Shot Wounds Research Articles

Outcomes and implications of pediatric spinal gun shot wounds: A cross-sectional analysis using 2017-2021 TQIP data

BackgroundPediatric morbidity and mortality due to gun violence has steadily risen in recent years, becoming the leading cause of death among children and teens as of 2022 per the Center for Disease Control (CDC). For patients under the age of 17 in the United States, gunshot wounds (GSWs) are the underlying cause of traumatic spinal cord injury (tSCI) in 8.3% of patients. Although prior studies have examined the broader trends of firearm-related deaths in children, investigation specifically focusing on gunshot wounds to the spine has not addressed the pediatric population. MethodsThe TQIP database from 2017 to 2021 was queried for patients under the age of 18 with gunshot traumas, and ICD-10 diagnosis codes were used to identify associated spinal injuries. The incidence across time and risk factors for adverse hospital outcomes were analyzed using multivariate logistic regression. Factors of interest included demographic characteristics, insurance provider, and comorbidities. ResultsA total of 3,155 gunshot injuries to the spine (GSIS) in the pediatric population were reported to TQIP between 2017 and 2021. Average patient age was 16 ± 2.8 years old and the majority of patients (n=1819, 57.6%) were uninsured. Assault was the intent of firearm discharge in 2,582 (81.8%) patients and unintentional injury occurred in 322 (10.2%) cases. Mortality occurred in 11.7% of GSIS, twice that of the 5.8% seen in all pediatric GSW. Those with psychiatric disorders were more likely to result in extended LOS (OR, 2.538; 95% CI, 1.638-3.932; P < 0.001) and in-hospital complications (OR, 1.841; 95% CI, 1.139-2.891; P = 0.012) when analyzed with multivariate binomial logistic regression. ConclusionIn this large-scale retrospective study using TQIP data, we identified trends in spine injuries sustained from gun trauma in the pediatric population. Consideration of demographics, hospital course, and outcomes as examined in this study can provide valuable insights to clinicians, public health organizations, and policy makers.

Exploring adverse events of Vilazodone: evidence from the FAERS database

ObjectiveThis study aims to conduct an exhaustive evaluation of Vilazodone's safety in clinical application and to unearth the potential adverse event (AE) risks associated with its utilization based on FDA Adverse Event Reporting System (FAERS) database.MethodsThis research employed data spanning from the first quarter of 2011 to the third quarter of 2023 from the FAERS database. Various signal detection methodologies, including the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM), were utilized to ascertain the correlation between Vilazodone and specific AEs.ResultsThe study compiled a total of 17,439,268 reports of drug AEs, out of which 5,375 were related to Vilazodone. Through signal mining, 125 Preferred Terms (PTs) encompassing 27 System Organ Classes (SOCs) were identified. The findings indicated a higher prevalence among females and patients within the 45 to 65 age bracket. The principal categories of AEs included Psychiatric disorders, Nervous system disorders, and Gastrointestinal disorders, with prevalent incidents of Diarrhoea, Nausea, and Insomnia. Moreover, the study identified robust signals of novel potential AEs, notably in areas such as sleep disturbances (Sleep paralysis, Hypnagogic hallucination, Rapid eye movements sleep abnormal, Sleep terror, Terminal insomnia, Tachyphrenia), sexual dysfunctions (Female orgasmic disorder, Orgasm abnormal, Disturbance in sexual arousal, Spontaneous penile erection, Anorgasmia, Sexual dysfunction, Ejaculation delayed), and other symptoms and injuries (Electric shock sensation, Violence-related symptom, Gun shot wound).ConclusionAlthough Vilazodone presents a positive prospect in the management of MDD, the discovery of AEs linked to its use, particularly the newly identified potential risks such as sleep and sexual dysfunctions, necessitates heightened vigilance among clinicians.

