Gunshot Wounds Research Articles

025. Brain Corpal Evacuation Caused by Air Gun: Management and Surgical Approach Evacuation with Neuronavigation Guiding

Background: In Indonesia, cases of injury from airgun are relatively common and do not immediately result in death because the projectile velocity of airgun is slower compared to the gunshot. Consequently, if the pellet hits the brain (brain injury), it may cause the patient to live with disabilities or infection problems due to the non-sterile of the airgun pellet. Surgical procedures often difficulties in determining the location of the pellet or foreign body, especially if the pellet of air gun penetrates to the contralateral side of the entry point. Neuronavigation is a modern system in neurosurgery that helps surgeons precisely locate targets with minimal disruption to critical brain and spinal structures. This allows for more precise and easier pellet evacuation. Report a patient who had a gunshot wound with the bullet entering from the left parietal region and penetrating through to the right parietal surface of the head, managed comprehensively with neuronavigation guidance. Case: A 5-year-old female patient presented to the emergency department with an open wound on the left parietal region of the head. Her Glasgow Coma Scale score was 8 (GCS: Eye: 2, Verbal: 2, Motor: 4), indicating a sedated state. Initial and specific treatments were administered to prevent deterioration and improve the patient’s prognosis. Surgical management, using neuronavigation guidance, was employed to determine the exact location of the foreign body. The procedure included debridement of the entry point in the parietal region and evacuation of the foreign body using neuronavigation guidance. Conclusion: Early management of gunshot injuries is crucial for improving prognosis. Neuronavigation guidance proved effective, and minimally invasive neurosurgical techniques may be a safe option for treating traumatic brain injuries caused by gunshots. This approach facilitates easier, faster, and more precise incision and evacuation of foreign bodies.

Treatment outcomes of retained bullet injuries to thoracoabdominal area: Insights from a single-center experience from Yemen

Treatment outcomes of retained bullet injuries to thoracoabdominal area: Insights from a single-center experience from Yemen

Do Children With Accidental Gunshot-related Fractures Experience Greater Risk of Mental Illness and Psychiatric Disorders? A Propensity-matched Study.

Firearm violence is the leading cause of death and is a major source of morbidity for children in the United States. While gunshot wounds (GSWs) are known to cause lasting psychological repercussions beyond physical injury, these effects are not well documented compared with the physical implications. Our study explores the association between accidental gunshot-related fractures in children and subsequent psychiatric outcomes. Relative to non-GSW-related fractures, do children sustaining an accidental GSW-related fracture experience higher risk of mental illness and psychiatric disorders? This study utilized the TriNetX US Collaborative Network as it provides comprehensive inpatient and outpatient data, longitudinal follow-up, and complete medical records across different facilities, closely reflecting real-world patient outcomes in orthopaedic practice. We retrospectively evaluated children diagnosed with an accidental GSW-related fracture and compared mental health diagnoses to children who experienced non-GSW-related fractures. Between January 1, 2003, and March 1, 2023, a total of 5071 children in the United States without preexisting anxiety, mood, psychotic, substance use, or insomnia disorders were reported to have experienced an accidental GSW-related fracture. Among these patients, 55% (2773) had a follow-up period of at least 1 year and met the inclusion criteria for the exposure cohort. In the non-GSW-related fracture cohort, a total of 61% (985,070) of children among 1,613,891 without the preexisting aforementioned conditions had a minimum follow-up period of 1 year and met the inclusion criteria. A total of 2769 children were successfully matched in each cohort using a greedy nearest neighbor propensity score-matching algorithm. Matching was based on age, gender, race, fracture location, and BMI, as these characteristics were identified through a regression analysis as potentially associated with psychiatric outcomes (p < 0.01). The mean ± SD age was 15 ± 4 years, and 16% (451) in the GSW cohort were girls. In the non-GSW cohort 17% (474) were girls. With respect to race and ethnicity, 62% (1709 in the GSW cohort; 1679 in the non-GSW cohort) were Black and 14% (384 in the GSW cohort; 386 in the non-GSW cohort) were Hispanic. Outcomes of interest were recorded for up to 3 years after the index event. The accidental GSW-related fracture cohort experienced a greater hazard of developing anxiety disorders (HR 3.8 [95% confidence interval (CI) 3.2 to 4.6]; p < 0.001), substance use disorders (HR 3.6 [95% CI 3.0 to 4.2]; p < 0.001), mood disorders (HR 2.4 [95% CI 1.9 to 3.1]; p < 0.001), non-mood psychotic disorders (HR 2.4 [95% CI 1.5 to 3.9]; p < 0.001), and insomnia (HR 1.8 [95% CI 1.4 to 2.3]; p < 0.001). Orthopaedic surgeons should implement early psychiatric screenings and integrate mental health support for children with gunshot-related fractures to address elevated risk of anxiety disorders, psychotic disorders, mood disorders, substance abuse, and insomnia. Future studies should focus on identifying effective interventions that mitigate these long-term psychological outcomes, with an emphasis on practical, targeted approaches in clinical care. Level III, prognostic study.

