Gunshot Wounds Research Articles

Bundling Procedures in Critically Ill Trauma Patients: Should It Be Done?

The precautions brought on by the COVID-19 pandemic led to the growing practice of bundling lines in patients requiring intubation. Our study aims to examine the effect of immediate bundled lines (IBL) on traumatic injuries. We hypothesized that severely injured patients may benefit from IBL. A retrospective review of all intubated trauma patients (1/2015-12/2020) at a Level I Trauma Center was conducted. Patients ≤18 years and those who died or were transferred prior to intensive care unit (ICU) admission were excluded. IBL was defined as placement of central venous catheter (CVC) and arterial line (AL) ≤4 hours after intubation. Delayed lines were any lines placed >4 hours after intubation. Primary outcome was time from intubation to CVC and AL. 728 patients were included. The majority received CVC and/or AL with 17.7% in a delayed fashion. Severe head injury (AIS ≥3) most often had immediate AL or delayed bundled lines (P < 0.001). IBL were more common with gunshot wounds (GSW) (P < 0.001) and blood transfusions (P < 0.001). IBL were associated with significantly lower GCS (P = 0.018) and higher median ISS. Multivariate logistic regression revealed severe/profound ISS, GSW, and pedestrian struck were predictive of IBL. Intubated trauma patients who presented with certain mechanisms (GSW, pedestrian struck), received blood transfusions, or exhibited severe/profound ISS may be more likely to receive IBL. IBL is not superior to either immediate AL or to no lines in terms of mortality. No lines had a significant effect on ICU LOS or hospital LOS, except in the setting of severe head injury.

Silent witnesses: unveiling the epidemic of femicides in North-west Tshwane, South Africa – a decade of analysis

BackgroundFemicides, defined as the gender-based killing of women, are a pressing public health issue worldwide, with South Africa experiencing some of the highest rates globally. This study focuses on the North-west region of Tshwane, particularly the Garankuwa area, aiming to address gaps in understanding the epidemiology, demographics, circumstances, and pathology associated with femicides. The Garankuwa mortuary serves as the primary site for this investigation, providing a detailed analysis over a ten-year period, shedding light on contributing risk factors in the context of systemic gender inequality.ObjectivesThe study had four main objectives: to analyse the demographics and incidence rates of femicides in the North-west Tshwane area, to examine the circumstances surrounding femicides (including the time, location, and demographic risk factors), to identify the causes and pathological characteristics of femicides; and to observe trends in femicide rates over the ten-year study period.MethodsThis study was a retrospective cross-sectional descriptive analysis, focusing on all deceased females admitted to the Garankuwa mortuary from 2009 to 2018. The inclusion criteria comprised female cases at autopsy, with a suspected homicidal manner of death. Excluded were cases classified as suicides, accidents, or natural deaths after further examination. Data was collected through the National Injury Mortality Surveillance System (NIMSS) and cross-verified with post-mortem reports, police data and death registers.ResultsOver the ten-year period, the Garankuwa mortuary admitted an annual average of 1131 bodies, with approximately 23.5% (266) being female. Of these, 17.5% were identified as femicides. The average incidence rate of femicides was 11.2 per 100,000 female population, showing a general decline over the study period, except for notable increases in 2013 and 2016. The study found that the most common months for femicides were September and December, with most incidents occurring at home, followed by residential areas and medical facilities. The geographic analysis identified Temba, Rietgat, and Akasia as the areas with the highest number of femicide cases. Demographically, the majority of femicide victims were black, with the most affected age group being 18–39 years. The leading causes of death were gunshot wounds, sharp force injuries and blunt force trauma, with significant incidences of strangulation and asphyxial deaths, primarily affecting the neck and head regions.ConclusionThis study highlights the high incidence and distinct characteristics of femicides in the North-west Tshwane area, underscoring the role of socio-economic disparities and racial demographics. The findings emphasize the necessity for targeted prevention programs, stricter firearm control measures, and community-based violence prevention strategies. The demographic data indicate that young black women are particularly vulnerable, necessitating protective and educational initiatives tailored to this group.

Caught in the Crossfire: A Single Institution's 10-Year Experience with Pediatric Firearm Injury.

