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1.
J Surg Res ; 245: 529-536, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470333

RESUMO

BACKGROUND: Gun violence among children and teenagers in the United States occurs at a magnitude many times that of other industrialized countries. The trends of injury in this age group relative to the adult population are not well studied. This study seeks to measure trends in pediatric firearm injuries in the United States. METHODS: Data from the National Trauma Data Bank (2010-2016) were used in selecting patients evaluated for firearm injury. Patients were classified as children and teenagers (<20 y) or adults (≥20 y). Changes in the proportion of firearm injuries among children and teenagers relative to the overall population (pediatric component) were determined using trend analyses. RESULTS: There were 240,510 firearm injuries with children and teenagers accounting for 45,075 of these injuries (pediatric component of 18.7%). Pediatric firearm injury was mostly among males (87.4%), Blacks (60.7%), and victims of assault (76.0%). The pediatric component of firearm injuries decreased from 21.7% in 2010 to 18.2% in 2016 (P-trend < 0.001). Although there was a decrease from 22.7% to 17.6% in the pediatric component of assault (P-trend < 0.001), there was an increase from 8.7% to 10.1% in the pediatric component of self-inflicted injuries (P-trend = 0.028). Substratification by race/ethnicity showed decrease in the pediatric component of firearm injuries among all groups (P-trend < 0.001) except Whites (P-trend = 0.847). CONCLUSIONS: Despite reductions in the pediatric component of firearm injuries, there remains a significant burden of injury in this group. Continued public health efforts are necessary to ensure safety and reduce firearm injuries among children and teenagers in the United States.


Assuntos
Efeitos Psicossociais da Doença , Violência/tendências , Ferimentos por Arma de Fogo/epidemiologia , Adolescente , Criança , Vítimas de Crime/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estados Unidos/epidemiologia , Violência/prevenção & controle , Violência/estatística & dados numéricos , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/etiologia , Adulto Jovem
2.
J Pediatr Ophthalmol Strabismus ; 56: e65-e67, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31821509

RESUMO

This report discusses the potential ocular injuries associated with an air-powered salt gun, a new product that may appeal to children. The authors hope to inform both providers and patients of the potential risks and treatment considerations if an injury of this type is sustained. [J Pediatr Ophthalmol Strabismus. 2019;56:e65-e67.].


Assuntos
Córnea/patologia , Traumatismos Oculares/diagnóstico , Cloreto de Sódio , Ferimentos por Arma de Fogo/diagnóstico , Cadáver , Feminino , Humanos , Pessoa de Meia-Idade , Índices de Gravidade do Trauma
3.
Iowa Orthop J ; 39(1): 173-177, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413691

RESUMO

Background: Although the rate of non-fatal gunshot wounds (GSW) has increased, few studies have compared the effectiveness of operative and nonoperative treatment with specific focus on infection. We compared the risk of septic arthritis in patients with traumatic arthrotomies caused by GSW treated operatively with irrigation and debridement versus nonoperatively with antibiotics and wound care. Methods: From 2009 to 2016, 46 patients at our institution sustained traumatic arthrotomies from low-velocity GSW with at least 90-day follow-up. Medical records were reviewed for demographic information, imaging, type and duration of antibiotics, details of operative and nonoperative interventions, and evidence of infection at follow-up visits. We measured the rate of septic arthritis using a 2-tailed t test. Results: The knee was the most commonly affected joint (34 patients; 73.9%). Eight patients (17.4%) were treated nonoperatively and 38 (82.6%) were treated operatively. In the nonoperative group, one patient (12.5%) developed a superficial wound infection that resolved with oral antibiotics. In the operative group, one patient (2.6%) developed a superficial wound infection requiring operative irrigation and debridement. There was no statistically significant difference in risk of infection between the two groups (P = 0.32). No patient developed septic arthritis. Conclusions: In select patients, nonoperative treatment with wound care and antibiotics may be sufficient for preventing infection after GSW-related traumatic arthrotomies. Findings of randomized studies and treatment algorithms are needed to further evaluate this relatively common injury.Level of Evidence: IV.