Oliguria caused by dehydration in combat trauma (case series)

Background. A combat gunshot wound is significantly different from a civilian trauma. It is characterized by the prevalence of penetrating injuries, which increases the volume of blood loss at the pre-hospital stage, and the destruction of large masses of muscle tissue (rhabdomyolysis), which leads to acute kidney injury. Moreover, combat trauma occurs in conditions of chronic background stress as a result of severe emotional and physical strain, uncomfortable weather conditions, and deprivation of sleep, drinking and food. So, such a phenomenon as voluntary dehydration is common among soldiers in combat conditions. In wounded, oliguria is often considered a result of acute kidney injury, but it can also be a symptom of severe dehydration. The purpose of our work was to analyze three clinical cases of oliguria caused by dehydration in wounded with combat trauma to better understand the severity of the condition of such victims and to improve medical aid for them. Materials and methods. The article describes three cases of men aged 35, 50 and 44 years with combat gunshot wounds to the extremities, who were admitted to the tertiary care hospital on the second day after the injury with oliguria (0.18–0.19 ml/kg/hr) and high creatinine (333 to 457 μmol/L). Results. All three patients were conscious, breathing spontaneously, had stable hemodynamics, and moderate anemia after pre-hospital blood transfusions. Focused ultrasound study revealed hyperdynamic left ventricle and small inferior vena cava with complete inspiratory collapse, which suggested hypovolemia. Upon further investigation of the medical history, patients admitted not drinking any liquid for one to two days prior to injury. Tissue hydrophilicity test was conducted which showed severe dehydration in all three cases. Infusion volume was calculated using P.I. Shelestiuk nomogram (modified by O.V. Kravets et al.) and amounted to 60 ml/kg of balanced crystalloid solutions. Upon starting rehydration, diuresis was restored within two hours and amounted to 0.7–2.1 ml/kg/h in all three patients. Creatinine levels normalized in 2–4 days. Patients were transferred to another hospital in a moderate condition in 4–5 days. Conclusions. Oliguria is a frequent complication of combat gunshot injury. Although it is most often associated with acute kidney injury from rhabdomyolysis, it should also be considered that in a combat environment, soldiers’ access to water may be limited and the injury may be accompanied by dehydration. In the cases presented, the differential diagnosis of the causes of oliguria in the wounded made it possible to detect signs of severe dehydration, abstain from the inappropriate use of saluretics, quickly compensate for the fluid deficit, and to avoid the development of kidney damage and the need for renal replacement therapy.

