Incidence Of Gunshot Wounds Research Articles

Features of pain in patients with gunshot wounds depending on the location of injury at the stages of treatment

The incidence of gunshot wounds during the Anti-Terrorist Operation/Joint Force Operation is 54–70 %. More attention should be paid to the problem of pain treatment in patients with gunshot wounds, because about 70 % have negative treatment outcomes, which leads to pain chronicity. Chronic pain, in turn, is associated with several mutually aggravating factors — this can lead to the development of extremely serious long-term consequences. The features of pain in this category of patients have not been sufficiently studied. Taking into account continuity and consistency, clear and high-quality pain control is necessary at all stages of treatment.

Principles of care for patients with craniofacial ballistic injuries

Abstract The mortality rate from firearm injuries in the United States has decreased from 30.3 per 100,000 people in 1990 to 20.6 in 2010, likely because of improvement in treatments. However, the incidence of gunshot wounds continues to increase, including the number of mass shootings, even though the definition of which is still unclear. According to Gun Violence Archives, there were 346 mass shootings in the United States, defined as 4 or more injuries in a single incident, in 2017, with 437 deaths and 1803 injured. This article briefly reviews the ballistics of firearms pertinent for maxillofacial surgeons and summarizes the lessons learned from caring for patients with ballistic injuries to the craniofacial region based on the available peer-reviewed publications and the authors' combined experience of more than six decades. Specifically, we discuss in details the roles of plastic surgeons as a member of the multidisciplinary trauma team in the following three phases: damage control, definitive treatment, and long-term rehabilitation.

Adolescent Gun Violence Shows an Age Group to Focus Trauma Prevention

IntroductionGun violence continues to escalate in America's urban areas. Peer groups of gun wound victims are potential targets for violence prevention initiatives; identification of this cohort is pivotal to efficient deployment strategies. We hypothesize a specific age at which the incidence of penetrating trauma increases significantly in adolescence, below which should be the focus on future trauma prevention. MethodsAdolescent trauma patients with gunshot wounds seen from July 2011 through June 2021 at a well-established, urban, academic level 1 trauma center were reviewed retrospectively and grouped by age. A linear regression and repeated measured analysis of variance evaluated the change in gunshot wound victims over this time, grouped by age. Demographics were extrapolated, and standard statistical analysis was performed. ResultsA total of 1304 adolescent trauma patients were included. Those aged 15 y and under had an unchanged incidence of gunshot wounds. However, those aged 16 y and more experienced the majority of increased gun violence; 92% were Black and 90% were male with a mortality of 12%. Adolescents aged 15 y and below were 95% Black and 84% male, with a mortality of 18%. ConclusionsPrimary prevention efforts to mitigate gun violence should be focused on adolescents below 16 y of age. Prevention of gun violence should include community outreach efforts directed toward middle school-aged children and younger, hoping to decrease the incidence of injury due to gun violence in older adolescents in the future.

Characteristic Features and Outcomes of Open Gunshot Fractures of Long-bones with Gustilo Grade 3: A Retrospective Study.

The incidence of gunshot injuries is growing, and civilian orthopedics should be more aware of the treatment and consequences of these injuries. This study aimed to describe the characteristic features and complications of gunshot injuries to long-bones. A total of 50 patients who presented with an open gunshot fracture of the tibia, humerus, and femur in the emergency room of our hospital were included in this study. Primary irrigation and debridement, as well as prophylactic antibiotics, were administered in the emergency room. The treatment was performed either conservatively (n=4) or surgically (n=46). The external fixator, nailing, or plating was used for surgical fixation. The mean age and follow-up duration of the patients were 32.3±9.9 years and 13.1±5.6 months, respectively. The most common injured long bone was the femur (32 of 50). Regarding the Gustilo grade, IIIa, IIIb, and IIIc were observed in 37, 7, and 5 patients, respectively. The Masquelet technique was used for 7 (14%) patients, and 12 (24%) cases had skin flaps. Furthermore, the vascular injury was present in 5 (10%) patients, and Malunion of the fracture site was observed in 5 (10%) cases. Nonunion of the fractured bone occurred in 13 (26%) patients that was significantly associated with the presence of vascular injuries (P=0.02). Postoperative infection occurred in 9 (18%) patients and was significantly associated with the presence of skin flap (P=0.014). Gunshot injuries of long bones are associated with a high incidence of post-treatment complications, such as infection and nonunion, and therefore, more intensive care should be taken to avoid these complications.