Pediatric firearm-related injuries are now the leading cause of death among children in the United States. We sought to characterize the experience of a large free-standing children's hospital treating children with firearm injuries. We reviewed all 2012-2022 gunshot wound encounters using the institutional trauma database of an urban Level 1 pediatric trauma center in Texas. Patient demographics, incident characteristics, and clinical outcomes were analyzed. Statistical analysis was performed using ANOVA and chi-square tests to evaluate the influence of socioeconomic factors. Injuries from recreational firearms like BB and pellet guns were excluded from this analysis. Two hundred eleven pediatric patients were treated for gunshot wounds during the study period. There was an upward trend in the number of injuries per year, ranging from 6 in 2012 to 39 in 2021. The average patient age was 10.2 years. Violent injuries accounted for 51.7%, while accidental injuries led to 44.1%, and self-inflicted injuries made up 4.3%. Based on the Child Opportunity Index. 63.0% of patients lived in neighborhoods in the lowest opportunity quartile, while only 2.8% of patients lived in neighborhoods in the highest opportunity quartile. 22.7% of patients sustained injuries characterized as "major trauma," as indicated by an Injury Severity Score of >15, and 8.5% of patients died. Firearms pose a substantial risk to children in the United States. There has been an increasing trend in pediatric firearm injuries over the last decade. The majority of children treated for firearm injury at our institution sustained injuries in the setting of gun violence. Injury prevention efforts should be aimed at decreasing intentional pediatric firearm injuries.

Ultrasound diagnosis of firearm damage to major arteries of the neck

Background. The presence of large vessels, many vital structures, and the lack of protection make the neck particularly vulnerable to various injuries, including gunshot wounds. The purpose was to evaluate the possibilities of ultrasonography in the diagnosis of gunshot injuries of the major arteries of the neck. Materials and methods. The analysis of the ultrasonography results in diagnosis of gunshot injuries to the large vessels of the neck in 53 injured persons was carried out. Visualization of the large vessels of the neck was carried out using linear and microconvex sensors in the frequency range of 5–10 and 4–9 MHz on the Philips HD11 device. Results. Damage to the common carotid artery was recorded in 38 cases, the internal carotid artery — in 23, the external carotid artery — in 21, the subclavian artery — in 24, the vertebral artery — in 15. The following types of damage were detected: intimal tear with flap formation in 27 cases, detachment of the intima in 45, pseudoaneurysm in 49 cases. A statistically significant difference (P &lt; 0.01) was found between the number of pseudoaneurysms and intimal tear with flap formation (P &lt; 0.01). Among injuries of the common carotid artery, pseudoaneurysm occurred significantly more often than intimal tear with flap formation (P &lt; 0.01) and intimal detachment (P &lt; 0.05). Damage to the common carotid artery was diagnosed statistically significantly more often than to the internal carotid artery (P &lt; 0.05) and external carotid artery (P &lt; 0.01), subclavian artery (P &lt; 0.05), and vertebral artery (P &lt; 0.001). Conclusions. Ultrasonography makes it possible to detect damage to all major arteries of the neck sustained due to combat trauma. Pseudoaneurysms statistically reliably prevail over intimal tear with flap formation and cervical artery dissection. Ultrasonography has sufficient sensitivity (87.8 %), specificity (60.9 %) and accuracy (82.6 %) in the diagnosis of gunshot injuries of the major arteries of the neck, as well as pseudoaneurysm (93, 75, 90.2 %, respectively).

