Death rate from handgun, long guns and knife wounds

Peter H. Proctor writes:

> 2) The main factor was apparently the substitution of handguns for
> long guns as home defense weapons. For penetrating trunchal
> wounds, the mortality rate for handguns is 15-20 %, roughly the
> same as for equivalent knife wounds. For (e.g) shotguns, the
> mortality rate is 70% or so. If memory serves, for high power
> rifles, about 30-40 %, BTW, the mortality rate from those wicked
> "assault weapons" is close to that for handguns, since they shoot
> a relatively low-powered round

Please provide a source for these claims.

> This is what I was taught in my training as a pathologist and seem
> to be pretty standard figures. Also, I saw roughly these figures
> presented at a Path convention and see no reason to question them.
> But I suppose I could find the reference somewhere.

Please do so. I've appended about 20 studies that all contradict this.

I looked in Medline for studies on gun shot and stab wound mortality
and turned up dozens. There was a consistent pattern across
different countries and wound locations -- gunshot wounds were far
more lethal. For example a study in The Journal of Trauma (36:4
pp516-524) looked at all injury admissions to a Seattle hospital over
a six year period. The mortality rate for gunshot wounds was 22%
while that for stab wounds was 4%. Even among patients that survived,
gunshot wounds were more serious -- the mean cost of treatment for
these patients was more than twice that for stab wounds.

> Apples and Oranges. I suspect the difference is " for equivalent
> trunchal wounds" which I carefully specified.. If you include
> superficial knife wounds and wounds that do not penetrate the
> peritoneum, your figures do sound about right. These are easy to
> treat and nobody ever dies from them.

Sorry, as I specifically stated those rates were for wounds serious
enough to warrant hospital admission, not superficial ones. Further,
the other studies mostly looked at equivalent wounds in equivalent
locations. **Without exception**, gunshot wounds were more serious and
more likely to lead to death. I've appended the abstracts of the studies
from Medline.

> But wait until you penetrate a viscous or ( especially ) cut a great
> vessel. The lesser energy involved in knife wounds is more than
> made up for by their larger size.

This does not seem to be the case. See the attached studies.

As for handgun vs long gun wound mortality, I suggest you look at
table 5.10 of "Point Blank" which presents the results of a
multivariate analysis based on NCS and SHR data and shows no
significant difference.

> Er, this just does not sound right. Long guns ( particularly
> shotguns) are much more destructive than handguns. Compare about
> 200 ft-lbs for 38 Special to 2000 ft lbs for a high-power military
> round.

The kinetic energy of the projectile is obviously not the only thing
that matters.

> One possibility---These figures are for people who actually make it
> to the hospital alive.

No. They are are based on the the NCS (victim survey) for the number
and type of woundings and the FBI's supplementary homicide reports for
the number and type of deaths.

Date: 21-Feb-97
Name: T13752_8Nbgjvm
Database: Medline <1992 to January 1997>

Set   Search                                                       Results
---------------------------------------------------------------------------
001   *wounds, gunshot/                                               1071
002   *wounds, stab/                                                   293
003   1 and 2                                                           52
004   from 3 keep 6,9,11,17,21-22,25,27-30,33-36,43-44,47-48,50-51      21

1. Authors

   Muckart DJ. Meumann C. Botha JB.

   Title

   The changing pattern of penetrating torso trauma in KwaZulu/Natal--a
   clinical and pathological review.

   Source

   South African Medical Journal. 85(11):1172-4, 1995 Nov.

   Abstract

   The number of patients who sustained penetrating torso trauma and were
   admitted to King Edward VIII Hospital and the surgical intensive care unit
   were reviewed over 10- and 5-year periods respectively. For the last 4
   months of 1992, a comparison was made between victims of trauma admitted
   to hospital and those whose bodies were taken directly to the South
   African Police medicolegal laboratories in Gale Street, Durban, where the
   majority of medicolegal autopsies in the Durban metropolitan area are
   performed. The total number of hospital admissions has not changed during
   the last decade, but the aetiology of injury has altered considerably.
   Stab wounds have declined by 30% whereas gunshot wounds have increased by
   more than 800%. The ratio of stab to gunshot wounds admitted to the
   intensive care unit reversed within the 5-year period 1987-1992. Direct
   admission to the mortuary was three times as common in cases of gunshot
   compared with stab wounds. The hospital mortality rate for gunshot wounds
   was 8 times that for stab wounds. The establishment of dedicated trauma
   centres is essential for the treatment of these injuries, and strategies
   to control the use of firearms are vital.