Assuntos
Artrite Infecciosa/terapia , Tratamento Conservador/métodos , Fraturas Intra-Articulares/cirurgia , Articulações/lesões , Articulações/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adulto , Artrite Infecciosa/etiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/terapia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico , Adulto Jovem
4.
Khirurgiia (Mosk) ; (8): 63-68, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464277

RESUMO

Thoracic and abdominal injuries caused air weapons are rarer compared with gunshot wounds. Nevertheless, pneumatic weapons are able to inflict potentially fatal lesions despite small mass and dimension of projectile. Three clinical cases of patients with various internal injuries are presented in the article. Differentiated diagnostic and surgical approach is suggested.


Assuntos
Traumatismos Abdominais/etiologia , Armas de Fogo , Traumatismos Torácicos/etiologia , Ferimentos por Arma de Fogo/etiologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , Armas de Fogo/classificação , Humanos , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/terapia , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/terapia
6.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31308258

RESUMO

BACKGROUND: Firearms are the second leading cause of pediatric death in the United States. There is significant variation in firearm legislation at the state level. Recently, 3 state laws were associated with a reduction in overall deaths from firearms: universal background checks for firearm purchases, universal background checks for ammunition purchases, and identification requirement for firearms. We sought to determine if stricter firearm legislation at the state level is associated with lower pediatric firearm-related mortality. METHODS: This was a cross-sectional study in which we used 2011-2015 Web-based Injury Statistics Query and Reporting System and Census data. We measured the association of the (1) strictness of firearm legislation (gun law score) and (2) presence of the 3 aforementioned gun laws with pediatric firearm-related mortality. We performed negative binomial regression accounting for differences in state-level characteristics (population-based race and ethnicity, education, income, and gun ownership) to derive mortality rate ratios associated with a 10-point change in each predictor and predicted mortality rates. RESULTS: A total of 21 241 children died of firearm-related injuries during the 5-year period. States with stricter gun laws had lower rates of firearm-related pediatric mortality (adjusted incident rate ratio 0.96 [0.93-0.99]). States with laws requiring universal background checks for firearm purchase in effect for ≥5 years had lower pediatric firearm-related mortality rates (adjusted incident rate ratio 0.65 [0.46-0.90]). CONCLUSIONS: In this 5-year analysis, states with stricter gun laws and laws requiring universal background checks for firearm purchase had lower firearm-related pediatric mortality rates. These findings support the need for further investigation to understand the impact of firearm legislation on pediatric mortality.


Assuntos
Armas de Fogo/legislação & jurisprudência , Ferimentos por Arma de Fogo/mortalidade , Adolescente , Criança , Estudos Transversais , Feminino , Homicídio/legislação & jurisprudência , Homicídio/tendências , Humanos , Masculino , Mortalidade/tendências , Suicídio/legislação & jurisprudência , Suicídio/tendências , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/diagnóstico , Adulto Jovem
8.
Sud Med Ekspert ; 62(2): 52-54, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31213593

RESUMO

This article reports the results of a forensic medical expertise of the gunshot wound in a serviceman wearing a bulletproof vest with special reference to the behaviour of the bullet that underwent deformation upon hitting the jacket. The authors emphasize the difficulty of differential diagnostics between the entry and exit wounds in the cases like that described in the paper. A series of experiments provided the data suggesting the specific mechanism by which exit gunshot wounds are formed in those parts of the body that adjoin the material from which the bulletproof vest is made. Special attention is given to the morphological features of such wounds and injuries to the biological tissues.


Assuntos
Balística Forense , Equipamentos de Proteção , Ferimentos por Arma de Fogo/diagnóstico , Diagnóstico Diferencial , Humanos
9.
Sud Med Ekspert ; 62(2): 55-60, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31213594

RESUMO

The objective of the present work was the analysis of the literature publications concerned with the modern approaches to the diagnostics of gunshot injuries with special reference to the most promising applications of the immunohistochemical methods. The use of certain antibodies for determining of intravitality and prescription of gunshot injuries is illustrated by concrete examples. It is concluded that further studies on the possibilities for the application of the immunohistochemical methods are needed.