Gunshot injuries: experience in a tertiary health facility in the Niger Delta Region of Nigeria

the incidence of gunshot injuries and its negative socio-economic impact has assumed an alarming dimension in our environment in recent times as a result of increase in various criminal activities arising largely from poverty including armed robbery, insurgencies, banditry, kidnappings, political thuggery and the like. We share our experience in our centre. a retrospective study of cases of gunshot injuries seen, admitted and managed at our health facility over a three-year period. Relevant information including: biodata, circumstances surrounding shooting, type/caliber of gun used, etc. were obtained from patient's case notes and other sources. Data were analysed using SPSS version 18. forty-one gunshot injury patients made up of 37 males and 4 females were studied. About 68% of the patients fell within the age group of 20-39 years. Students were the most commonly affected group (21%). Armed robbery was the most common aetiology of GSI in our patients (43.9%). Low-velocity guns were largely used (46%). The extremities were the most commonly injured (65.9%). Fractures occurred in 63.4% of patients the femur being the most frequently fractured (22.6%). Patients received various treatment modalities including, wound debridement (78%) and exploratory laparotomies (26.8%) while 3 (7.35%) of them died. armed robbery and other criminal activities continue to constitute important factors responsible for GSI in our environment. There is need for government and all stakeholders to do more in terms of fighting crime in addition to placing policies to alleviate socioeconomic deprivation.

Incidence of Gunshot Wounds to Head and Neck Increased during COVID-19 Pandemic

PurposeCOVID-19 was declared a pandemic by the World Health Organization on March 2020. Since then, there was an increase in the number of firearm purchases. The purpose of this study was to investigate whether the incidence of gunshot wounds (GSWs) to the head and neck increased during the COVID-19 pandemic. Materials and methodsThis cross-sectional study reviewed patients in the Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, GA. Patients were included if they: 1) sustained GSW to head and neck, 2) activated the Trauma Registry, and 3) were treated at GMH. Patients were stratified according to date of injury into 1 distinct time period: 1) March 13 to August 13, 2019 (i.e., before the COVID-19 pandemic, BC19) or 2) March 13 to August 13, 2020 (i.e., during initial 6 months of the COVID-19 pandemic, C19) (Figure 1). March 13 was chosen because COVID-19 was announced as a national emergency on that date. The research team collected patient demographics, distressed communities index (DCI), social history, and etiology of GSW. Details regarding extent of GSW injury (i.e., isolated soft tissue, bony, other locations of injuries) were recorded. Injury severity was described using the following variables: status of patient and Glasgow Coma scale (GCS) on arrival to GMH, cardiopulmonary resuscitation (CPR) in Emergency Department (ED), diagnosis of shock on admission, disposition from ED, ICU length of stay (LOS), total days on mechanical ventilator (MV), hospital LOS, and hospital discharge status. Descriptive statistics were performed. Univariate and bivariate analysis were performed. The Chi-squared test was used for categorical variables. Statistical significance was P < .05. ResultsDuring the study period, 948 patients sustained GSW. Of them, 215 patients had GSWs to head and neck. The BC19 group had 96 patients (78 males) with a mean age of 31.5 years old (range 7-82). The C19 group had 119 patients (101 males) with an average age 32.7 years (range 14-82). Overall, there was a 10.4% increase in incidence of GSW to head and neck during C-19 (Figure 2). The data showed that alcohol abuse was associated with an increase in GSW to the head and neck (P < .0001). The mean DCI for C19 group was lower than BC19 by 8%, meaning that the distress to the population was decreased. GSW to base of skull occurred 34.5% more often during C19 (P = .002), and intracranial injuries occurred 26% more often during BC19 (P = .03).In the BC19 group, 85.4% of the patients arrived alive to GMH, compared to 16% in C19 group. Patients had shock on admission (BC-19; n = 22, 22.9 %, C-19; n = 24, 20.2%). Researchers found that the status on arrival to ED (i.e., alive) was statistically significant (P < .0001). Outcomes dataResearchers found a 10.4% increase in the incidence of GSWs to the head and neck during C-19. Specifically, the peak incidence occurred during May, June, and July, with 25 cases per month (Figure 2). The peak in incidence was parallel with the shelter-in-place order in the state of GA that was issued on April 3, 2020. The finding is consistent with previous studies that showed an increase in gun violence during the COVID-19 pandemic. ConclusionIn conclusion, understanding the underlying causes for the increase in GSW to the head and neck during the COVID-19 pandemic is imperative for implementing gun violence prevention programs. Health system leaders should develop partnerships that embrace medical professional organization support to proactively reduce firearm-related injury during periods of social isolation.