Experience of surgical treatment of combat pancreatic trauma

Background. Pancreatic injuries is a complex challenge for trauma surgeons, especially if combat, due to the presence of combined injuries and complications. The aim: to provide a structure, peculiarities of diagnosis and treatment of combat pancreatic trauma. Materials and methods. A retrospective analysis was done of medical records of 58 inpatients who sustained combat pancreatic trauma during the war in Ukraine. Their average age was 37.4 ± 3.6 years (range 21–60 years). The mechanism of combat injury included gunshot wounds (87.9 %), explosive (10.3 %) and closed injuries (1.7 %). All the wounded underwent laboratory and instrumental investigations. Results. According to the nature of the combat injury, pancreatic injuries were categorised into gunshot shrapnel wounds — 50 (86.2 %), gunshot bullet wounds — 1 (1.7 %), explosive trauma — 6 (10.3 %), and closed combat trauma — 1 (1.7 %) case. Distribution by location of pancreatic injury: tail — 38 (65.5 %), head — 11 (19 %), body — 5 (8.6 %), body and tail — 2 (3.4 %), head and tail — 2 (3.4 %) cases. The following methods of surgical intervention were used: damage control surgery (DCS) — 51 (87.9 %) cases, one-stage surgery — 7 (12.1 %) cases. Distribution by the type of surgical intervention for pancreatic injury: drainage of the parapancreatic space — 45 (77.6 %), pancreatorrhaphy — 4 (6.9 %), distal pancreatosplenectomy — 3 (5.2 %), removal of foreign bodies (metal fragments) — 3 (5.2 %), distal resection of the pancreas with spleen preservation — 1 (1.7 %), pancreatoduodenectomy — 1 (1.7 %), subtotal resection of the body and tail of the pancreas with splenectomy — 1 (1.7 %) case. Common complications (n = 42): peritonitis — 9 (21.4 %), acute surgical sepsis — 8 (19 %), acute renal failure — 7 (16.7 %), multiple organ failure syndrome — 7 (16.7 %), pneumonia — 6 (14.3 %), bleeding — 4 (9.5 %), pulmonary embolism — 1 (2.4 %). Organ-specific complications (n = 28) were as follows: acute pancreatitis — 21 (75 %), pancreatic fistula — 4 (14.3 %), pseudocysts — 2 (7.1 %), abscess — 1 (3.6 %) case. Treatment outcomes: 33 patients (56.9 %) were transferred to the next stage of treatment, 19 (32.8 %) died, and 6 (10.3 %) were discharged with a definite outcome. Mortality rate: 5 (26.3 %) died in the first 3 days, 14 (73.7 %) cases died in the period from 4 to 15 days. Conclusions. The incidence of combat pancreatic trauma among abdominal wounds is 8.7 %. Surgical treatment for combat pancreatic trauma using the DCS is performed in 87.9 % of cases, and in the volume of a single-stage operation, in 12.1 %. The DCS leads to a reduction in the incidence of complications. The overall complication rate for combat pancreatic trauma is 72.4 %, and the incidence of organ-specific complications is 48.3 %. Mortality from pancreatic injuries is 32.8 %. Combat trauma to the head of the pancreas was mainly treated with closed drainage. Distal injuries were treated by resection or drainage.

Outcomes of popliteal artery injuries in a level 1 trauma centre: a 6-year review

PurposeTo determine modifiable and non-modifiable factors contributing to limb loss in PAI the relevance and accuracy of published scoring systems for PAI within a South African State hospital.MethodologyRetrospective review of patients (> 18 years) with PAI, presenting to CMJAH trauma unit from 1 January 2017 to 31 December 2022.ResultsSixty-four patient records were analysed. Thirty (46.9%) had blunt trauma and thirty-four (53.1%) had penetrating trauma. Gunshot wounds (GSW) were the most common mechanism of injury (MOI). Blunt PAI had a 40% amputation rate and penetrating trauma, 33.3%. Forty-seven (73.4%) had a delay to surgery of > 6 h. The mean time to arrival at our emergency department was 478 min, and the mean time from arrival to surgery was 368 min (total delay of 838 min). The primary amputation rate was 28.6%, and 63.5% had successful limb salvage surgeries. The secondary amputation rate was 7.8%.ConclusionCompared to international literature, our rate of primary amputation is high (10% vs. 28.8%) and prolonged ischaemia is the likely cause. Only 17 (26.6%) patients presented before 6 h. Of the 45 patients that had an attempt at revascularisation, 7.8% had a secondary amputation. Thus, despite prolonged ischaemia, revascularisation should be attempted in patients with at least two viable compartments on fasciotomy. The MESS and POPSAVEIT scoring systems should not be relied on in patients with delayed presentations. Strengthening referral triage for suspected PAI to Level 1 Trauma centres directly will decrease the delays and likely improve the outcomes.

The use of human tissue surrogates in anatomical modeling for gunshot wounds simulations: an overview about “how to do” experimental terminal ballistics

Human tissue simulating materials are currently used in scientific research mainly because they help to avoid possible ethical issues, unlike what happens with studies involving live animals and/or human cadavers. The use of ballistic gelatin as a human soft tissue surrogate stands out, although other types of materials can be used, including polyurethane and polydimethylsiloxane in the simulation of bones and skin respectively, not to mention some computational models that completely replace the physical use of surrogate models for gunshot wound simulation. The use of human tissue surrogates can be useful in reconstructing the dynamics of a crime scene when important forensic traces cannot be found. In the absence of projectiles but in possession of the possible firearm used in the crime, for example, it is possible to verify whether the weapon in question actually fired the fatal gunshot by comparing the injury found on the victim with the injury produced on the simulant material that best represents the anatomical area impacted, as indicated in the literature. Thus, scientific advances in experimental research in terminal ballistics with tissue surrogates can positively impact applied forensic sciences in the search for better technical assistance to the justice system in solving criminal situations.

