TY - JOUR
T1 - Gunshot wounds and blast injuries to the face are associated with significant morbidity and mortality
T2 - Results of an 11-year multi-institutional study of 720 patients
AU - Shackford, Steven R.
AU - Kahl, Jessica E.
AU - Calvo, Richard Y.
AU - Kozar, Rosemary A.
AU - Haugen, Christine E.
AU - Kaups, Krista L.
AU - Willey, Marybeth
AU - Tibbs, Brian M.
AU - Mutto, Susan M.
AU - Rizzo, Anne G.
AU - Lormel, Christy S.
AU - Shackford, Meghan C.
AU - Burlew, Clay Cothren
AU - Moore, Ernest E.
AU - Cogbill, Thomas H.
AU - Kallies, Kara J.
AU - Haan, James M.
AU - Ward, Jeanette
PY - 2014/2
Y1 - 2014/2
N2 - BACKGROUND: Gunshot wounds and blast injuries to the face (GSWBIFs) produce complex wounds requiring management by multiple surgical specialties. Previous work is limited to single institution reports with little information on processes of care or outcome. We sought to determine those factors associated with hospital complications and mortality. METHODS: We performed an 11-year multicenter retrospective cohort analysis of patients sustaining GSWBIF. The face, defined as the area anterior to the external auditory meatuses from the top of the forehead to the chin, was categorized into three zones: I, the chin to the base of the nose; II, the base of the nose to the eyebrows; III, above the brows. We analyzed the effect of multiple factors on outcome. RESULTS: From January 1, 2000, to December 31, 2010, we treated 720 patients with GSWBIF (539 males, 75%), with a median age of 29 years. The wounding agent was handgun in 41%, explosive (shotgun and blast) in 20%, rifle in 6%, and unknown in 33%. Prehospital or resuscitative phase airway was required in 236 patients (33%). Definitive care was rendered by multiple specialties in 271 patients (38%). Overall, 185 patients died (26%), 146 (79%) within 48 hours. Of the 481 patients hospitalized greater than 48 hours, 184 had at least one complication (38%). Factors significantly associated with any of a total of 207 complications were total number of operations (p < 0.001), Revised Trauma Score (RTS, p < 0.001), and head Abbreviated Injury Scale (AIS) score (p < 0.05). Factors significantly associated with mortality were RTS (p < 0.001), head AIS score (p < 0.001), total number of operations (p < 0.001), and age (p < 0.05). An injury located in Zone III was independently associated with mortality (p < 0.001). CONCLUSION: GSWBIFs have high mortality and are associated with significant morbidity. The multispecialty involvement required for definitive care necessitates triage to a trauma center and underscores the need for an organized approach and the development of effective guidelines. LEVEL OF EVIDENCE: Therapeutic/care management, level III.
AB - BACKGROUND: Gunshot wounds and blast injuries to the face (GSWBIFs) produce complex wounds requiring management by multiple surgical specialties. Previous work is limited to single institution reports with little information on processes of care or outcome. We sought to determine those factors associated with hospital complications and mortality. METHODS: We performed an 11-year multicenter retrospective cohort analysis of patients sustaining GSWBIF. The face, defined as the area anterior to the external auditory meatuses from the top of the forehead to the chin, was categorized into three zones: I, the chin to the base of the nose; II, the base of the nose to the eyebrows; III, above the brows. We analyzed the effect of multiple factors on outcome. RESULTS: From January 1, 2000, to December 31, 2010, we treated 720 patients with GSWBIF (539 males, 75%), with a median age of 29 years. The wounding agent was handgun in 41%, explosive (shotgun and blast) in 20%, rifle in 6%, and unknown in 33%. Prehospital or resuscitative phase airway was required in 236 patients (33%). Definitive care was rendered by multiple specialties in 271 patients (38%). Overall, 185 patients died (26%), 146 (79%) within 48 hours. Of the 481 patients hospitalized greater than 48 hours, 184 had at least one complication (38%). Factors significantly associated with any of a total of 207 complications were total number of operations (p < 0.001), Revised Trauma Score (RTS, p < 0.001), and head Abbreviated Injury Scale (AIS) score (p < 0.05). Factors significantly associated with mortality were RTS (p < 0.001), head AIS score (p < 0.001), total number of operations (p < 0.001), and age (p < 0.05). An injury located in Zone III was independently associated with mortality (p < 0.001). CONCLUSION: GSWBIFs have high mortality and are associated with significant morbidity. The multispecialty involvement required for definitive care necessitates triage to a trauma center and underscores the need for an organized approach and the development of effective guidelines. LEVEL OF EVIDENCE: Therapeutic/care management, level III.
KW - Gunshot wounds to the face
KW - management
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=84894055362&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84894055362&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e3182aaa5b8
DO - 10.1097/TA.0b013e3182aaa5b8
M3 - Article
C2 - 24398775
AN - SCOPUS:84894055362
SN - 2163-0755
VL - 76
SP - 347
EP - 352
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 2
ER -