2. Authors

   Heary RF. Vaccaro AR. Mesa JJ. Balderston RA.

   Title

   Thoracolumbar infections in penetrating injuries to the spine.

   Source

   Orthopedic Clinics of North America. 27(1):69-81, 1996 Jan.

   Abstract

   A detailed review of the TJUH experience and the published literature on
   gunshot and stab wounds to the spine has been presented. The following
   statements are supported. (1) Military (high-velocity) gunshot wounds are
   distinct entities, and the management of these injuries cannot be carried
   over to civilian (low-velocity) handgun wounds. (2) Gunshot wounds with a
   resultant neurologic deficit are much more common than stab wounds and
   carry a worse prognosis. (3) Spinal infections are rare following a
   penetrating wound of the spine and a high index of suspicion is needed to
   detect them. (4) Extraspinal infections (septic complications) are much
   more common than spinal infections following a gunshot or stab wound to
   the spine. (5) Steroids are of no use in gunshot wounds to the spine. In
   fact, there was an increased incidence of spinal and extraspinal
   infections without a difference in neurologic outcome compared with those
   who did not receive steroids. (6) Spinal surgery is rarely indicated in
   the management of penetrating wounds of the spine. The recommendations for
   treatment at TJUH of victims of gunshot or stab wounds with a resultant
   neurologic deficit are as follows. (1) Spine surgery is indicated for
   progressive neurologic deficits and persistent cerebrospinal fluid leaks
   (particularly if meningitis is present), although these situations rarely
   occur. (2) Consider spine surgery for incomplete neurologic deficits with
   radiographic evidence of neural compression. Particularly in the cauda
   equina region, these surgeries may be technically demanding because of
   frequent dural violations and nerve root injuries/extrusions. These cases
   must be evaluated in an individual case-by-case manner. The neurologic
   outcomes of patients with incomplete neurologic deficits at TJUH who
   underwent acute spine surgery (usually for neural compression secondary to
   a bullet) were worse than the outcomes for the patients who did not have
   spine surgery. A selection bias against the patients undergoing spine
   surgery was likely present as these patients had evidence of ongoing
   neural compression. (3) A high index of suspicion is necessary to detect
   spinal and extraspinal infections. (4) Do not use glucorticoid steroids
   for gunshot wound victims. (5) Conservative (nonoperative) treatment with
   intravenous broad spectrum antibiotics and tetanus prophylaxis is the sole
   therapy indicated in the majority of patients who sustain a penetrating
   wound to the thoracic or lumbar spines.

3. Authors

   Madiba TE. Mokoena TR.

   Title

   Favourable prognosis after surgical drainage of gunshot, stab or blunt
   trauma of the pancreas [see comments].

   Source

   British Journal of Surgery. 82(9):1236-9, 1995 Sep.

   Abstract

   The records of 152 patients with pancreatic injury treated over a 5-year
   period were reviewed. The diagnosis was made at laparotomy in all
   patients. Gunshot wounds, stab wounds and blunt trauma occurred in 63, 66
   and 23 patients respectively with mean ages of 28, 28 and 30 years.
   Multiple organ injury was most common after gunshot wounds. Intraoperative
   management was by drainage of the pancreatic injury site alone in the
   majority of patients in all aetiological groups. The rate of fistula
   formation was 14 per cent after gunshot wounds, 9 per cent after stab
   injury and 13 per cent after blunt trauma. Death occurred after 24 h in 8,
   2 and 10 per cent of patients following gunshot wounds, stab wounds and
   blunt trauma respectively, and was attributable to other organ damage. It
   is concluded that gunshot injury to the pancreas may be more extensive
   than other injuries, but conservative management with surgical drainage of
   pancreatic injury is justified irrespective of the mechanism of injury.

4. Authors

   Velmahos GC. Degiannis E. Hart K. Souter I. Saadia R.

   Title

   Changing profiles in spinal cord injuries and risk factors influencing
   recovery after penetrating injuries.

   Source

   Journal of Trauma. 38(3):334-7, 1995 Mar.