BEFORE THE ORIGIN OF CLINICAL «MASKS» OF THORACIC AND PELVIC TRAUMA OF SHOOTING ORIGIN

Abstract. The imperialist war waged by rusism in Ukraine is aimed at the destruction of the state and its people. Consequently, it (rusism) does not hesitate to act on the front lines and towards the civilian population in the rear. To achieve this goal, invaders employ not only powerful weaponry but also those prohibited by the international community (bullets with displaced center of gravity, etc.). Relevance of the problem. Due to this, predicting the course of injuries in such conditions is impossible, and each observation is of paramount importance, defining the relevance of the issue. Objective. To share the features of diagnosing certain gunshot injuries and the origin of the brachial plexus syndrome. Materials and Methods. Two civilian trauma cases with particular and fortunate outcomes were under our observation. In the diagnostic process, besides standard methods, all radiological ones were applied, aiding in understanding the peculiarities of the injuries. Results. In the thoracic patient, due to the change in bullet trajectory, it passed subcutaneously from the right lumbar region into the left pleural cavity, damaging the diaphragm and lung. In the «urological» patient, a bullet from the gluteal region lodged subcutaneously beneath the pubic bone. Conclusions. Damage to the diaphragmatic nerve in various areas can lead to manifestations of traumatic brachial plexus syndrome in conditions of warfare.

Trends in changing the structure of anesthesia at the advanced stages of medical care in modern armed conflict

The objective was to analyze the structure of anesthesia provided to the wounded at the advanced stages of medical care in the active phase of hostilities.Materials and methods. A retrospective analysis of the medical data of anesthesia was performed. The data on the structure of anesthesia in military medical organizations of 1–3 levels in the zone of a special military operation for the period from 01.2023 to 07.2024 were analyzed.Results. In the structure of combat trauma, with the need for surgical intervention, gunshot wounds amounted to 85.2%, there was a predominance of combined (71.5%) and multiple (19.8%) wounds.The low proportion of combined general anesthesia and the lack of use of inhalation anesthesia at some stages is explained by the special conditions of care. Regional anesthesia (RA), including as part of combined anesthesia, in the structure of anesthesia at the stages of emergency specialized surgical care amounted to 34.5%, and at the stages of qualified surgical care – 25.4%. The lowest rates of RA use were at the stages of level 1, as well as at the stages of level 2 with a 100% flow of primary wounded.Conclusion. RA occupies a significant share in the structure of anesthesia at the military stages of medical evacuation; an increase in the frequency of its use is possible due to the introduction of ultrasonic navigation.

ULTRASOUND IMAGING OF COMLICATIONS IN COMBAT CHEST TRAUMA

Abstract. Objective. The aim is to evaluate the effectiveness of ultrasound diagnostics in combat chest trauma at the stage of specialized surgical care. Materials and Methods: 53 cases of complications from combat chest trauma were analyzed during patient evacuation at the stage of specialized surgical care to assess the specificity, accuracy, and sensitivity of the ultrasound method for early detection of complications and to guide further treatment tactics. Results. The ultrasound diagnostic method has advantages in detecting complications of gunshot wounds to the chest, not only during the qualified medical care stages but also where continuous monitoring of these complications is required during further medical evacuation and treatment strategy selection. Conclusions.Therefore, the monitoring of chest trauma complications should be informative at all stages of medical care, accessible, and effective in determining the subsequent treatment strategy.

CONCEPTUAL APPROACHES TO THE DIAGNOSIS AND TREATMENT OF PENETRATING GUNSHOT WOUNDS OF THE ABDOMEN WITH DAMAGE TO THE PANCREAS