Gun shot injuries to the temporal bone: Anatomic predictors of mortality

PurposeTo explore anatomic predictors of mortality from gunshot wounds involving the temporal bone. MethodsA retrospective search of radiology reports was performed for all patients with CT reports suggestive of gunshot wounds (GSW) to the TB (2000–2020). All cases were reviewed by the senior author to confirm injury to the temporal bone. Detailed demographic and radiographic data were collected. Main findingsA total of 120 patients met inclusion criteria. The majority of patients were male (n = 101) and the average age was 32.9. The squamosa was the most commonly involved subsite (n = 90), followed by the mastoid (n = 43). Squamosal entry site had the highest associated mortality (89.7 %). For those with known disposition, 65.8 % (79 of 120) expired on the same hospital admission. Inpatient otolaryngology consultation was noted in 18.3 % (n = 22) of patients, with poor outpatient follow-up. ConclusionsThis series represents the largest survey of GSW to the temporal bone to date. Although associated mortality is high and outpatient follow-up poor, otolaryngologists should be aware of associated morbidities to facilitate both inpatient and subsequent outpatient management.

Abstract 018: External carotid artery Pseudo aneurysm induced Internal Carotid Artery compression causing acute ischemic stroke

Introduction Here, we describe a patient in whom ischemic stroke was caused by compression of the Internal Carotid Artery (ICA) by a Pseudoaneurysm (PSA) of the External Carotid Artery (ECA) after Gun Shot injury. Eventually, the PSA of the Internal maxillary artery (IMAX) was embolized, resulting in resolution of the patient's symptoms. Methods Case Report Results A 75‐year‐old male with a history of atrial fibrillation on Eliquis presented to the emergency department after sustaining a gunshot wound to the left face. He had extensive injuries through the left masticator and submandibular space with an inferior orbital wall fracture. A Computed Tomography Angiography (CTA) neck showed injuries to the left proximal IMAX with a small PSA. As the PSA was asymptomatic it was managed with observation. On HOD day 13, CTA was done for a brief period of unresponsiveness, which showed high‐grade narrowing of left cervical ICA due to extrinsic compression from PSA which was supplied by a branch of the left ECA with distal re‐constitution (image A). The next day, patient developed right sided plegia and aphasia with NIHSS of 17. A CT head showed no acute intracranial abnormality. The patient underwent emergent Digital Subtraction Angiography (DSA), which demonstrated occlusion of the left cervical ICA from compression from a left IMAX PSA which was treated with n‐butyl‐cyanoacrylate TRUFILL embolization with resolution of flow limitation in the left cervical ICA (Image B1,B2). After embolization, the patient was oriented and able to lift right arm and leg anti‐gravity. Magnetic Resonance Imaging (MRI) was contraindicated due to retained bullet fragments. Repeat CT head did not show stroke. Conclusion A Pseudo aneurysm is characterized by a rupture of the arterial wall and the formation of an aneurysmal sac by the adjacent structures while the sustaining artery remains intact. The most prevalent causes are penetrating or acute blunt neck trauma, hyperextension injury, and injury to the base of the skull (1). Predisposing factors for PSA include carotid endarterectomy or a late complication of carotid artery dissection, infection, radiotherapy, and malignancy (1‐2). Cox et al. reported 124 patients with significant neck and head penetrating injuries. Eleven patients were found to have thirteen head and neck PSA: two in the ICA, one in the vertebral artery, and ten involving branches of the ECA. Two of seven symptomatic PSAs manifested with episodes of massive hemorrhage (3). There have been case reports describing the consequences of an elongated styloid process causing an ischemic stroke due to subsequent dissection and PSA formation (4). According to our knowledge, this case report is one of the first to describe acute ischemic symptoms resulting from ECA PSA‐induced ICA compression, with resolution of symptoms following PSA embolization. The educational value of our case lies not only in the rarity of the condition but also in the uniqueness of its presentation. This case is a fundamental addition to the existing literature on rare neuro‐vascular anomalies leading to potential catastrophic outcomes.