Gunshot injuries in Owerri, a 10 years (2001-2010) postmortem study

This study is to establish the demographic parameters, typical entry and exit wound sites, immediate causes of death and annual incidence of gunshot injuries in Owerri. The records of gunshot victims in the case notes, Post-mortem registers, departmental and medical records databases of FMC Owerri were used as the sources of data for this study from January 2001 to December 2010. One hundred and one cases of gunshot injuries (GSI) that resulted in death met the inclusion criteria of this study. Ninety-six per cent of the victims were males; mean age was 52.2±21.3 years and age range of 19-71 years. The most affected age groups were those in the 21-30 years age groups followed by 31-40 years. The most frequent site of entry wound was thorax (36.7%), followed by head and neck region (22.8%), abdomen (19.8%) and lower limbs (13.9%). A total of 56.4% (57cases) had established sites of exit wounds while in 33.7% (34 cases) the exit wounds were not defined. The incidence of GSI was highest in 2003 (17.82%), followed by 2008 (14.85%) and 2007 (13.46%). The immediate causes of death were a haemorrhagic shock in 84 cases (83.2%), head injuries with skull fractures 10cases (9.9%) and septicaemia in 7 cases (6.9%). Effective legislation and gun control policy would prevent the unnecessary death of our young men through violence, gangsterism and substance abuse.

Gunshot wound incidence as a persistent, tragic symptom of area deprivation

BackgroundMore than 30,000 Americans die every year of firearm-related injuries. Gun violence is frequently addressed by law enforcement and policing, as opposed to public health interventions that might address poverty or deprivation. Our goal was to evaluate the past 20 years of gunshot wound injury demographics seen at our level I academic trauma center and create a risk map model correlating gunshot wound incidence with area deprivation. MethodsPatients admitted for gunshot wound-related injuries between 1996 and 2017 were identified using our trauma registry. Demographic and injury data were extracted and analyzed. Multivariable logistic regression models were created to identify predictors of mortality. Geographic information system mapping of incident location and home address was completed to identify zip code hot spots of high gunshot wound incidence. Area Deprivation Indices, which reflect local income or poverty, housing, education, and employment were used as a marker of relative economic disadvantage. Spearman rank correlation was used to determine the relationship between Area Deprivation Indices score and gunshot wound rate. ResultsA total of 2,413 patients with gunshot wounds were evaluated. The cohort had a mean age of 28.8 ± 11.5 and was 89.6% male. Mean Injury Severity Score was 11 ± 12.5. gunshot wounds were most frequently a result of assault (91.1%), followed by unintentional injury (3.4%). Geographic information systems mapping revealed significant clustering of gunshot wounds. The areas with highest per capita incidence of gunshot wounds was strongly correlated with Area Deprivation Indices (0.594, P < .001). ConclusionGeographic regions of known lower socioeconomic resources have higher incidence of gunshot wounds in our community. Both Area Deprivation Indices and gunshot wound incidents in these distressed communities remained unchanged throughout the past 20 years, despite law enforcement crime suppression efforts. Gunshot wounds appear to be a symptom of area deprivation, similar to failing schools and poor health outcomes. Efforts to decrease poverty and community capacity-building may help alleviate this area deprivation.

Selective non-operative management for penetrating abdominal injury in a Dutch trauma centre.

Selective non-operative management (SNOM) for penetrating abdominal injury (PAI) is accepted in trauma centres in South Africa and the US. Owing to the low incidence of gunshot wounds (GSWs) in Western Europe, few are inclined to practise SNOM for such injuries although it is considered for stab wounds (SWs). This study evaluated the outcome of patients admitted to a Dutch level 1 trauma centre with PAI. A retrospective study was undertaken of all PAI patients treated over 15 years. In order to prevent bias, patients admitted six months prior to and six months following implementation of a treatment algorithm were excluded. Data concerning type of injury, injury severity score and treatment were compared. A total of 393 patients were included in the study: 278 (71%) with SWs and 115 (29%) with GSWs. Of the 178 SW patients in the SNOM group, 111 were treated before and 59 after introduction of the protocol. The SNOM success rates were 90% and 88% respectively (p=0.794). There were 43 patients with GSWs in the SNOM cohort. Of these, 32 were treated before and 11 after implementation of the algorithm, with respective success rates of 94% and 100% (p=0.304).The protocol did not bring about any significant change in the rate of non-therapeutic laparotomies for SWs or GSWs. However, the rate of admission for observation for SWs increased from 83% to 100% (p<0.001). There was a decrease in ultrasonography for SWs (from 84% to 32%, p<0.001) as well as for GSWs (from 87% to 43%, p<0.001). X-ray was also used less for GSWs after the protocol was introduced (44% vs 11%, p=0.001). SNOM for PAI resulting from either SWs or GSWs can be safely practised in Western European trauma centres. Results are comparable with those in trauma centres that treat high volumes of PAI cases.

