Necessity breeds invention: a study of outpatient management of low velocity gunshot wounds.

BACKGROUND

Since the late 1980s, the emergency department (ED) at the Mater Hospital, Belfast, has implemented a policy of treating conservatively patients who sustain low velocity gunshot wounds to the lower limbs. Wounds are cleaned and minimally debrided under local anaesthetic in the ED. Patients are given oral antibiotics, and reviewed 48 hours later at the ED review clinic.

OBJECTIVE

To investigate the outcome of outpatient ED management of low velocity gunshot wounds to the lower limbs.

METHOD

This was a retrospective, observational study from January 2000 to September 2004 inclusive. Notes were retrieved of those patients who had gunshot wound mentioned in the triage text. Patients were included if they presented with a low velocity gunshot wound to the lower limbs. Demographics and treatment regimen were recorded.

RESULTS

In total, 90 patients sustained low energy injuries to the lower limb, with 70.5% of wounds involving the skin and soft tissue only. Most patients (n = 67) were treated as outpatients, which included 80% of unilateral injuries and 46.6% of bilateral injuries presented. There were 56 patients reviewed at clinic. Three patients developed minor complications

CONCLUSION

Irrigation and minimal debridement in the outpatient setting is an acceptable method of treatment for low energy gunshot wounds to the lower limbs, without orthopaedic or vascular involvement.