Infection Rate and Antibiotic Administration for Urban Low-Energy Gunshot Wounds at an Academic Level 1 Trauma Center.

The purpose of this study was to review rates of infection after civilian ballistic fractures and assess the effect of early antibiotic administration (EAA) on infection rates. This was a retrospective cohort study done at an urban Level 1 Trauma Center. Patients ages 16 years and older with ballistic orthopaedic extremity injuries between May 2018 and December 2020 were enrolled. A total of 827 ballistic fractures were identified, and 371 fractures were analyzed after exclusions. The primary outcome measure was the incidence of infection within 90 days postinjury, correlated with the timing of antibiotic administration. Seventy percent of the extremity injuries received EAA (<3 hours of hospital admission) and 30% did not. Infections occurred in 6.9% of patients with EAA and in 7.3% of those without. We found no notable association between EAA and infection on multivariate logistic regression (odds ratio [OR] 1, 95% Confidence Interval [CI] 0.4 to 2.4, P = 0.99). Compartment syndrome (OR 5.4, 95% CI 1.1 to 26.4, P = 0.04) and surgical treatment of fracture (OR 12.9 95% CI 1.7 to 97.9, P = 0.01) were independently associated with higher odds of infection. We found no notable association between vascular injury or visceral injury and infection. Lower extremity fracture location was markedly associated with infection on multivariate logistic regression (OR 2.8; 95% CI 1 to 7.8; P = 0.05) when compared with upper extremity, hand, and foot locations. The highest infection rate was observed in tibial shaft fractures at 22%. Early antibiotic treatment did not markedly reduce infection odds in civilian low-energy ballistic fractures. The study underscores the need for context-specific, evidence-based treatment strategies. III (retrospective cohort study).

P0669 Safety of intravenous and subcutaneous guselkumab induction administration: Results from the GALAXI and GRAVITI studies in participants with Crohn’s Disease

Abstract Background Guselkumab (GUS) is a dual-acting IL-23 inhibitor that potently neutralizes IL-23 and binds to CD64, a receptor on cells that produce IL-23. Induction with both intravenous (IV) and subcutaneous (SC) GUS was effective in phase 2/3 clinical trials of participants (pts) with moderately to severely active Crohn’s disease (CD). To characterize the safety of GUS IV and SC induction regimens, we evaluated safety data from clinical trials of GUS in CD. Methods We evaluated data from phase 2/3 CD studies with IV induction (GUS 200mg IV q4w in GALAXI 1, 2, and 3) and SC induction (GUS 400mg SCq4w in GRAVITI) to assess rates of safety events (proportions of pts with ≥1 event) during the induction period (Week 0-12). Results During the induction period, rates were not higher in either the IV or the SC groups than the respective placebo (PBO) groups for adverse events (AEs), serious AEs, or AEs leading to discontinuation (Table 1). Serious infections occurred in 1 pt in the GUS IV group and 1 pt in the GUS SC group; neither led to discontinuation of study treatment. No serious infections were reported in PBO-treated pts in either group. Of the 1376 GUS SC injections during the induction period in GRAVITI, 6 (0.4%) were associated with injection site reactions, which included pruritus, erythema, and swelling. Injection site reactions beyond the induction period with GUS SC in GALAXI and GRAVITI remained low (≤1%) and were comparable regardless of induction administration route. No cases of active tuberculosis, anaphylaxis, serum sickness reactions, major adverse cardiovascular events, or venous thromboembolism were reported during the induction period. In the IV induction group, 1 opportunistic infection (esophageal candidiasis) was reported in a PBO-treated pt and 2 were reported in GUS-treated pts (cytomegalovirus infection and esophageal candidiasis). In the SC induction group, 1 opportunistic infection of esophageal candidiasis was reported in a PBO-treated pt and 0 were reported in GUS-treated pts. One malignancy (basal cell carcinoma) not leading to discontinuation was reported in a pt in the GUS 400 mg SC group. One death was attributed to a non-suicidal (not self-inflicted) gunshot wound in a pt treated with GUS SC. Clinically significant hepatic disorders were reported in 2 pts in the GUS 200mg IV group (1 SAE and 1 AE that led to discontinuation) and 1 pt in the GUS 400mg SC group (1 AE that led to discontinuation) during the induction period. All cases were confounded by additional diagnoses or concomitant medications. Conclusion Both IV and SC induction demonstrated comparable safety results consistent with the well-characterized GUS safety profile. No new safety concerns were identified.