Incidence of Gunshot Wounds: Before and After Implementation of a Shall Issue Conceal Carry Law

This study examined the incidence of gunshot wounds before and after enacting a conceal carry (CC) law in a predominately rural state. A retrospective review was conducted of all patients who were admitted with a gunshot injury to a Level I trauma center. Patient data collected included demographics, injury details, hospital course, and discharge destination. Among the 238 patients included, 44.6% (n = 107) were admitted during the pre-CC period and 55.4% (n = 131) in the post-CC period. No demographic differences were noted between the two periods except for an increase in uninsured patients from 43.0% vs 61.1% (p = 0.020). Compared to pre-CC patients, post-CC patients experienced a trend toward increased abdominal injury (11.2% vs 20.6%, p = 0.051) and increased vascular injuries (11.2% vs 22.1%, p = 0.026) while lower extremity injuries decreased significantly (38.3% vs 26.0%, p = 0.041). Positive focused assessment with sonography in trauma (FAST) exams (2.2% vs 16.8, p < 0.001), intensive care unit admission (26.2% vs 42.0%, p = 0.011) and need for ventilator support (11.2% vs 22.1%, p = 0.026) all increased during the post-CC period. In-hospital mortality more than doubled (8.4% vs 18.3%, p = 0.028) across the pre- and post-CC time periods. Implementation of a CC law was not associated with a decrease in the overall number of penetrating injuries or a decrease in mortality.

ANÁLISE GEOESTATÍSTICA DA INCIDÊNCIA DE DOENÇAS RELACIONADAS AO TRAUMA NOS BAIRROS DO MUNICÍPIO DE CAMPOS DOS GOYTACAZES

INTRODUÇÃO: anualmente ocorrem 5,8 milhões de óbitos por trauma mundialmente, o que representa cerca de 10% entre todas as causas de morte; sendo os jovens e adultos jovens a faixa etária mais prevalente. OBJETIVOS: analisar a associação de patologias relacionadas ao trauma nos diversos bairros de Campos dos Goytacazes por meio de dados geoestatísticos. MÉTODOS: trata-se de um estudo observacional e analítico com avaliação de uma amostra de pacientes atendidos no Hospital Ferreira Machado (HFM), no setor de politrauma, utilizando relatórios gerados pelo software KLINICOS. RESULTADOS: no período de janeiro a maio de 2018 o setor de politrauma foi responsável por 26% dos atendimentos de emergência e urgência do HFM sendo a faixa etária mais prevalente de 20 a 29 anos. O bairro Jockey Club teve a maior incidência tanto de agressões por arma branca e por lesão corporal (@ 5%), quanto de acidentes envolvendo motociclistas (@ 7%). Já o bairro Santa Rosa foi o segundo mais incidente dos ferimentos por arma de fogo e o primeiro dos acidentes envolvendo ciclistas. CONCLUSÕES: os bairros com maior incidência de vítimas por arma de fogo, arma branca e agressão corporal pertencem a Guarus. Já os acidentes envolvendo motociclistas e ciclistas são mais incidentes no Jockey, bairro situado entre duas grandes rodovias que ligam a cidade de Campos dos Goytacazes a Farol e a São João da Barra.