   Abstract

   OBJECTIVE: The changing profiles of spinal cord injuries in South Africa
   are addressed in this study. DESIGN: A retrospective analysis of 551
   patients with spinal cord injury. MATERIALS AND METHODS: The cause of
   injury was motor vehicle crashes in 30%, stab wounds in 26%, gunshot
   wounds in 35%, and miscellaneous causes 9%. MEASUREMENTS AND MAIN RESULTS:
   There was a significant shift from stab wounds towards bullet wounds over
   the last five years. Bullet spinal cord injuries increased from 30 cases
   in 1988 to 55 cases in 1992, while stab spinal cord injuries decreased
   from 39 cases in 1988 to 20 cases in 1992. The incidence of spinal cord
   injuries following a motor vehicle crash showed a declining tendency after
   a transient increase (28 cases in 1988, 40 in 1990, 31 in 1992). Moreover,
   the problem of severe septic complications has been investigated and
   various risk factors for sepsis that might impair the rehabilitation
   process have been examined. The risk of developing septic complications
   was higher in gunshot spine injuries (21 cases out of 193) than in knife
   injuries (5 cases out of 143). The presence of a retained bullet did not
   seem to increase the chances for sepsis. In seven patients the sepsis was
   the direct consequence of the retained bullet while in 14 patients sepsis
   developed with no bullet in situ. Furthermore, the site of the injury
   (cervical, thoracic, lumbar spine) did not correlate with the
   abovementioned risks. CONCLUSIONS: Gunshots carry a heavier prognosis.
   Only 32% of our gunshot cases underwent a significant recovery as opposed
   to 61% of stab cases and 44% of the motor vehicle crash victims.

5. Authors

   Degiannis E. Velmahos GC. Florizoone MG. Levy RD. Ross J. Saadia R.

   Title

   Penetrating injuries of the popliteal artery: the Baragwanath experience.

   Source

   Annals of the Royal College of Surgeons of England. 76(5):307-10, 1994
   Sep.

   Abstract

   This study describes the management of 43 patients with penetrating injury
   of the popliteal artery. Of these patients, 33 (76.5%) had bullet wounds,
   four patients (9.5%) pellet wounds and 6 (14%) knife wounds. Patients with
   'hard' signs of arterial injury underwent exploration without preoperative
   angiograms. There were no negative explorations. Patients with only 'soft'
   signs of arterial injury underwent preoperative angiograms. Of this group,
   75% had positive angiograms and underwent exploration. There were no
   false-positive or false-negative preoperative angiograms in the group of
   patients with 'soft' signs in this study. Definitive orthopaedic
   management of associated fractures followed vascular reconstruction. There
   was no difference in the short-term patency of autologous saphenous vein
   graft as against PTFE grafts. Fasciotomy was performed on patients who had
   arterial and venous injury or presented late. Overall amputation rate was
   14% and for bullet injuries 18%.

6. Authors

   Rothlin M. Vila A. Trentz O.

   Title

   [Results of surgery in gunshot and stab injuries of the trunk]. [German]

   Source

   Helvetica Chirurgica Acta. 60(5):817-22, 1994 Jul.

   Abstract

   Between 1981 and 1990, 105 patients suffering from gunshot and stab wounds
   were admitted to the Department of Surgery of Zurich University Hospital.
   There were 17 female and 88 male patients aged 16-74 years (average 31
   years) whose charts were studied retrospectively. 44 patients demonstrated
   gunshot injuries, while 60 suffered from stabwounds and 1 patient had
   both. The injuries were the result of a crime in 59, a suicide in 33 and
   an accident in 11 cases. In 2 patients the cause was not conclusive
   proven. Injuries to the lung (n = 54), the liver (n = 27) and to the
   stomach (n = 23) were seen most frequently. 45 patients underwent
   laparotomy, while 16 had a thoracotomy performed. Both thoracotomy and
   laparotomy were necessary in 10 cases. Complications were observed in
   29.5% of the cases. They were significantly more frequent in patients with
   gunshot injuries (p < 0.0004). Overall mortality amounted to 14.3% (n =
   15). Patients with gunshot wounds had a significantly higher mortality
   rate (p < 0.0005). Debridement and selective closure of the wounds (n =
   25) did not result in a higher rate of abscess formation than open
   treatment (n = 17).