Summary. The goal is to determine the main directions of the concept of diagnosis and treatment of penetrating gunshot wounds of the abdomen with damage to the pancreas. Materials and methods. A retrospective analysis of the medical records of inpatient patients treated in the VMC of the Northern region, who received combat trauma of the pancreas during the war in Ukraine, was conducted. All the wounded were examined, complaints, medical history were studied, general clinical blood and urine tests were performed, biochemical analysis of blood and abdominal secretions, ultrasound examination of the abdomen and pleural cavity, radiographic examinations of the chest and abdomen, multispiral computed tomography of the chest and abdomen with contrast and without, video endoscopic methods, X-ray spectral and X-ray structural analysis of secretions from the abdomen and pancreatic tissues, electron microscopy, world microscopy, immunohistochemistry, mathematical and statistical methods. The results. The diagnostic component of the concept is implemented through the study of complaint data, anamnesis, local examination, laboratory, instrumental, hardware, histological and immunohistochemical studies. The therapeutic component, which combines conservative and operative measures depending on the patient’s geodynamic stability, is aimed at correcting hemodynamic disorders and influencing the four directions of the conceptual model of treatment of penetrating gunshot wounds to the abdomen with pancreatic damage. It is mandatory to study the foreign bodies of firearm origin that injured the pancreas and the possibilities of modern magnetic surgical instruments for the removal of ferromagnetic foreign bodies. The examination and control of treatment carried out covers research at the atomic and molecular level, at the subcellular level, at the cellular and tissue level, at the organ and clinical levels. All these studies are implemented within the framework of clinical and experimental research design with data analysis using mathematical and statistical methods. Conclusions. Conceptual approaches to the diagnosis and treatment of penetrating gunshot wounds to the abdomen with damage to the pancreas are based on a systematic analysis. The conceptual model is based on the following areas: localization of pancreatic injury, presence or absence of pancreatic duct injury, severity of pancreatic injury according to AAST, presence of combined injuries to other organs.

A 14-Year-Old Child with Craniofacial Injuries Caused by Traumatic Gunshot

Ballistic trauma is an injury resulting from the impact of a projectile on the body. Gunshot wounds to the head are among the most lethal. Although they were rare in civilian practice, their incidence has increased in recent years in the civilian population due to the resurgence of armed conflicts and terrorism. Severe firearm-related head injuries in children are very rare and poorly studied; they are most often due to suicide attempts. CT is the imaging modality of choice. It aids in initial management, monitors progression. We present the case of a 14-year-old child admitted for a gunshot injury. The patient was initially hospitalized in the intensive care unit before undergoing initial imaging in our department.

Low-Velocity Ballistic Trauma–Related Upper Extremity Nerve Injury: A Systematic Review and Meta-Analysis

Purpose: Optimal management of upper extremity nerve palsy caused by low-velocity ballistic trauma (LBT) remains controversial. The aim of this systematic review was to summarize the available evidence on the management of nerve injuries caused by LBT to the upper extremity. Methods: A literature search was completed for the keywords “Upper extremity,” “Nerve Injury,” and “Ballistic.” 2 independent reviewers conducted a systematic screening of all articles and collected data from relevant publications. The data were summarized and pooled using a random-effect model. Results: 14 studies met inclusion criteria. Cohorts between 6 and 168 patients (n = 848) with upper extremity LBT were reported. Neurologic deficits were present in 45% (95% CI: 38 to 52%) of patients at the time of injury evaluation. Nerve exploration was done in 50% (95% CI: 27 to 73%) of these patients with neurologic deficits. Early nerve exploration was done in 19% (95% CI: 9 to 32%) of all patients. Surgical findings included nerve continuity (49%; 95% CI: 14 to 84%), nerve contusion (30%; 95% CI: 12 to 50%), and nerve transection (31%; 95% CI: 14 to 50%). Nerve transection rates found at the time of exploration ranged from 0 to 71% (mean 31%). Outcomes were good in 62% (95% CI: 41 to 81%); however, analyses were limited by subjective outcome reporting of the studies. Conclusions: Contrary to historical teaching that LBT causes neurapraxia, this review identified that 31% of resulting nerve injuries were neurotmesis (transections). These results advocate for systematic clinical follow-up and appropriately timed nerve intervention (within 3 to 6 months of injury) when neurologic deficits persist after ballistic injury. Level of evidence: Level III

Treatment Outcomes of Total Hip Arthroplasty Following Hip Joint Gunshot and Shell Fragment Injuries: Insights From a Single-Center Retrospective Study in Yemen

Treatment Outcomes of Total Hip Arthroplasty Following Hip Joint Gunshot and Shell Fragment Injuries: Insights From a Single-Center Retrospective Study in Yemen