Review of 166 Gunshot Injury Cases in Dogs

The study is aimed to establish predilection signalment and history data, and to investigate clinical findings and risk factors associated with a poor outcome in dogs with projectile injuries. A retrospective study was undertaken of 166 canine cases in which a projectile was found on radiograph in a university׳s diagnostic imaging center more than a 4-year period. The study included dogs with both apparent (obvious recent traumatic event) and incidental (traumatic event unknown to the owner) projectile injury. Radiographs were reviewed and data regarding projectile position according to body region, number and type of projectile(s), bone fracture(s), and wound(s) related to projectile were recorded. The dogs were divided into groups according to owner address, hunting accident vs. shooting unrelated to hunting, and projectile type found on radiographs. Overall, 160 dogs met the inclusion criteria, making 0.76% the incidence of gunshot injuries. Further, 91 dogs were received with incidental projectile injury, and 75 dogs had apparent projectile injury. Male dogs were overrepresented (74.1%). Hunting accidents were the cause of projectile injury in 12.7% of cases. Fractures were observed in 20.5% of dogs. Most of the dogs (62%) were from an urban area, and the most common projectile type was airgun projectile (62%). The risk of fatal outcome was 14.4 times higher in dogs with thoracic injuries. Projectile injuries are still a real cause of trauma, especially in urban areas and in male dogs. Most gunshot injuries do not cause fatalities, although the thoracic projectile injury was associated with a greater fatality risk.

Gunshot Injuries to the Spine.

After experiencing a peak more than two decades ago, the incidence of gunshot injuries has recently stabilized1,2. Nevertheless, the effects of gunshot injuries to the spine and associated neurological sequelae continue to be substantial. In fact, approximately 14% of all civilian spinal cord injuries since 2010 are …

FIREARM INJURIES IN THE SPINE. EFFECTIVE STRATEGY FOR DIAGNOSIS AND TREATMENT

The incidence of gunshot wounds to the spine on civilians has increased alarmingly and accounts for 13% to 17% of all traumatic spinal injuries, placing them in third place among the most frequent mechanisms. However, the management of these injuries is still controversial. At present there is little information on the management of these lesions, conservative treatment (non-surgical) being recommended in most publications. Based on the current literature, we propose a procedural protocol aimed at improving the quickness of management, as well as the prognosis of the patient. For this purpose, once the patient is hemodynamically stabilized, the following should be assessed: 1) Stability; 2) Compressive extrusion; 3) Accommodation or not in the discal space, and 4) Contact with CSF. These points are relevant to make the best decision.

Declaration of a state of emergency in Trinidad and Tobago: effect on the trauma admissions at the National Referral Trauma Centre.

To determine the effect of a State of Emergency (SOE) on penetrating injuries at the main trauma center in Trinidad and Tobago. Emergency room registers were accessed in order to identify all patients treated for penetrating injuries from July 1, 2010 through December 30, 2012. This study period was chosen to include injuries one year before and one year after the SOE that spanned from August 21, 2011 to December 5, 2011. Data were analyzed using SPSS version 19 and a P value<.05 was considered statistically significant. There were 1,067 patients treated for penetrating injuries. There were significantly more injuries from gunshots compared to stab wounds (64.7% vs 35.3%; P<.001), and this pattern was maintained during the SOE (54.7% vs 45.3%; P=.37). There was a significant fall in mean monthly admissions for penetrating trauma during the SOE when compared to the 12-month period before its imposition (17.7, SD=4.0 vs 38.9, SD=12.3; CI, 5.6-36.8; P=.0108). One year later, mean monthly admissions for penetrating trauma were similar to those during the SOE (22.7, SD=2.1 vs 17.6, SD=4.0; CI, -2.3-12.3; P=.1295). The incidence of gunshot wounds remained low and stab wounds increased. This study has demonstrated that there was a reduction in the incidence of penetrating trauma at the national trauma center after the SOE, with a shift from gunshot to stab wounds.

Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons.

The incidence of gunshot wounds from civilian firearms is increasing. Despite this fact, guidelines on indications for bullet removal are scarce. In this analysis, we combine an overview of the available literature in these rare entities with our experiences in our own clinical practices. We conducted a systematic literature search of computerized bibliographic databases (Medline, EMBASE, and the Cochrane Central Register). The local experience of the authors was reviewed in light of the available literature. 145 full-text articles were suitable for further evaluation. Only six retrospective studies were available, and no prospective study could be retrieved. Most of the articles were case reports. In the South African co-author's own clinical practice, approximately 800 patients are treated per year with gunshot wounds. In summary, there are only a few clear indications for bullet removal. These include bullets found in joints, CSF, or the globe of the eye. Fragments leading to impingement on a nerve or a nerve root, and bullets lying within the lumen of a vessel, resulting in a risk of ischemia or embolization, should be removed. Rare indications are lead poisoning caused by a fragment, and removal that is required for a medico-legal examination. In all other cases the indication should be critically reviewed.