Arrow shot injury to the oro facial regions: Report of two cases

Background: Arrow injury is a case of foreign body impaction. It can affect any part of the body. Arrow injury to the head and neck region can be life-threatening. An arrow is a weapon consisting of a thin, straight stick with a sharp point, designed to be shot from a bow. It is one of the oldest tools for hunt and war. Many health practitioners especially in the developed world now regard arrows as extinct. It has been completely replaced by advanced modern weaponry. This is not the case in our environment where the use of arrows with their attendant injury is still relatively common.&#x0D; Case report: The first case is a 25-year-old farmer, a Nigerian man was seen at the Accident and emergency unit of our centre with an hour history of arrow injury to the right side of the face following the farmer-herder clash. The examination was remarkable for an impacted arrow that was made up iron (impregenation with poisonous substance could not be ascertained) on the right side of the face. He had an urgent plain radiograph of the head and neck which revealed an impacted arrow in the right zygomatic bone. He subsequently had emergency exploration and removal of the arrow. The post-operative period was uneventful.&#x0D; The second case was a 37-year-old man who presented to the accident and emergency department with difficulty breathing following an arrow shot injury to the oral cavity. He was a passenger in a bus that was attacked by armed bandits. On examination, there was an arrow penetrating through the right edge of the tongue, the floor of the mouth to the contralateral submandibular and cervical regions. About 5.0cm of the tail of the arrow could be seen jutting out of the mouth. The exploration was done via a Risdon incision (submandibular incision) on the opposite side of the entry wound (left submandibular) in a retrograde approach. The dissection was advanced into the subcutaneous tissue, platysma, and deep fascial plane to expose the tip of the arrow. The post-operative period was uneventful.&#x0D; Conclusion: We have illustrated our experience on the cases of arrow injury to the orofacial region. The two cases presented early. There was no pre-hospital attempt at pulling out the arrow. Arrow injury is still common in our community. There is a need for government at all levels to intensify effort on conflict management and resolution.

SDMS CME Credit – Complications of Delayed Arterial Injury After a Gun Shot Wound to the Upper Extremity: A Case Study

SDMS CME Credit – Complications of Delayed Arterial Injury After a Gun Shot Wound to the Upper Extremity: A Case Study

Penetrating brain injury from an accidental air gun shot: a case report

Background: Air gun shot injury is a gunshot wound from a pistol or rifle that fires a bullet. The most common part of the body that penetrates in air gunshot injuries is the head, especially the orbit. The majority of fatal cases have been reported to enter that location and commonly involve children and adults. This report presents an interesting point of air gunshot injuries with brain damage surgical management. Case Description: A 6-year-old boy got referred from other hospitals and came unconscious after being shot in the head by an air gun about eight hours before being admitted to the hospital with a range of about two meters. The patient was said to have accidentally been shot from the front of the head. The patient had a history of vomiting without a history of consciousness and seizure. On the primary survey, the airway, breathing, and circulation were clear, with a Glasgow Coma Scale (GCS) of 13. Based on the clinical examination and the result of the head CT scan, the patient was diagnosed with penetrating brain injury at the left parietal region, with multiple fragmented objects, intracerebral hemorrhage, and intraventricular hemorrhage. We then perform urgent surgery to debride and extract the bullet. There was no surgical morbidity in this patient, who was allowed to go home. Conclusion: Penetrating brain injuries resulting from air gunshot wounds require exceptional management. Early surgery to debride the wound with consideration of bullet extraction is needed to prevent further complications and for a better outcome for the patient.

Complications of Delayed Arterial Injury After a Gun Shot Wound to the Upper Extremity: A Case Study

Vascular trauma can be a life-threatening event. Various complications can arise when injury to an artery occurs. Thus, early diagnostic imaging may be necessary for emergency treatment. A case study is presented of a delayed arterial injury, after a gunshot wound, involving the right upper extremity. This case demonstrates the importance of continued clinical surveillance and management. Duplex sonography has been shown to have 94% to 97% sensitivity and 82.5% to 98% specificity, regarding vascular injury. This case study describes the use of duplex sonography for the identification and clinical follow-up of multiple arterial injuries that presented 1 month after the initial traumatic incident.

Role and place of videothoracoscopy in gun shot wounds of the chest

Role and place of videothoracoscopy in gun shot wounds of the chest

The hunter and the hunted: Using web‐sourced imagery to monitor leopard (Panthera pardus pardus) trophy hunting

