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Penetrating chest injuries in the firearm era
T E Madiba1, S R Thomson, N Mdlalose
1Department of Surgery, University of Natal and King Edward VIII Hospital, Private Bag 7, Congella, 4013, Durban, South Africa. madiba@med.und.ac.za
Insights
Firearm chest wounds have higher mortality and longer hospital stays than stab wounds. However, early death rates are similar, supporting the use of existing stab wound management protocols for firearm injuries.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Emergency Medicine
Background:
- Firearm chest injuries are increasingly common.
- Existing management algorithms for chest trauma have not been specifically evaluated for firearm injuries.
Purpose of the Study:
- To evaluate the efficacy of the current management algorithm for penetrating chest injuries in patients with firearm wounds.
- To compare outcomes of firearm chest injuries with stab chest injuries.
Main Methods:
- Retrospective analysis of all patients with penetrating chest trauma admitted to an urban tertiary hospital over one year.
- Comparison of injury characteristics, management, and outcomes between firearm and stab wounds.
Main Results:
- 116 firearm and 473 stab wounds were analyzed.
- Firearm injuries showed more normal X-rays, fewer pneumothoraces, and more contusions compared to stab wounds.
- While overall mortality and ICU stay were higher for firearm injuries, early mortality rates were similar, and pneumothoraces were less frequently requiring drainage.
Conclusions:
- Despite higher overall mortality and longer hospital stays, the similar early mortality rates between firearm and stab chest injuries support the continued use of the stab wound management algorithm for all penetrating chest trauma.
- The management of hemothorax and hemopneumothorax was comparable between injury types when drainage criteria were met.
Background:
firearm wounds of the chest are now common at our institution. The management algorithm for firearm wounds has not been evaluated for this mode of injury.
Methods:
records of all patients with penetrating chest injuries admitted to an urban tertiary hospital over 1 year were retrieved and analysed.
Results:
there were 473 stab and 116 firearm wounds. In comparison to stab injuries firearm wounds had significantly more normal X-rays (14 vs. 5%), fewer pneumothoraces (15 vs. 37%), and more contusions (43 vs. 2%). The frequency of haemothoraces (34 vs. 23%) and haemopneumothoraces (36 vs. 35%) was similar in both groups. Stabbing caused all the 18 cardiac injuries. Associated abdominal injuries occurred in 8% of stab and 34% of firearm injuries. Pneumothoraces due to firearms were uncommon and rarely required drainage. More pneumothoraces were treated nonoperatively among firearm injuries in contrast to stabbing injuries where the opposite applied. The management of haemothorax and haemopneumothorax was similar in both groups that fulfilled the criteria for drainage. The rate of ICU admission was higher and the hospital-stay longer following firearm injuries. Fifty-nine patients died (10% of the total), 33 (28%) from the firearm injuries and 26 (6%) from stab-wounds. Early deaths were 1 and 3% for stabs and firearms, respectively.
Conclusions:
patients with firearm injuries reaching hospital suffered three times higher mortality and a longer ICU and hospital stay than those with stab injuries. However, early mortality was similar for both modes of injury and validates the continued application of the stab wound derived management algorithm to all modes of injury.