VESS19. Firearm Injuries to the Lower Extremities Are Associated With a Higher Risk of Amputation and Death Compared With Other Lower Extremity Penetrating Traumas

Abstract

Firearm injuries have traditionally been associated with poorer outcomes compared with other penetrating trauma. Lower extremity trauma with vascular injury is a common presentation at many centers. Our goal was to compare firearm and nonfirearm penetrating injuries requiring vascular repair. We analyzed the National Inpatient Sample from 2010 to 2014 for all penetrating lower extremity injuries requiring vascular repair based on International Classification of Diseases, 9th edition, codes. Our primary outcomes were lower extremity amputation and death. We identified 19,494 patients with penetrating injuries requiring vascular repair—15,727 firearm injuries (80.7%) and 3767 nonfirearm injuries (19.3%). The majority of patients were male (91%) and intent was most commonly assault (63.2%). The majority (72.9%) had an arterial injury and 43.8% had a venous injury. Levels of injury included iliac (19.3%), femoral-popliteal (60%), and tibial (13.2%). Interventions included direct vascular repair (52.1%), ligation (22.1%), bypass (19.4%), and endovascular procedures (3.6%). Patients with firearm injuries were more frequently younger, of black race, male, on Medicaid, with lower household income, with assault intent, and with multiple injuries. Firearm injuries compared with nonfirearm injuries, respectively, were more often to be arterial (75.5% vs 61.9%), involve iliac (20.6% vs 13.7%) and femoral-popliteal vessels (64.7% vs 39.9%), have an endovascular repair (4% vs 2.1%), and less often to have a bypass (2.5% vs 6.5%; P < .001 for all). Multivariable analysis showed that lower extremity penetrating injury from a firearm was independently associated with postoperative amputation (odds ratio, 4.78; 95% confidence interval, 2-11; P < .0001) and mortality (odds ratio, 1.74; 95% confidence interval, 1.14-2.65; P = .01). Firearm injury is independently associated with amputation and mortality compared with nonfirearm injuries for lower extremity injuries requiring vascular repair. These data can continue to guide public health discussions about morbidity and mortality from firearm injury.