In Reply: Comparison of In-Hospital Mortality and Neurosurgical Intervention Between Intracranial Gunshot Wounds Arising from Long Guns and Handguns: A Propensity Score-Matched Study.

In Reply: Comparison of In-Hospital Mortality and Neurosurgical Intervention Between Intracranial Gunshot Wounds Arising from Long Guns and Handguns: A Propensity Score-Matched Study.

Letter: Comparison of In-Hospital Mortality and Neurosurgical Intervention Between Intracranial Gunshot Wounds Arising from Long Guns and Handguns: A Propensity Score Matched Study.

Letter: Comparison of In-Hospital Mortality and Neurosurgical Intervention Between Intracranial Gunshot Wounds Arising from Long Guns and Handguns: A Propensity Score Matched Study.

P0608 Safety of guselkumab in Inflammatory Bowel Disease up to 1 year: Integrated safety analysis of phase 2 and 3 studies in Crohn’s Disease and Ulcerative Colitis

Abstract Background Guselkumab (GUS), a dual-acting IL-23 inhibitor that potently neutralizes IL-23 and binds to CD64 (a receptor on cells that produce IL-23), is currently approved in the United States for treatment of ulcerative colitis (UC) and worldwide for the treatment of plaque psoriasis and psoriatic arthritis. While GUS has been shown to be safe in Crohn’s disease (CD) and UC, safety results have only been reported in individual trials to date. To characterize the overall safety profile of GUS in inflammatory bowel disease (IBD), we evaluated pooled safety data from Phase 2/3 clinical trials of GUS in CD and UC. Methods Participants (pts) with moderately to severely active CD (n=1492; GALAXI 1, 2, and 3, and GRAVITI) or UC (n=1514; QUASAR Induction Study 1, Induction Study 2, and Maintenance Study and VEGA-GUS monotherapy arm only) were assigned to GUS 200 mg intravenous (IV) or 400 mg subcutaneous (SC) induction (GRAVITI only) at Weeks 0, 4, and 8, followed by GUS 100 mg SC every 8 weeks or 200 mg SC every 4 weeks; or placebo (PBO). SC maintenance treatment continued through approximately 1 year. GUS studies were pooled for the induction period (GALAXI, GRAVITI, and QUASAR; IV and SC, Weeks 0-12 [VEGA excluded due to no PBO control]) and through 1 year (GALAXI, GRAVITI, QUASAR, and VEGA). In this pooled analysis, safety events were normalized to 100 pt-years (PY) of follow-up with corresponding confidence intervals. Results Through Week 12, 1703 pts were treated with GUS with 399.9 PY of follow-up. Rates of adverse events (AEs) were similar between pts treated with GUS (200 mg IV or 400 mg SC) and PBO (Figure 1A). AEs occurred at a rate of 202.82/100 PYs and 223.26/100 PY, serious AEs at 11.75/100 PY and 28.56/100 PY, AEs leading to study agent discontinuation at 5.50/100 PY and 16.32/100 PY, and serious infections at 1.50/100 PY and 1.17/100 PY, for GUS and PBO, respectively. Through 1 year, 2057 pts were treated with GUS, with 1752.1 PY of follow-up. Rates of AEs, SAEs, AEs leading to discontinuation, and serious infections, were no higher in GUS-treated than PBO-treated pts (Figure 1B). Through 1 year, no anaphylactic or serum sickness reactions were reported, and rates of malignancy, opportunistic infection, major adverse cardiovascular events, and clinically important hepatic disorders were low (Table 1). In GUS-treated pts, one pt (from an endemic region) reported active tuberculosis, and 2 deaths (acute myocardial infarction in a pt with pre-existing cardiovascular risk factors and non-suicidal gunshot wound, respectively) occurred. Conclusion Through 1 year of treatment, GUS demonstrated a favorable safety profile comparable to placebo in patients with CD and UC. No new safety concerns were identified.

A Decadal Review of Reconstruction of Maxillofacial Gunshot Injuries and the Trajectory Forward

A Decadal Review of Reconstruction of Maxillofacial Gunshot Injuries and the Trajectory Forward

A Medical Miracle: Surviving a Perforating Gunshot Injury to the Neck

A Medical Miracle: Surviving a Perforating Gunshot Injury to the Neck

High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approach

BackgroundOperative mortality for high-grade liver injury (HGLI) remains 42% to 66%, with near-universal mortality after retrohepatic caval injury. The objective of this study was to evaluate mortality and complications of...

Military influences on the evolution of clinical trials throughout history.

