting that antibiotic prophylaxis may not have a large impact on infectious risk. However, because this study is nonrandomized, and because this study is underpowered for multivariable modeling of infectious risk, it remains possible that subgroups of this population may still benefit from antibiotic prophylaxis.

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The Impact of Area Deprivation Index, Geography, and Mechanism on Incidence of Ballistic Injury to the Upper Extremity

Brown,

Van Handel,

Shim

et al. 2024

Ann Plast Surg

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Introduction This study investigates the intersection of ballistic injuries, geography, and Area Deprivation Index (ADI). We hypothesized that both ADI and geography are correlated with incidence of upper extremity ballistic injuries. Further, we characterize and compare 2 distinct upper extremity gunshot injury populations presenting to our institution: those sustaining violent ballistic injuries and those who suffer an accidental, self-inflicted injury. Our purpose is to evaluate the impact of geography and ADI on the pattern of upper extremity gunshot injuries in Illinois and Missouri. Materials and Methods This was a retrospective review of adult patients sustaining ballistic injury to the upper extremity at a single urban level I trauma center over 10 years (n = 797). Seven hundred thirty patients had home addresses in Illinois or Missouri; these addresses were geocoded and included for analysis. Mechanism of injury was self-reported. ADI was measured from the 2019 Neighborhood Atlas, in which deprivation increases from 1 to 100. Comparisons between groups were conducted with unpaired t tests, Fisher exact test, or χ 2 testing, where appropriate. Results Addresses constituted 259 unique census tracts, and the average number of upper extremity gunshot wound incidents per tract was 3, with a maximum of 22; 15.4% of census block tracts made up almost half (48.4%) of the total ballistic injuries in the study period; 97.7% of violent injuries occurred in Urban areas, as compared with only 60% of accidental injuries (P < 0.05). ADI and incidence of upper extremity ballistic injury were positively correlated. ADI varied significantly between patients sustaining violent (median, 94; mean, 86.1) versus accidental self-inflicted (median, 79; mean, 70.9) injuries (P < 0.05). Fifty percent of violent injuries in our data set occurred in block groups from the 2 most deprived quintiles. Conclusions Upper extremity gunshot wounds in general are concentrated in census blocks with high ADI. Violent injuries in particular are more likely to occur in urban areas with high ADI, whereas patients with accidental, self-inflicted injuries are more geographically and socioeconomically diverse. These differing populations require unique approaches to reduce incidence and morbidity.

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Epidemiology of Upper Extremity Firearm Injuries among Major Trauma Hospitals in the United States

Cited by 4 publications

References 28 publications

The Epidemiology, Management, and Outcomes of Civilian Gunshot Wounds to the Upper Extremity at an Urban Trauma Center

The Epidemiology, Management, and Outcomes of Civilian Gunshot Wounds to the Upper Extremity at an Urban Trauma Center

Antibiotic Prophylaxis and Infectious Complications in Isolated Gunshot Wounds to the Upper Extremity

The Impact of Area Deprivation Index, Geography, and Mechanism on Incidence of Ballistic Injury to the Upper Extremity

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