Pseudoaneurysm of the Lingual Artery in a Patient With Facial Trauma From Gunshot Wounds

A pseudoaneurysm is an abnormal dilatation within the wall of a blood vessel due to the formation of a hematoma in the vessel wall after vessel injury. Because of the protective nature of the facial skeleton and the deep location of the lingual artery, the lingual artery pseudoaneurysm is rare. The authors report a case of a 20-year-old male who suffered multiple gunshot wounds, including to the mouth, presenting with immediate life-threatening injuries. On hospital day 1, otolaryngology performed debridement of the mandible, retrieval and removal of bullet fragments, intermaxillary fixation, external fixation of the mandible, intra-oral laceration repair, repair of tongue laceration, and tracheotomy revision. On postoperative day 15, the otolaryngology service was called for the abrupt onset of major oral cavity bleeding. computed tomography-angiogram detected a pseudoaneurysm of the lingual artery and was successfully treated with endovascular coil embolization.

Performing magnetic resonance imaging in patients with gunshot wounds: a guide for radiologists

INTRODUCTION: The safety of magnetic resonance imaging (MRI) in patients with metallic foreign bodies is an important aspect that has been the subject of many scientific papers and guidelines. The issue of MRI in patients with implanted medical devices is well researched. However, for gunshot wounds, there are no clear guidelines for practitioners, and most recommendations are to refuse to perform the study if there is the slightest doubt about its safety.OBJECTIVE: To systematize information on the safety and quality of MRI in patients with gunshot wounds and to develop practical guidelines for radiologists.MATERIALS AND METHODS: We have analyzed and summarized the main domestic and foreign recommendations for ensuring safety during MRI, generally accepted classifications and mechanisms of gunshot wounds.RESULTS: A review of physical risk factors in MRI, their causes, and recommendations for their minimization is presented. The influence of metallic objects on the appearance of artefacts on MRI images is considered. The algorithm of decision making on the safety of MRI in a patient with a bullet or shotgun wound is given. Two clinical observations are presented to illustrate the application of this algorithm.CONCLUSION: Performing MRI in gunshot wounds is feasible but requires careful analysis of the risks and the importance of diagnostic information. Interviewing the patient in these situations is often uninformative, so radiography or CT are the methods of choice for detection of metallic foreign bodies. To minimize the risks of MRI, a scan protocol should be prepared in advance and the patient should be monitored after each pulse sequence.

Pathological Changes and Sodium Rhodizonate Test as Tools for Investigating Gunshot Wounds in Veterinary Forensic Pathology.

Gunshot wound morphology and gunshot residues (GSRs) evaluation have been poorly investigated in veterinary forensic pathology. The aims of the present study were to assess the gunshot wound morphology in animals and evaluate the detectability of lead deriving from GSRs using colorimetric techniques. To these aims, cadavers were divided into four different groups. Group A comprised eight animals who died from firearm-related injuries, while groups B and C included dog limbs shot using different shooting ranges; group D comprised dog limbs stabbed with a screwdriver. Morphological analysis was performed on all entry gunshot wounds. Lead residues were investigated using a Bullet Hole Testing Kit (BTK) and Rhodizonate Sodium histochemical staining (NaR-s). Gunshot wounds in group A showed an abrasion ring associated with hemorrhages and tissue necrosis. Groups B and C showed injuries related to the shooting range. NaR-s showed positive results in both animals that died from gunshot wounds and experimentally shot limbs. However, the number of positive cases and the pattern of lead distribution varied with the shooting range. Positive results by BTK were limited to close-contact shots in group B limbs. Our results suggest that both pathological examination and NaR tests represent valid tools for investigating gunshot wounds in veterinary pathology.