Brown-Séquard-Plus Syndrome Because of Penetrating Trauma in Children

Brown-Séquard syndrome is an uncommon condition involving incomplete spinal cord injury, with ipsilateral motor and proprioception loss, contralateral pain, and decreased temperature. Brown-Séquard-plus syndrome is associated with additional neurologic findings involving the eyes, bowel, or bladder. We describe an adolescent with Brown-Séquard-plus syndrome attributable to a stab injury. Our patient's clinical features of spinal and neurogenic shock overlapped at presentation. He was managed with high-dose steroids, along with intense physiotherapy and rehabilitation, resulting in good neurologic recovery. Appropriate medical (and surgical, when indicated) management usually results in good to complete recovery of neurologic function, depending on the level and grade of injury. With the increasing incidence of gunshot wounds and stab injuries in children, pediatricians, including pediatric neurologists and emergency physicians, are more likely to encounter these types of spinal cord injuries in children.

Versorgungsstrategien bei Schussverletzungen der Extremität

The incidence of gunshot wounds is increasing also in Europe and surgeons in urban trauma centers are more frequently confronted with this type of injury. Since there is no established treatment algorithm for gunshot injuries to the extremities, the surgeon should rely on established soft tissue injury and fracture protocols. Gunshot fractures with minor soft tissue destruction should be treated as closed fractures. The treatment of choice for unstable fractures is early internal stabilization, whereas stable fractures may be treated by functional bracing. The administration of an antibiotic prophylaxis for fractures with minor soft tissue injury is controversial. Gunshot fractures with major soft tissue injury should be treated as open fractures. Debridement of nonviable tissue and external fixation are recommended. Prophylactic intravenous antibiotics are mandatory and prophylactic fasciotomy is often required. Upon definitive internal stabilization, bone grafting should be considered since gunshot fractures are usually associated with a high degree of comminution. Articular gunshot injuries are treated as open joint injuries and require irrigation, debridement, foreign body removal and antibiotic prophylaxis.

PS15 PAEDIATRIC GUN SHOT INJURIES IN NEW ZEALAND: A DEMOGRAPHIC ANALYSIS OF AN AVOIDABLE CAUSE OF SIGNIFICANT CHILDHOOD MORBIDITY

Purpose New Zealand has a reputation for an outdoors lifestyle that includes hunting and tramping. New Zealanders own over a million guns and these are widely distributed throughout the rural and urban communities. Although its gun laws are not liberal, children still suffer gun shot injuries. The aim of this study was to examine the injuries children receive from firearms in New Zealand, their circumstances and long term morbidity.Methodology A retrospective review of all children admitted to the four New Zealand paediatric surgical hospitals (at Auckland, Hamilton, Wellington and Christchurch) with gun shot injuries over 10 yr period 1996–2005 was undertaken. Data were compared with published literature from elsewhere.Results Overall, the incidence of gunshot injuries in New Zealand is low compared with many other developed countries. The majority are caused by air rifles. Most are superficial but some may lead to long term morbidity.Conclusions Although New Zealand gun laws require air rifle owners to be over 18 yrs of age, children often are victims of air rifle misuse, particularly in urban areas. Mortality is rare, but some children suffer long term morbidity. Our data may enable preventative measures to be better focused.

Penetrating gunshot wounds of the chest in civilian practice: experience with 250 consecutive cases.

Our experience indicates a continued rising incidence of gunshot wounds of the chest in the United States. During the past 4 1/2 years, 250 consecutive cases were treated at the King-Drew Medical Center in Los Angeles. Ninety per cent presented with a haemothorax or haemopneumothorax. Pneumothorax alone was present in only 3 per cent of cases. Twenty per cent had associated intra-abdominal injuries, involving mostly the diaphragm, liver, spleen and the gastrointestinal tract. Eighty per cent were treated with tube thoracostomy and among these there were 2 deaths, neither being related to the chest injury. About 16 per cent underwent thoracotomy with a mortality of 12.8 per cent, all the deaths being caused by severe cardiac wounds. The overall mortality was 2.8 per cent. The complication rate was 5.3 per cent, most complications occurring in patients with associated intra-abdominal and spinal cord injuries. The average period of hospitalization was 6.5 days. The management plan and the indications for the two courses of therapy are discussed.