Could We Have Stopped the Bleed? An Examination of 5,765 Homicide Autopsies Across 13 Years

Since 2015, the Stop the Bleed (STB) Campaign has trained more than 5.3 million Americans in tourniquet application, wound packing, and extremity compression. Yet, population-level impact remains unclear. We performed a statewide evaluation of autopsy reports to quantify such deaths.

The Maryland Chief Medical Examiner's office investigates all homicides statewide. We analyzed autopsies for all gunshot wound and stab wound homicide victims from 2005 to 2017. Homicides were categorized as isolated or nonisolated extremity injuries. We identified vascular injuries potentially amenable to STB. Multivariate logistic regressions stratified by mechanism compared the odds of major vascular injury between isolated vs nonisolated extremity injuries.

Among 5,765 victims (88% men, 82% Black race, median age 28 years), 84% had gunshot wounds and 16% stab wounds. Extremity injuries occurred in 47% of gunshot wound and 35% of stab wound victims. Of those, 2.4% (n = 55) of gunshot wound and 5.3% (n = 17) of stab wound victims had isolated wounds. Major vascular injuries were more common in isolated vs nonisolated extremity wounds (gunshot wound: 33% vs 5.0%; stab wound: 59% vs 9.5%). Gunshot wound victims with isolated extremity wounds had 10-fold greater odds of vascular injury compared with those with nonisolated injuries (odds ratio 10.1 [95% CI 5.8 to 17.5], p < 0.01). The difference was not significant for stab wound victims (odds ratio 3.7 [95% CI 0.5 to 17.1], p = 0.11).

We found a significant burden of extremity wounds with major vascular injury among a large cohort of gunshot wound and stab wound homicide victims. Gunshot wound victims with isolated extremity injuries were substantially more likely to sustain fatal vascular injury. These findings highlight isolated extremity wounds as a prime target for bystander hemorrhage control through STB interventions.