Intraoral gunshot injury associated with soot in the deep airways

In suicidal gunshots to the head, the oral cavity ranks among the preferred entrance sites. If the weapon’s muzzle end is located within the mouth, it is to be expected that the cartridge discharge residues are deposited on the buccal and palatal mucosa, the tongue and the pharynx, often in combination with tears of the lips due to the expanding combustion gases. Ensuing from the bullet entrance wound and any concomitant injuries, blood is released into the upper airways and subsequently aspirated into the lung periphery provided that respiration continues for at least a short time. Evidently, this impedes the detection of additional soot deposits in the trachea, bronchi and alveoli. Using the example of an intraoral gunshot with a revolver cal. 357 Magnum, the paper points out that in individual cases it may be possible to prove the presence of gunshot residues in the deep airways.

Analysis of Early Surgical Treatment of Incorrectly Consolidated Gunshot Fractures of the Scapula

Objective. The objective of our study was to analyze the structure of incorrectly consolidated gunshot fractures of the scapula and early outcomes of surgical treatment. Material and Methods. We analyzed 10 cases of incorrectly consolidated gunshot fractures of the scapula in Ukrainian Armed Forces servicemen, received as a result of combat operations, and early outcomes of surgical treatment. The main indications for surgical treatment were as follows: severe impairment of function of the upper limb due to pain, fractures of the articular surface of the scapula with displacement of fragments over 2 mm, fractures of the acromion with displacement of more than 8 mm, and damages to muscles and skin. In addition to radiography in standard projections, preoperative examination included computed tomography (CT). Evaluation of functional outcomes was carried out within 1 to 4 months according to the Oxford Shoulder Score (OSS) scale. The average period of postoperative survey was 2.6 months. Results. Incorrect consolidation of fractures was caused by a long period of preoperative preparation and conservative treatment of wounds in patients due to openness and infection of bullet wounds in 2 patients and shrapnel wounds because of mortar, artillery, tank and rocket attacks in 8 patients. Staged treatment until wound healing was carried out in hospitals and military hospitals of Ukraine using VAC (Vacuum-Assisted Closure) devices. Four cases were right-sided and six were left-sided; 7 of 10 cases were intra-articular fractures with displacement of fragments of the articular surface by 2 mm or more. The average duration of injury at the time of surgery was 4.2 months (range from 2 to 8 months). In addition to eliminating displacements and deformities of incorrectly consolidated fractures and osteosynthesis of fragments, the treatment included replacing the soft tissue defect of the shoulder and shoulder girdle with a non-free thoracodorsal musculocutaneous flap on a neurovascular pedicle in 3 of 10 patients. Seven patients had an isolated wound to the scapula area. Three of 10 patients had a combined wound to the scapula with a defect of the humeral head, upper third of the humerus, and acromial end of the clavicle. These patients underwent implantation of an articulating spacer, restoration of the configuration of the proximal end of the humerus, and reconstruction of the rotator muscles to make possible the shoulder joint arthroplasty. The average value according to the results of a survey of patients on the OSS scale was 20.2 (±4.39) points before surgery and 34.1 (±7.56) points after surgery, which can be considered a good result according to the OSS scoring system. Conclusions. The analysis of the early outcomes showed that reconstructive treatment of gunshot old fractures of the scapula creates biomechanical prerequisites for restoring the function of the upper limb, reduces pain syndrome, and allows for active postoperative rehabilitation.

Simultaneous Coronoid Bone Grafting in Ballistic Facial Trauma Patients Undergoing Coronoidectomy.

Ballistic facial trauma can cause complex fractures and overlying soft tissue damage, with a zone of injury that extends beyond the bullet tract. Early skeletal fixation is indicated, and previous large case series describe the use of debrided bone fragments as 'spare part' grafts. This series presents the indications and techniques for simultaneous coronoid bone grafting in 2 patients who sustained a gunshot wound to the right midface and required coronoidectomy. The coronoid process was used as (1) an interposition graft in the lateral buttress of the right maxilla for stability, and (2) an onlay graft on the right inferior orbital rim for contour. Both patients did not have graft infection, extrusion, or malposition at the 1-month clinic follow-up. The coronoid process of the mandible is a viable, safe spare-part option, despite the possible location of the coronoid process within the zone of injury in the reconstruction of complex ballistic facial trauma.