7. Authors

   Coimbra R. Prado PA. Araujo LH. Candelaria PA. Caffaro RA. Rasslam S.

   Title

   Factors related to mortality in inferior vena cava injuries. A 5 year
   experience.

   Source

   International Surgery. 79(2):138-41, 1994 Apr-Jun.

   Abstract

   Forty-nine patients sustaining Inferior Vena Cava (IVC) injuries, during a
   5 year period were retrospectively analyzed in order to assess those
   factors related to early deaths. Mean age was 32 and 45 were male. GSW was
   the most frequent mechanism of injury (59.2%), followed by SW (28.6%) and
   blunt trauma (12.2%). There were 4 injuries in the supra diaphragmatic
   IVC, 14 retrohepatic, 16 suprarenal and the remaining 15 were in the
   infrarenal portion of the IVC. Twenty patients were in shock and 8 were
   unstable on admission. The liver was the most frequently injured organ in
   association with IVC and there were also 7 concomitant abdominal vascular
   injuries. Venorrhaphy was performed in 28 patients, IVC ligature in 5,
   intracaval shunt in 3 and in the remaining 13, only temporary hemostasis
   was attempted. Mortality rate was 100% in supra diaphragmatic injuries,
   71.4% in retrohepatic, 68.8% in suprarenal and 33% in infrarenal injuries.
   There was a significant difference when comparing mortality rate in stable
   against shock or unstable patients on admission (p < 0.001), as well as in
   those with diaphragmatic IVC injuries compared with all other injury sites
   together (p < 0.05). Hemodynamic instability on admission was the most
   important cause of early deaths, and all patients with concomitant
   abdominal vascular injuries also died.

8. Authors

   Degiannis E. Velmahos G. Krawczykowski D. Levy RD. Souter I. Saadia
   R.

   Title

   Penetrating injuries of the subclavian vessels.

   Source

   British Journal of Surgery. 81(4):524-6, 1994 Apr.

   Abstract

   A study was made of 76 patients with subclavian vessel injury. The
   mechanism of trauma was stabbing in 40 patients (53 per cent) and gunshot
   in 36 (47 per cent). There were marked differences between the two groups
   in clinical presentation, operative management and outcome. The group with
   gunshot injury was characterized by a more immediate threat to life, and a
   greater need for a median sternotomy and use of interposition grafts. The
   mortality rate in patients with gunshot wounds was more than twice that in
   the group with stab injury.

9. Authors

   Tang E. Berne TV.

   Title

   Intravenous pyelography in penetrating trauma.

   Source

   American Surgeon. 60(6):384-6, 1994 Jun.

   Abstract

   Intravenous pyelograms (IVPs) are routinely used in the workup of
   suspected urologic injuries. The indications for obtaining IVPs have not
   been well characterized. This study examined 67 patients with penetrating
   trauma who received formal IVPs with nephrotomography in the radiology
   department. Of 35 stab wounds, 19 patients presented without hematuria and
   accounted for only one positive IVP. No intervention was undertaken in
   this patient. There were 14 stab wound patients with microscopic
   hematuria, with three positive IVPs. No intervention was necessary in any
   of these patients. The two remaining stab wound patients both had gross
   hematuria and renal injuries requiring intervention. However, only one of
   the two had a positive IVP, showing a blurred kidney margin. One patient
   had a pseudoaneurysm of a branch of the renal artery, and the other had an
   arteriovenous fistula. Of 32 patients with gunshot wounds, 15 presented
   without hematuria. Of the 15, one had a positive IVP but did not have a
   renal injury on exploration. None of the other 13 patients in this group
   undergoing exploration had renal injuries. Of the 11 patients with
   microscopic hematuria, three had hematomas and one had gross extravasation
   on IVP. Of the six patients with gross hematuria, three had positive IVPs,
   showing a hematoma, a renal fracture, and indistinct renal outline,
   respectively. In this limited study, omitting IVPs on the patients with
   negative urinalyses would not have missed any significant injuries. We
   suggest that more study is needed in this area because our present
   standard may lead to unnecessary expense and delay.

10. Authors

    Velmahos GC. Degiannis E. Souter I. Saadia R.

    Title

    Penetrating trauma to the heart: a relatively innocent injury.

    Source

    Surgery. 115(6):694-7, 1994 Jun.

