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Management and outcomes of firearm-related vascular injuries
Karolina Nyberger1,2,3, Eva-Corina Caragounis4, Pauline Djerf5
1Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden. karolina.nyberger@gmail.com.
Insights
Firearm vascular injuries are a significant public health concern, with lower extremity injuries being most common but chest and abdominal injuries proving most lethal. Early hemorrhage control is critical for improving survival rates in these critical vascular trauma cases.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Public Health
Background:
- Firearm violence represents a major global public health challenge.
- Vascular injuries resulting from firearms are associated with high mortality rates.
- Understanding the epidemiology of these injuries is crucial for developing effective interventions.
Purpose of the Study:
- To analyze the population-based epidemiology of firearm-related vascular injuries.
- To identify patterns, locations, and outcomes of vascular trauma caused by firearms.
- To inform strategies for reducing morbidity and mortality associated with firearm vascular injuries.
Main Methods:
- A retrospective nationwide epidemiological study was conducted using data from the Swedish Trauma Registry (SweTrau) between 2011 and 2019.
- The study included 71,879 trauma patients, identifying 1010 with firearm injuries, of which 162 had vascular injuries.
- Data analysis focused on patient demographics, injury characteristics, surgical interventions, and mortality outcomes.
Main Results:
- 162 patients sustained 238 firearm-related vascular injuries, predominantly affecting the lower extremities (41.7%), abdomen (18.9%), and chest (18.9%).
- Common femoral artery injuries were most frequent (17.6%). Hemodynamic instability was observed in 37.7% of patients, with thoracic aorta and femoral artery injuries being most common in this subgroup.
- The 30-day and 90-day mortality rates were 29.9% and 33.3%, respectively. Chest or abdominal vascular injuries, particularly to the thoracic aorta or femoral artery, were associated with increased 24-hour mortality.
Conclusions:
- Firearm-related vascular injuries result in substantial morbidity and mortality.
- While lower extremity injuries are most common, thoracic and abdominal vascular injuries carry the highest lethality.
- Enhanced early hemorrhage control strategies are essential for improving patient outcomes in firearm vascular trauma.
Background:
Violence due to firearms is a major global public health issue and vascular injuries from firearms are particularly lethal. The aim of this study was to analyse population-based epidemiology of firearm-related vascular injuries.
Methods:
This was a retrospective nationwide epidemiological study including all patients with firearm injuries from the national Swedish Trauma Registry (SweTrau) from January 1, 2011 to December 31, 2019. There were 71,879 trauma patients registered during the study period, of which 1010 patients were identified with firearm injuries (1.4%), and 162 (16.0%) patients with at least one firearm-related vascular injury.
Results:
There were 162 patients admitted with 238 firearm-related vascular injuries, 96.9% men (n = 157), median age 26.0 years [IQR 22-33]. There was an increase in vascular firearm injuries over time (P < 0.005). The most common anatomical vascular injury location was lower extremity (41.7%) followed by abdomen (18.9%) and chest (18.9%). The dominating vascular injuries were common femoral artery (17.6%, 42/238), superficial femoral artery (7.1%, 17/238), and iliac artery (7.1%, 17/238). Systolic blood pressure (SBP) < 90 mmHg or no palpable radial pulse in the emergency department was seen in 37.7% (58/154) of patients. The most common vascular injuries in this cohort with hemodynamic instability were thoracic aorta 16.5% (16/97), femoral artery 10.3% (10/97), inferior vena cava 7.2% (7/97), lung vessels 6.2% (6/97) and iliac vessels 5.2% (5/97). There were 156 registered vascular surgery procedures including vascular suturing (22%, 34/156) and bypass/interposition graft (21%, 32/156). Endovascular stent was placed in five patients (3.2%). The 30-day and 90-day mortality was 29.9% (50/162) and 33.3% (54/162), respectively. Most deaths (79.6%; 43/54) were within 24-h of injury. In the multivariate regression analysis, vascular injury to chest (P < 0.001) or abdomen (P = 0.002) and injury specifically to thoracic aorta (P < 0.001) or femoral artery (P = 0.022) were associated with 24-h mortality.
Conclusions:
Firearm-related vascular injuries caused significant morbidity and mortality. The lower extremity was the most common injury location but vascular injuries to chest and abdomen were most lethal. Improved early hemorrhage control strategies seem critical for better outcome.
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