School of Medicine and Health Sciences Poster Presentations

Title

Cause of Death and Wounding Pattern in Firearm-Related Violence in Washington, D.C.

Document Type

Poster

Abstract Category

Clinical Specialties

Keywords

surgery, trauma, gunshot wound, autopsy

Publication Date

Spring 5-1-2019

Abstract

Cause of Death and Wounding Pattern in Firearm-Related Violence in Washington, D.C. Background Previous studies on gunshot wound (GSW) management have often excluded firearm deaths and autopsy reports from analysis. Recent research has found that GSW fatalities in civilian public mass shootings (CPMS) most often involve injury to the head, chest, and extremities. This study investigates the mechanism of death and wounding pattern among firearm fatalities in Washington, D.C. Methods One hundred and eighty two autopsies representing all GSW fatalities in the D.C. area from January 1, 2016, to December 31, 2017 were included. Date of injury, date of death, age, gender, race, manner of death (homicide, suicide, unknown, or confirmed accident), types of weapon used (handgun, rifle, shotgun, unknown), number and location of GSWs, pre-hospital interventions, and transport were collected. Congruent with the approach taken by trauma surgeons, each skin wound was counted as a separate GSW. GSWs were catalogued by body region, which was defined as head (including face), neck, chest/upper back (defined as above the costal margin or above the tip of the scapula), abdomen/lower back (including groin and buttocks), and extremity. Non-penetrating graze wounds were not counted as GSWs. Outcomes included fatal organ or vascular injury. Results One hundred and eighty two autopsy reports were reviewed. The population was 91% male with a mean age of 31 (SD 12.5 y). Homicide accounted for 92% of fatalities followed by suicide (7.1%), accident (0.5%), and unknown (0.5%). Handguns were used in 99% of cases while rifles were used in the remaining 1% of cases. GSW locations were distributed as follows: 30% chest/upper back, 23% head/face, 21% extremity, 19% abdomen/lower back, 7% neck. The organs most commonly fatally injured were the brain (39%), lung parenchyma (37%), heart (27%), thoracic aorta (19%), and liver (19%). Transport to trauma center rates differed with head wounds being less likely to be transported (45% vs. 55%, p = 0.0003), and abdominal wounds being more likely to be transported (45% vs. 29%, p = 0.03). Conclusion The head and chest are the most commonly injured areas in firearm-related fatalities. While the extremity injuries account for a large proportion of GSWs, these injuries rarely result in death. The brain, heart, and lung were the most common fatally injured organs. Internal bleeding from penetrating trunk and head wounds is best addressed by rapid transport to the hospital for management.

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Presented at Research Days 2019.

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Cause of Death and Wounding Pattern in Firearm-Related Violence in Washington, D.C.

Cause of Death and Wounding Pattern in Firearm-Related Violence in Washington, D.C. Background Previous studies on gunshot wound (GSW) management have often excluded firearm deaths and autopsy reports from analysis. Recent research has found that GSW fatalities in civilian public mass shootings (CPMS) most often involve injury to the head, chest, and extremities. This study investigates the mechanism of death and wounding pattern among firearm fatalities in Washington, D.C. Methods One hundred and eighty two autopsies representing all GSW fatalities in the D.C. area from January 1, 2016, to December 31, 2017 were included. Date of injury, date of death, age, gender, race, manner of death (homicide, suicide, unknown, or confirmed accident), types of weapon used (handgun, rifle, shotgun, unknown), number and location of GSWs, pre-hospital interventions, and transport were collected. Congruent with the approach taken by trauma surgeons, each skin wound was counted as a separate GSW. GSWs were catalogued by body region, which was defined as head (including face), neck, chest/upper back (defined as above the costal margin or above the tip of the scapula), abdomen/lower back (including groin and buttocks), and extremity. Non-penetrating graze wounds were not counted as GSWs. Outcomes included fatal organ or vascular injury. Results One hundred and eighty two autopsy reports were reviewed. The population was 91% male with a mean age of 31 (SD 12.5 y). Homicide accounted for 92% of fatalities followed by suicide (7.1%), accident (0.5%), and unknown (0.5%). Handguns were used in 99% of cases while rifles were used in the remaining 1% of cases. GSW locations were distributed as follows: 30% chest/upper back, 23% head/face, 21% extremity, 19% abdomen/lower back, 7% neck. The organs most commonly fatally injured were the brain (39%), lung parenchyma (37%), heart (27%), thoracic aorta (19%), and liver (19%). Transport to trauma center rates differed with head wounds being less likely to be transported (45% vs. 55%, p = 0.0003), and abdominal wounds being more likely to be transported (45% vs. 29%, p = 0.03). Conclusion The head and chest are the most commonly injured areas in firearm-related fatalities. While the extremity injuries account for a large proportion of GSWs, these injuries rarely result in death. The brain, heart, and lung were the most common fatally injured organs. Internal bleeding from penetrating trunk and head wounds is best addressed by rapid transport to the hospital for management.