    Abstract

    BACKGROUND. The purpose of this study was to examine the mortality rate of
    penetrating cardiac trauma in a large urban hospital. METHODS. This was a
    retrospective study over a period of 5 years and 5 months of all patients
    admitted alive with a stab or a gunshot cardiac injury. RESULTS. There
    were 310 patients with a stab wound and 63 with a gunshot wound. The
    overall mortality rate was 19%. The mortality rates for the stab and the
    gunshot groups were 13% and 50.7%, respectively. In the 296 patients with
    a cardiac stab wound confined to a single chamber and with no other
    associated extracardiac injury the mortality rate was 8.5%. CONCLUSIONS.
    An isolated cardiac stab wound is a relatively innocent injury in a
    patient at a hospital accustomed to managing penetrating trauma
    expeditiously.

11. Authors

    Mock C. Pilcher S. Maier R.

    Title

    Comparison of the costs of acute treatment for gunshot and stab wounds:
    further evidence of the need for firearms control [see comments].

    Source

    Journal of Trauma. 36(4):516-21; discussion 521-2, 1994 Apr.

    Abstract

    Gun control is proposed primarily to decrease the incidence of injury and
    death from gunshot wounds (GSWs). We hypothesize that decreasing the
    number of GSWs will also produce significant economic savings, even if
    personal violence were to continue at the same rate, maintaining the same
    overall incidence of penetrating trauma. We analyzed charges and
    reimbursements for the treatment for all patients with GSWs (n = 1116) and
    stab wounds (SWs) (n = 1529) admitted to a level I trauma center from 1986
    through 1992. Mean and median charges were higher for GSWs ($14,541;
    $7,541) than for SWs ($6,446; $4,249) (p < 0.05). There was a 12% per year
    increase in the annual number of GSWs (p = 0.001), leading to a
    disproportionate increase in the annual total charges for GSWs (p =
    0.013), compared with SWs. Public expenditures, including bad debt and
    government reimbursement, increased for GSWs (p = 0.019) but not SWs.
    Thus, if all patients with GSWs instead suffered SWs, there would be an
    annual savings of $1,290,000 overall and of $981,000 of public funds from
    this institution alone. Treatment costs for GSWs are higher than those for
    SWs and are rising more rapidly, with an increasing amount of public funds
    going to meet these costs. Considerable savings to society would accrue
    from any effort that decreased firearm injuries, even if the same level of
    violence persisted using other weapons.

12. Authors

    Rizoli SB. Mantovani M. Baccarin V. Vieira RW.

    Title

    Penetrating heart wounds.

    Source

    International Surgery. 78(3):229-30, 1993 Jul-Sep.

    Abstract

    In 3 years, 26 patients were operated for penetrating heart wounds at our
    institution, the majority between 30 to 60 minutes after injury.
    Twenty-two patients with a possible heart wound were immediately taken to
    the operating room for thoracotomy. One patient initially underwent
    laparotomy while 2 were observed before operating-room thoracotomy. One
    patient underwent emergency-room thoracotomy. Three patients with no vital
    signs on admission died, 82.6% of the remainder survived. Stab wounds
    determined the best survival rate: 94%, whereas for gunshot wounds it was
    only 50%. Our experience at this Brazilian Trauma Center reveals that
    delay in reaching the hospital selected the patients, that clinical
    condition on arrival, method of injury (knife or gunshot), emergency room
    staffed with trauma surgeons and aggressive operating room treatment for
    penetrating heart wounds results in a remarkable survival rate.
    Emergency-room thoracotomy should be reserved for patients "in extremis"
    or when there is no operating room available.

13. Authors

    Macho JR. Markison RE. Schecter WP.

    Title

    Cardiac stapling in the management of penetrating injuries of the heart:
    rapid control of hemorrhage and decreased risk of personal contamination.

    Source

    Journal of Trauma. 34(5):711-5; discussion 715-6, 1993 May.

