DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida.
DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida.
J Surg Res. 2024 Feb;294:106-111. doi: 10.1016/j.jss.2023.09.067. Epub 2023 Oct 20.
Ballistic injuries cause both a temporary and permanent cavitation event, making them far more destructive and complex than other penetrating trauma. We hypothesized that global injury scoring and physiologic parameters would fail to capture the lethality of gunshot wounds (GSW) compared to other penetrating mechanisms.
The 2019 American College of Surgeons Trauma Quality Programs participant use file was queried for the mortality rate for GSW and other penetrating mechanisms. A binomial logistic regression model ascertained the effects of sex, age, hypotension, tachycardia, mechanism, Glasgow Coma Scale, ISS, and volume of blood transfusion on the likelihood of mortality. Subgroup analyses examined isolated injuries by body regions.
Among 95,458 cases (82% male), GSW comprised 46.4% of penetrating traumas. GSW was associated with longer hospital length of stay (4 [2-9] versus 3 [2-5] days), longer intensive care unit length of stay (3 [2-6] versus 2 [2-4] days), and more ventilator days (2 [1-4] versus 2 [1-3]) compared to stab wounds, all P < 0.001. The model determined that GSW was linked to increased odds of mortality compared to stab wounds (odds ratio 4.19, 95% confidence interval 3.55-4.93). GSW was an independent risk factor for acute kidney injury, acute respiratory distress syndrome, venous thromboembolism, sepsis, and surgical site infection.
Injury scoring systems based on anatomical or physiological derangements fail to capture the lethality of GSW compared to other mechanisms of penetrating injury. Adjustments in risk stratification and reporting are necessary to reflect the proportion of GSW seen at each trauma center. Improved classification may help providers develop quality processes of care. This information may also help shape public discourse on this highly lethal mechanism.
弹道伤会引起暂时和永久性的空化现象，使其比其他穿透性创伤更具破坏性和复杂性。我们假设，与其他穿透性机制相比，全身损伤评分和生理参数无法捕捉到枪击伤（GSW）的致命性。
查询了 2019 年美国外科医师学会创伤质量计划参与者的使用文件，以确定 GSW 和其他穿透性机制的死亡率。二项逻辑回归模型确定了性别、年龄、低血压、心动过速、机制、格拉斯哥昏迷评分、ISS 和输血量对死亡率的影响。亚组分析检查了身体各部位的孤立伤。
在 95458 例（82%为男性）中，GSW 占穿透性创伤的 46.4%。与刺伤相比，GSW 与更长的住院时间（4 [2-9] 天与 3 [2-5] 天）、更长的重症监护病房住院时间（3 [2-6] 天与 2 [2-4] 天）和更多的呼吸机天数（2 [1-4] 天与 2 [1-3] 天）相关，所有 P 值均<0.001。该模型确定，与刺伤相比，GSW 与更高的死亡几率相关（比值比 4.19，95%置信区间 3.55-4.93）。GSW 是急性肾损伤、急性呼吸窘迫综合征、静脉血栓栓塞、脓毒症和手术部位感染的独立危险因素。
基于解剖或生理紊乱的损伤评分系统无法捕捉到 GSW 与其他穿透性损伤机制相比的致命性。需要调整风险分层和报告，以反映每个创伤中心所见 GSW 的比例。改进分类可能有助于提供者制定护理质量流程。这些信息还可能有助于塑造关于这种高致命性机制的公众讨论。