AbstractSustainable offtake of any threatened species and objective monitoring thereof relies on data‐driven and well‐managed harvest quotas and permit compliance. We used web‐sourced images of African leopard (Panthera pardus pardus) trophy hunts to determine whether online photographs could assist in monitoring and documenting trophy hunting in Africa. Of 10,000 images examined, 808 (8%) showed leopard trophy hunts and could be contextualized by date and country. From a subset of photos (n = 530), across six countries between 2011 and 2020, we extracted information on the leopards killed and hunter demographics. We found no significant differences in leopard sex, age, or shot wound position between countries, and most trophy leopards were in good physical condition. Most hunters were White (96%) and estimated at over 40 years old (82%), with the proportion of women hunters in younger age classes significantly higher than in older classes. Rifles, bows, and hounds were used in all countries, except Tanzania and Zambia, where rifles were exclusively used. Online images could not be reasonably compared to the CITES trade database, but in South Africa, more than half (57%) of all nationally registered leopard trophy hunts in the last decade (2010–2020) have been posted online. Online images also reveal hunting violations, including non‐permitted hunting of female leopards and illegal hounding. Such monitoring methods may become increasingly useful as social media usage grows and provide valuable insight into this multi‐million dollar industry.

A comparison of the outcome of Gun Shot Wounds with and without skin closure in terms of wound healing time and wound infection.

Objective: To compare the outcome of Gun Shot Wounds with and without skin closure in terms of wound healing time and wound infection. Study Design: Comparative Study. Setting: East Surgical Ward Mayo Hospital Lahore Pakistan. Period: 6 Months (from 1st January 2020 to 30th June 2020). Material &amp; Methods: Sample size of 300 patients was used by consecutive convenient non probability sampling. Patients were divided into Group A and Group B with 150 patients in each group by lottery method. Group A patients underwent wound debridement and primary skin closure while group B patients underwent wound debridement and wound packing. Outcome was measured in terms of wound healing time and wound infection 24 and 48 hours post operatively. P-value less than 0.05 was taken as significant. Results: Two hundred and fourteen (n=214,71.33 %) patients were male and 86 (28.66 %) were female with mean age of 32 ± 7.56 years. The wound healing time in Group A patients was 6 days ± 2.18 days while in group B it was 13 days ± 3.87 days (P value 0.01). After 24 hours, Frequency of wound infection was 43 (14.3%) in Group A patients while 31(10.3%) in Group B patients (P value = 0.19). Similarly, after 48 hours wound infection rate was 17 (5.6%) in Group A while 11 (3.6%) in Group B (P value = 0.42). Conclusion: Applying skin stiches on Gun Shot Wounds after sufficient debridement and irrigation leads to early healing of the wound.

Statistical analysis of yarn characteristics for multilayer fabric matrix meant for hemostasis and tissue regeneration

Effective wound handling involves understanding the processes caused by several factors, such as the type of wound treated, the healing process, the general health of the patient (e.g., the existence of other diseases), the social environment, and the chemical and physical properties of available dressings. For the treatment of shot or burn wounds, the multilayer matrices that will be made must provide efficient oxygen permeability, but most importantly to simulate the structural and biological characteristics of the extracellular skin matrix (ECM). In order to achieve, by mechano-textile processing technologies, the textile structures that can be used as a base layer in the multilayer matrix, raw materials based on cotton, Lenpur, and bamboo mixed with zinc oxide were selected and analysed in accredited testing laboratories, from the point of view of the physical-mechanical characteristics. The results obtained in the case of the experimental program were analysed from a statistical point of view, the description of the statistical populations being made using a specialized program that allowed the calculation of the distribution parameters: mean, median, and standard deviation. To determine the outliers, for all the characteristics of the experimented variants the Q-Q Plot graphs were used. The information obtained as a result of the statistical analysis will be used to design the textile layers of the multilayer matrix using statistical techniques to create probabilistic prediction models that model the dependent variable Y is the hygroscopicity, depending on the independent variables x1 – linear density, x2 – twist/ply, x3 – breaking force, x4 – elongation at break

An Optic Nerve Avulsion Due to A Gun Shot Injury: A Case Report

Purpose: To present a rare case of optic nerve avulsion due to gun shot injury. Case Report: A 30-year-old man presented with sudden visual loss on the Right Eye (RE) after a gun shot on his left frontal bone. On examination of the RE, he had periorbital hematoma and edema, and also conjunctival chemosis. There was no light perception of the RE, and his pupil was dilated and nonreactive to light. There’s also an eye movement resistance. On the examination of the Left Eye, he had periorbital hematoma and edema, visual acuity was 1.0 and other examinations was within normal limit. B-scan USG of the RE showed a hyperechoic image on the retinal projection in front of the optic nerve. CT-scan showed multiple metal density fractions in the subcortical cortical left frontal lobe and right retrobulbar. On funduscopic examination, there was bleeding in the inferior vitreous originating from the optic nerve papilae. The patient underwent craniotomy, debridement, and corpus alienum extraction by neurosurgeon and plastic surgeon. The patient was treated with high dose steroid (methyl prednisolone 4 x 250 mg iv). After a week of therapy, there was no improvement of his RE visual acuity. Conclusion: Optic nerve avulsion is a rare case with devastating results because there’s still no definite therapy to improve the outcome.