    Abstract

    The resuscitation of patients with cardiopulmonary arrest from a
    penetrating injury of the heart requires emergency thoracotomy and control
    of hemorrhage. Suture control may be technically difficult in patients
    with large or multiple lacerations. Emergency cardiac suturing techniques
    expose the surgeon to the risk of a contaminated needle stick. After we
    determined that rapid control of hemorrhage from cardiac lacerations could
    be achieved in anesthetized sheep with the use of a standard skin stapler,
    the technique was applied in the clinical setting. Twenty-eight patients
    underwent emergency stapling of 33 cardiac lacerations at our institution
    from September 1987 to December 1991. Seventy-nine percent (22) of the
    patients sustained stab wounds, and 21% (6) were injured by gunshots.
    Fifty-eight percent (19) of the injuries involved the right ventricle, 27%
    (9) involved the left ventricle, 9% (3) involved the right atrium, and 6%
    (2) involved the left atrium. In 93% (26) of the patients, control of
    hemorrhage was achieved within 2 minutes of exposure of the injuries. Both
    patients in whom control could not be achieved had sustained large-caliber
    gunshot injuries. Fifteen (54%) of the patients survived, including one
    patient with two cardiac lacerations and another with three lacerations.
    Of the surviving patients, two had mild neurologic deficits. No personal
    contamination occurred related to the use of the stapler. We conclude (1)
    cardiac stapling is highly effective in the management of hemorrhage from
    penetrating injury, particularly in the setting of multiple cardiac
    lacerations; (2) the technique may not be effective with certain types of
    gunshot wounds; and (3) the use of the stapler for emergency cardiorrhaphy
    eliminates the risk of personal contamination from a needle stick.
    [Full paper reveals survival rate of 17% for gunshot wounds and 64%
    for stab wounds. TL]

14. Authors

    Mitchell ME. Muakkassa FF. Poole GV. Rhodes RS. Griswold JA.

    Title

    Surgical approach of choice for penetrating cardiac wounds.

    Source

    Journal of Trauma. 34(1):17-20, 1993 Jan.

    Abstract

    One hundred nineteen patients suffered penetrating cardiac trauma over a
    15-year period: 59 had gunshot wounds, 49 had stab wounds, and 11 had
    shotgun wounds. The overall survival rate was 58%. The most commonly
    injured structures were the ventricles. Twenty-seven patients had injuries
    to more than one cardiac chamber. Thirty patients had associated pulmonary
    injuries. Emergency thoracotomy was performed in 47 patients with 15%
    survival. Median sternotomy was used in 30 patients with 90% survival.
    Seventeen of the 83 patients with thoracotomies required extension across
    the sternum for improved cardiac exposure or access to the contralateral
    hemithorax. Only one patient with sternotomy also required a thoracotomy.
    All pulmonary injuries were easily managed when sternotomy was used. We
    conclude that sternotomy provides superior exposure for cardiac repair in
    patients with penetrating anterior chest trauma. We feel it is the
    incision of choice in hemodynamically stable patients. Thoracotomy should
    be reserved for unstable patients requiring aortic cross-clamping, or when
    posterior mediastinal injury is highly suspected.
    [Full paper reveals survival rates of 46% for gunshot wounds, 78% for
    stab wounds, and 36% for shotgun wounds. TL]

15. Authors

    Kaufman JA. Parker JE. Gillespie DL. Greenfield AJ. Woodson J.
    Menzoian JO.

    Title

    Arteriography for proximity of injury in penetrating extremity trauma.

    Source

    Journal of Vascular & Interventional Radiology. 3(4):719-23, 1992 Nov.

    Abstract

    Arteriography for proximity of injury was studied prospectively at a
    trauma center. Findings in 85 patients with penetrating extremity wounds
    were analyzed to determine the prevalence and types of vascular
    abnormalities seen with these injuries. Ninety-two limb segments were
    studied for 77 gunshot and 15 stab wounds. Arteriographic findings were
    positive in 24% overall but in only 5% for injuries confined to major
    vessels. A 60% positive rate was seen in a small subgroup of 10 patients
    with fractures due to gunshot wounds. The most frequently injured vessels
    were muscular branches of the deep femoral artery (59%); the most common
    injury was focal, non-occlusive spasm (42%). All patients were treated
    conservatively, without sequelae at follow-up. In this study, the vascular
    injuries found at arteriography for proximity of injury in penetrating
    trauma due to bullets of knives, particularly in the thigh, did not
    require surgical or radiologic intervention.

16. Authors

    Nagel M. Kopp H. Hagmuller E. Saeger HD.

    Title

    [Gunshot and stab injuries of the abdomen]. [German]

    Source

    Zentralblatt fur Chirurgie. 117(8):453-9, 1992.