Clinical trials of drugs, procedures, and other therapies play a crucial role in advancing medical science by evaluating the safety, efficacy, and optimal use of medical interventions. The design and implementation of these trials have evolved significantly over time, reflecting advancements in medicine, ethics, and methodology. Early historical examples, such as King Nebuchadnezzar II's and his captives' dietary experiment and Ambroise Paré's treatment of gunshot wounds, laid some foundational principles of trial design. The momentum of clinical trial development increased notably with James Lind's 1747 trial for scurvy and continued to progress during World War I with innovations in blood transfusion techniques. World War II (WWII) marked a pivotal moment with breakthroughs in oncology, including the development of the first modern chemotherapeutic agents derived from mustard gas and the introduction of the randomized controlled trial, credited to British epidemiologist Austin Bradford Hill, which revolutionized trial design. More recent conflicts, such as those in Vietnam, Iraq, and Afghanistan, have driven advancements in trauma care, heroin addiction treatment, and hemorrhage management. In response to historical abuses committed by the Nazis during WWII, the evolution of clinical trials has increasingly emphasized ethical standards, particularly informed consent, starting with the Doctors' Trial and the Nuremberg Code. This article discusses how military needs and wartime innovations have shaped modern clinical research, highlighting the interplay between military imperatives and medical progress. Ultimately, clinical trials play an essential role in advancing medical science and improving patient outcomes.

Does Facial Gunshot Wound Location Affect the Need for Airway Intervention?

Does Facial Gunshot Wound Location Affect the Need for Airway Intervention?

Forensic veterinary evaluation of injuries caused by a shot with a smoothbore weapon in domestic dogs

Gunshot injuries in animals are an important subject of forensic veterinary expert opinions. The common occurrence of shootings with hunting weapons in veterinary and forensic practice and the need to determine their cause and effects and to identify the ammunition used, make it necessary to investigate characteristic features of injuries caused by various types of ammunition. This experiment involved shooting research material, i.e. nine carcasses of domestic dogs, with various calibres from distances of 0 m (contact shot), 1.2 m and 10 m. Pellets with diameters of 2.4 mm or 8.45 mm and slugs were used to obtain the full spectrum of injuries that may result from a shot with a smoothbore weapon. Next, colour tests were performed to identify gunshot residues in the area of the wound, as well as imaging tests, i.e. X-ray and CT, necropsy and a histopathological examination of tissues around the entry wound. The results reveal the possibility of extensive injuries to the tissues and bones of victims of gunshot wounds. A thorough analysis of the results of the experiment with projectiles of various calibres indicates that the extent and location of the damage are correlated with the calibre, diameter and bodymass of the pellets, their initial velocity and the distance between the end of the barrel and the object shot.

Temporal Bone Gunshot Wounds: A Multi-institutional Retrospective Study.

To investigate management practices and outcomes in a retrospective cohort of patients who have sustained temporal bone gunshot wounds (TBGSW). Retrospective chart review. Five participating hospitals. Twenty-two patients met inclusion criteria: experienced a TBGSW, survived ≥30 days following the injury, and were evaluated and managed by a neurotologist between 2019 and 2023. No specific interventions were performed for the purposes of this study. Characteristics, evaluation, management, and outcomes of TBGSW survivors. Patients were found to have a mean age of 33 ± 18 years and were predominantly male (18/22, 81.8%). Majority of patients (17/22, 77.3%) had mastoid injury. Most patients (14/22, 63.6%) had some evidence for vascular injury, most frequently the internal carotid artery (9/22, 40.9%). Almost three-quarters (17/22, 77.3%) of patients had clinical exam findings of facial nerve injury, which was the most common indication for surgery. Otologic surgery was performed in 72.7% (16/22), with delayed adverse events most commonly including cholesteatoma and external auditory canal stenosis. Though evidence for hearing impairment was clinically present in at least 15 of 22 patients (68.2%), hearing rehabilitation was pursued in only two patients. With increasing numbers of TBGSW survivors, there is a growing need for practicing neurotologists to be familiar with the wide spectrum of injury patterns and possible complications to inform clinical management in these patients. Early neurotologic assessment and follow-up beyond the acute period is crucial to minimize morbidity in this high-risk cohort.

Unsuccessful Treatment Of Femoropopliteal Pseudoaneurysms Secondary To Gunshot Wounds By Minimally Invasive Strategies

Unsuccessful Treatment Of Femoropopliteal Pseudoaneurysms Secondary To Gunshot Wounds By Minimally Invasive Strategies