Evaluation of clinician accuracy in describing gunshot wound injuries

A large series of gunshot wounds is analyzed to determine, first, whether the wounds were described with enough detail to estimate the distance and direction of fire; and second, to utilize the autopsy description to determine accuracy. All of the University of Miami-Jackson Medical Center (UM-JMC) records coded as gunshot wounds and treated during calendar year 1995 were included in this study. The analysis is of 566 shootings from bullets in which 1259 wounds were described in the hospital records. Of the 1259 bullet wounds, the size and/or shape was described in only 63 (5%) and only four wounds (0.3%) had any indication of distance of fire. The location of the wound could be determined to within 3 cm in 655 (52%) and only 39 (3%) of the wounds were measured from some landmark. Directionality was neither indicated nor determinable in 897 (71%) of the wounds examined. Fifty-five (9%) cases resulted in death and were compared with medical examiner autopsies. Clinical information was inadequate for comparison in three (6%) of these cases. In 22 cases that were said to have one wound, only 14 (64%) of these were correctly documented. Of 16 cases with 2 wounds, 9 (56%) were correctly identified by the clinicians. When greater than 2 wounds were present (14), the clinicians were wrong 93% of the time. This study demonstrates that clinicians responsible for treating gunshot-wounded persons do not adequately document or interpret these wounds.