    Abstract

    From 1973 to 1991 a total of 422 patients underwent surgery because of an
    abdominal trauma. 12 patients had gunshot wounds and 46 patients stab
    wounds. In a retrospective study the diagnostic and therapeutic procedure
    and the indication for surgery are analysed. After gunshot wounds of the
    abdomen we always performed a laparotomy. In 11 od 12 cases we found
    serious intra-abdominal injuries. Only in one case the laparotomy was
    "unnecessary", because of a tangential wound without penetrating of the
    abdominal wall. After stab wounds the diagnostic and therapeutic
    management was more selective. Indications for mandatory laparotomy after
    stab wounds were a manifest hemorrhagic shock, evisceration and a still
    left weapon in the abdomen (n = 22). The first clinical examination was
    completed by ultrasound or peritoneal lavage. Pathological findings like
    free intraperitoneal fluid or a positive lavage also were indications for
    laparotomy (n = 9). The other patients were observed closely, including
    repeated physical examination. The indication for surgery then based on
    the development of clinical signs. The time between first examination and
    laparotomy was never more than 12 hours. 39 patients (84.7%) had injuries
    of intraabdominal organs. 5 patients (10.8%) had a negative laparotomy.
    The mortality rate was 3.4%, but there was no death as a result of the
    selective approach.

17. Authors

    Saltzman LE. Mercy JA. O'Carroll PW. Rosenberg ML. Rhodes PH.

    Title

    Weapon involvement and injury outcomes in family and intimate assaults.

    Source

    JAMA. 267(22):3043-7, 1992 Jun 10.

    Abstract

    OBJECTIVE--To compare the risk of death and the risk of nonfatal injury
    during firearm-associated family and intimate assaults (FIAs) with the
    risks during non-firearm-associated FIAs. DESIGN--Records review of police
    incident reports of FIAs that occurred in 1984. Victim outcomes (death,
    nonfatal injury, no injury) and weapon involvement were examined for
    incidents involving only one perpetrator. SETTING--City of Atlanta, Ga,
    within Fulton County. PARTICIPANTS--Stratified sample (n = 142) of victims
    of nonfatal FIAs, drawn from seven nonfatal crime categories, plus all
    fatal victims (n = 23) of FIAs. MAIN OUTCOME MEASURES--Risk of death (vs
    nonfatal injury or no injury) during FIAs involving firearms, relative to
    other types of weapons; risk of nonfatal injury (vs all other outcomes,
    including death) during FIAs involving firearms, relative to other types
    of weapons. RESULTS--Firearm-associated FIAs were 3.0 times (95%
    confidence interval, 0.9 to 10.0) more likely to result in death than FIAs
    involving knives or other cutting instruments and 23.4 times (95%
    confidence interval, 7.0 to 78.6) more likely to result in death than FIAs
    involving other weapons or bodily force. Overall, firearm-associated FIAs
    were 12.0 times (95% confidence interval, 4.6 to 31.5) more likely to
    result in death than non-firearm-associated FIAs. CONCLUSIONS--Strategies
    for limiting the number of deaths and injuries resulting from FIAs include
    reducing the access of potential FIA assailants to firearms, modifying
    firearm lethality through redesign, and establishing programs for primary
    prevention of violence among intimates.

18. Authors

    Mercer DW. Buckman RF Jr. Sood R. Kerr TM. Gelman J.

    Title

    Anatomic considerations in penetrating gluteal wounds.

    Source

    Archives of Surgery. 127(4):407-10, 1992 Apr.

    Abstract

    A retrospective study of 81 patients with penetrating gluteal wounds was
    performed to determine if the site of penetration was useful in predicting
    the likelihood of associated vascular or visceral injury. There were 53
    gunshot wounds and 28 stab wounds, including one impalement. The gluteal
    region was divided into upper and lower zones by determining whether entry
    occurred above or below the greater trochanters. Sixty-six percent of all
    penetrating gluteal wounds entered the upper zone. Thirty-two percent of
    patients with upper zone penetration had associated vascular or visceral
    injury. Only one of 27 patients with lower zone penetration sustained
    major injury. The site of entry plays a critical role in determining the
    likelihood of serious injury associated with penetrating gluteal wounds.
    Wounds penetrating above the greater trochanters demand thorough
    evaluation, especially gunshot wounds.