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All patients with truncal gunshot wounds deserve trauma team activation
Jack Sava1, Kathleen Alo, George C Velmahos
1Division of Trauma and Critical Care, Department of Surgery, University of Southern California Keck School of Medicine and the Los Angeles County/University of Southern California Medical Center, Los Angeles, California 90033, USA.
Background:
Traditional criteria for trauma team activation (TTA) include hypotension, tachycardia, tachypnea, and unresponsiveness. In a recent revision of the Resources for Optimal Care of the Trauma Patient, gunshot wound to the trunk (GSWT) was recommended as an independent criterion for major resuscitation and TTA. To validate this suggestion, we reviewed records of patients with GSWT to see if patients not meeting standard TTA criteria had serious injuries that would benefit from TTA.
Methods:
This study was a retrospective trauma registry study at a large Level I trauma center. Records of all patients over an 8.5-year period with GSW to chest, back, or abdomen/pelvis were included in the study. Patients who died in hospital, required ICU admission within 24 hours, had non-orthopedic operation within 24 hours, or had ISS > 15 were considered severely injured, and were assumed to benefit from TTA.
Results:
Between January 1993 and June 2000, 4,198 patients were admitted with GSWT, 94% of whom met traditional TTA criteria. Sixty-one percent of patients meeting traditional TTA criteria had severe injury, compared with 45.7% for those without TTA criteria. Of the 234 patients who did not meet traditional TTA criteria, 9.4% required early ICU admission, 29.5% required non-orthopedic operation within 24 hours, and 1.3% died.
Conclusion:
Patients with GSWT often require high-level care, even when physiologic TTA criteria are absent on admission. Gunshot wound to the trunk should be an independent criterion for TTA.