Trauma, firearms, and pregnancy: Beyond the cushion

Pregnancy introduces unique anatomical and physiological changes that could influence injury susceptibility, including redistribution of abdominal organs and adipose tissue that could provide a protective "cushion effect" against penetrating trauma. This study aimed to understand how injury patterns and clinical outcomes differ between pregnant trauma patients (PTPs) and their non-pregnant counterparts presenting after penetrating trauma, hypothesizing that PTPs have a lower mortality risk and incur less severe abdominal injuries due to the proposed cushion effect.

The 2020-2021 Trauma Quality Improvement Program database was queried for all female patients <50-years-old presenting after penetrating trauma. The primary outcome was mortality, and secondary outcomes included the incidence of gunshot wounds and abdominal injuries. We compared pregnant versus non-pregnant patients with bivariate and multivariable logistic regression analyses.

From 25,812 female patients, 531 (2.1 %) were PTPs. Gunshot wounds were more prevalent among PTPs (64.2 % vs. 46.0 %, p < 0.001), and PTPs exhibited a higher incidence of gastrointestinal injuries (8.5 % vs. 6.3 %, p = 0.04). PTPs also had more in-hospital cardiac arrests (2.1 % vs. 1.0 %, p = 0.02) and increased mortality (7.5 % vs. 5.6 %, p = 0.052) however similar associated risk of death (OR = 1.08, CI 0.65-1.77, p = 0.78) compared to non-pregnant patients.

The prevalence of firearm violence emphasizes the need for targeted primary preventive strategies for PTPs. Furthermore, the heightened vulnerability of PTPs to gastrointestinal injuries following penetrating trauma, potentially attributed to the gravid uterus's spatial changes, challenges any proposed "cushion effect."