The Effectiveness of Bedside Low Pressure Irrigation on Pistol Caliber Gun Shot Wounds Bacterial Contamination

Controversy exists regarding the benefit of low-pressure irrigation of pistol caliber gunshot wounds. Our study set to examine the effect of low-pressure irrigation on bacteria quantity in a simulated gunshot wound.

Close Range Gun Shot Injury Bilateral Ruptured Testis Repair Using Tunica Vaginalis Flap

Close Range Gun Shot Injury Bilateral Ruptured Testis Repair Using Tunica Vaginalis Flap

Suicide with Very Close Shot Wounds, A Case Report

Background: Currently victims of gunshot wound violence are very often found because more and more members of civil society have firearms, both for self-defense and for other purposes. In principle, examination of gunshot wound victims is the same as examination of wounds in other traumas, but there is one specific thing, namely, doctors must know and understand about firearms, ammunition and bullets. Without understanding this, it will be difficult to provide adequate assistance, because injury to the body is ultimately based on these three elements. In gunshot wounds, there are two types of wounds, including incoming gunshot wounds and exit gunshot wounds. incoming gunshot wounds consist of: contact wound, close gunshot wound (near wound), and distant gunshot wound (distant wound). This case report aims to determine the cause of death of the victim, which was found through forensic and histopathological examination, whether the victim died due to suicide, murder or accident. The case that occurred in Serdang Bedagai on October 6, 2019 at 07:30 WIB, the victim was a 44 years old male, the victim was found dead in his house. On external examination, he found one incoming gunshot wound to the right side of the head and one exit gunshot wound to the left head. On internal examination, there was blood absorption in the brain and its layers. There was a penetrating wound that entered the right scalp and a penetrating wound on the left side of the scalp. From the results of forensic and histopathological examinations on a male victim aged 44 years, especially the internal examination of the corpse, it can be concluded that the cause of death of the victim is the destruction of brain tissue which causes loss of function of body organs due to very close gunshot wounds. And the victim allegedly committed suicide.

Self-Inflicted Gun Shot Wounds: A Retrospective, Observational Study of U.S. Trauma Centers.

IntroductionIntentional self-harm (suicide) by firearms is a growing problem in the United States. Currently, there are no large studies that have identified risk factors for patients who die from self-inflicted gunshot wounds. Our objectives are to 1) identify risk factors for patients with the highest morbidity and mortality from self-inflicted gunshot wounds (SIGSWs) at trauma centers 2) present the outcomes of victims of SIGSW by handguns (HG) versus all other specified guns (AOG) and 3) compare the presentations and outcomes of victims with head or face (HF) injuries to other regions of the body.MethodsWe performed a retrospective analysis from the National Trauma Database (NTDB) data between 2012 and 2013 of all SIGSW patients who presented to trauma centers. Categorical data included patient characteristics upon presentation and outcomes which were compared between patients with HG injury versus AOG injury using the Chi-Squared test, where AOG includes shotguns, hunting rifles, and military firearms. Additionally, analysis of head and face (HF) injuries versus other bodily injuries (OBI) were compared between the HG group versus AOG group using Chi-squared test.ResultsThere were 7,828 SIGSWs, of those, 78% (6,115) were white and 84.3% (6,600) were male. There were 5,139 HG injuries, 1,130 AOG injuries, and 1,405 unidentified gun injuries. The HG group was likely to be older (>55 years old), hypotensive (systolic blood pressure < 90), have a lower Glasgow Coma Score (GCS < 9), use illegal, or use prescription drugs. In comparing HF injuries (4,799) versus other bodily injuries (OBI) (3,028), HF group was more likely to use handguns, expire in ED, require ICU, and have a higher percent of overall mortality. Of the total OBI, the thorax, upper extremities, and abdomen were the most commonly injured.ConclusionIn our retrospective study of SIGSWs, we were able to demonstrate that SIGSW by handguns are associated with higher rates of mortality versus all other types of firearms. SIGSWs in older white males with handguns are the most at-risk for severe complications. Future efforts should improve screening methods for handguns in suicidal patients and at developing prevention programs.