Arc-like curvilinear bullet pathways along inner surface of skull - two cases.

To provide example cases within the peer-reviewed literature of a phenomenon related to certain gunshot wounds of the head where the bullet pathway courses along the inner table of the skull. Presentation of two cases discovered at medicolegal autopsy. The two cases provide radiologic and autopsy demonstration of bullet pathways within the head where the projectiles track along the inner aspect of the cranium, in a circumferential manner, such that the bullets are recovered in a location on the opposite side of the brain/head, with no projectile pathway within the intervening deep structures of the brain. The cases provide photographic and radiologic autopsy documentation of the phenomenon, which is described in forensic pathology textbooks and rare peer-reviewed literature sources, but without photographic demonstration. Recognition of this phenomenon in the clinical setting, or when correlating autopsy external and radiologic findings with historical information, may provide an explanation for situations where immediate incapacitation does not occur following a gunshot wound of the head.

Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children

IntroductionIn stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients. MethodsThe American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (<18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission. Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) < 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries. ResultsAmong 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < .01). There was higher use of LAP at pediatric centers (p < .01). Although there was no difference in mortality or complications by operative type, open patients were more severely injured, had a longer LOS (p < .01), and had more subsequent procedures (11% of open, 2 % LAP, 7% LCO, p < .01). ConclusionIn stable children with penetrating abdominal trauma, LAP is most often utilized after stabbing and at pediatric trauma centers, but its overall use remains uncommon. LAP patients had lower rates of subsequent procedures and no increase in unexpected operations suggesting low rates of missed injuries. Criteria are needed to identify stable patients presenting after penetrating trauma who can benefit from a LAP approach. Level of EvidenceIII.

Air Rescue Missions for Suicide: A Retrospective Analysis of a 12-Year Period From a German Rescue Helicopter Base

ObjectiveTypical reasons for calling the rescue helicopter are medical emergencies, such as heart disease, trauma, and neurologic emergencies. However, there are also a small number of patients with attempted or completed suicide. The aim of this article was a general analysis and evaluation of the specific circumstances of emergencies related to suicide or attempted suicide in the prehospital environment involving the rescue helicopter (helicopter emergency medical services) Christoph 38 of the DRF Stiftung Luftrettung gAG based in Dresden, Germany. MethodsThe data of all emergency interventions performed by the helicopter emergency medical services in Dresden, Germany, between January 1, 2008, and December 31, 2020, were analyzed by examining the DIVI rescue protocols and electronic data (MEDAT and HEMSDER (Convexis, Germany)) with regard to suicide-related variables. The time, methods and information about the reason, sociodemographic data, and results of medical treatment were recorded and retrospectively analyzed. ResultsThere were a total of 17,754 emergencies during the study period. Of these, 277 cases (1.56%) were due to suicide. The average time for the emergency services to arrive at the scene of the emergency was 11.14 minutes. There were 52 patients with a completed suicide, 183 with a suicide attempt, and 42 patients with a suicide threat. Eleven were pronounced dead before or at the time of arrival of the emergency doctor. Of the 241 patients who were still alive when the emergency physician arrived, 101 were endotracheally intubated and mechanically ventilated, and 25 patients received cardiopulmonary resuscitation. In 19.57% of the patients, health problems were noted as the primary reason for attempted/completed suicide. In a further 12.68%, partnership problems or the loss of a partner were cited. The most common method used was an overdose (49.39%) followed by leaping from a great height (20%) and hanging (15.51%). Stab wounds and gunshot wounds were observed in 24% of the cases. The overall mortality rate was 18.77%. The method used, sex, and a suicide note were identified as possible influencing factors for the fatal outcome of a suicide. ConclusionThe number of suicide victims is low compared with the total number of 17,754 deployments. However, the mortality rate for these missions is quite high at 18%. Although some factors and circumstances could be identified in this study, many backgrounds and explanations are still missing. Therefore, this study shows a general need for more research in regard to better prevention as well as improved education and training of emergency response teams.