The case of the disappearing bullet: An extraluminal compression of the biliary tree

Penetrating abdominal injuries, especially from gun shot wounds, are a common occurrence in South African hospitals, and a vast majority of these patient receive surgical intervention for suspected intra-abdominal injuries. Not all bullets are found and removed however, and we detail the case of a gentleman who presented to our institution with obstructive jaundice secondary to an extraluminal compression of his biliary tree by a retained migrated bullet, that spontaneously resolved, without any surgical intervention.

Civilian Gun Shot Wounds Associated With Spinal Injuries.

Study Design:RetrospectiveObjective:To evaluate functional outcomes and characteristics associated with gunshot wound (GSW) to the spine.Methods:Patients with GSW to the spine managed at a Level 1 Trauma Center from January 2003 to December 2017 were enrolled. Patient demographics, diagnoses, level of injury, American Spinal Injury Association (ASIA) score, ambulatory status at follow-up, bowel and bladder function, clinical improvement, and mortality were evaluated. Clinical improvement was defined as a progression in ambulatory status category at latest follow up.Results:51 patients with GSW of the spine were identified. 48 (94.1%) were male and 3 (5.9%) were female, with a mean age of 27 years-old (range 15-56). 38 (74.5%) were Caucasian, 7 (13.7%) were African American, 1 (2.0%) Asian-American, and 5 (9.8%) were Other/Unknown. 46 (90.2%) patients had GSW related spinal fractures and 44 (86.3%) had neurological deficits. Among patients with neurologic deficits, 5 (9.8%) had Cauda Equina Syndrome, 1 (2%) had Brown-Sequard Syndrome, and 38 (74.5%) spinal cord injuries: ASIA A 26 (68.4%); ASIA B 3 (7.9%); ASIA C 7 (18.4%); ASIA D 2 (5.3%). At mean follow-up time of 4.2 years (SD 3.9), 27 (52.9%) patients were wheelchair bound, 11 (21.6%) were ambulating with assistance, and 13 (25.5%) had normal ambulation. ASIA grade (A or B) was significantly, P < 0.00001, associated with being wheelchair bound and having neurogenic bowel or bladder at follow-up.Conclusions:Most spinal GSW patients (70.6%) did not have any clinical improvement in ambulatory status and most injuries were ASIA A.

Regional anaesthesia for labour, operative vaginal delivery and caesarean delivery: a narrative review.

This narrative review discusses recent evidence surrounding the use of regional anaesthesia in the obstetric setting, including intrapartum techniques for labour and operative vaginal delivery, and caesarean delivery. Pudendal nerve blockade, ideally administered by an obstetrician, should be considered for operative vaginal delivery if neuraxial analgesia is contraindicated. Regional techniques are increasingly utilised in clinical practice for caesarean delivery to minimise opioid consumption, reduce pain, improve postpartum recovery and facilitate earlier discharge as part of enhanced recovery protocols. The evidence surrounding transversus abdominis plane and quadratus lumborum blockade supports their use when: long-acting neuraxial opioids cannot be administered due to contraindications; if emergency delivery necessitates general anaesthesia; or as a postoperative rescue technique. Current data suggest quadratus lumborum blockade is no more effective than transversus abdominis plane blockade after caesarean delivery. Transversus abdominis plane blockade, wound catheter insertion and single shot wound infiltration are all effective techniques for reducing postoperative opioid consumption, with transversus abdominis plane blockade favoured, followed by wound catheters and then wound infiltration. Ilio-inguinal and iliohypogastric, erector spinae plane and rectus sheath blockade all require further studies to determine their efficacy for caesarean delivery in the presence or absence of long-acting neuraxial opioids. Future studies are needed to: compare approaches for individual techniques; determine which combinations of techniques and dosing regimens result in optimal analgesic and recovery outcomes following delivery; and elucidate the populations that benefit most from regional anaesthesia in the obstetric setting.