Assuntos
Imuno-Histoquímica , Ferimentos por Arma de Fogo/diagnóstico , Humanos
10.
Sud Med Ekspert ; 62(2): 61-66, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31213595

RESUMO

This article reports the results of the analysis of the literature publications illustrating the current state of forensic medical expertise of gunshot injuries formed as a consequence of the interaction of the projectile with the obstacle. Also presented are the results of the experimental studies in this field and the prospects for their further development. The completeness of the solution of the topical problems of forensic medical ballistics is estimated. Taken together, the literature data and the results of the authors' original investigations provided the objective grounds for carrying out the experimental studies of gunshot injuries resulting from ricocheting bullets and shotgun pellets depending on the conditions and circumstances of the shot.


Assuntos
Armas de Fogo , Balística Forense , Ferimentos por Arma de Fogo/diagnóstico , Humanos
11.
Surg Radiol Anat ; 41(9): 1065-1069, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31254040

RESUMO

INTRODUCTION: In the following article, we are presenting a clinical observation of Baron Larrey. In 1804, Larrey was the inspector general of health, as well as the chief surgeon of the imperial Napoleonic Guard. He participated in all of Napoleon's campaigns. A paleopathological study was performed on a skull from Dupuytren's Museum (Paris) with a long metal stick in the head. We report here a clinical case as well as the autopsy description of this soldier's skull following his death. We propose a different anatomical analysis of the skull, which allowed us to rectify what we believe to be an anatomical error and to propose varying hypotheses regarding the death of soldier Cros. MATERIALS AND METHODS: The skull was examined, observed and described by standard paleopathology methods. Measurements of the lesion were performed with metric tools and expressed in centimeters. Historical research was made possible through the collaboration with the Museum of Medicine History-Paris Descartes University. RESULTS: Following the above detailed anatomical analysis of the path of the metal rod, we propose various possible lesions in soldier Cros due to the accident. At the inlet, the frontal sinuses could have been damaged. At the level of the second portion of the intracranial path, all of the anatomical elements present in the cavernous sinus could have been injured (cranial nerves III, IV, V1 and V2, VI, internal carotid artery and cavernous sinus). The exit orifice of the foreign body passes through the left condylar fossa of the occipital bone, points to a highly probable lesion of the left hypoglossal nerve (12th cranial nerve). CONCLUSION: The paleopathological study of human remains, when combined with anatomical and clinical knowledge of the pathologies of the head and neck, can rectify diagnoses of the past.


Assuntos
Restos Mortais/anatomia & histologia , Antropologia Forense/métodos , Crânio/anatomia & histologia , Ferimentos por Arma de Fogo/diagnóstico , Adulto , Autopsia , Restos Mortais/lesões , Cadáver , História do Século XIX , Humanos , Masculino , Militares , Museus , Crânio/lesões , Ferimentos por Arma de Fogo/etiologia
12.
Ulus Travma Acil Cerrahi Derg ; 25(3): 259-267, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135949

RESUMO

BACKGROUND: Several scoring systems have been and continue to be developed in numerous countries with the goal of quickly and accurately assessing the severity of trauma injuries. The aim of this study was to identify factors that help to determine the gravity of damage and to minimize it, in order to reduce mortality and morbidity. It is important that the criteria set for the determination of the severity of trauma are objective, measurable, and comparable. This study was an assessment of the contribution of vital signs, hemogram values, and trauma severity scores recorded at initial admission in the prediction of mortality in patients with firearm trauma wounds. METHODS: This was a retrospective cohort study. Patients with gunshot injuries who were admitted to the emergency department (ED) of a single facility between December 2015 and March 2016 were included in the study. Statistical software was used to perform bivariate analyses using a t-test or the Mann-Whitney U test for continuous variables, depending on the distribution of variables, and logistic regression analysis was utilized to determine independent predictors of mortality after ED admission. A p value of <0.05 was considered statistically significant. RESULTS: A total of 418 patients were included. A statistically significant difference was found between the white blood cell count, respiratory rate, Glasgow Coma Scale score, Abbreviated Injury Scale score, and the Injury Severity Score (ISS) of the patients who survived and those who died (p<0.05). The analysis also indicated that a systolic blood pressure below 90 mmHg and a heart rate above 100 beats/minute were independent variables in terms of the expectation of mortality. CONCLUSION: The objective assessment of the ISS at admission to the ED is an important element in the calculation of hemoglobin requirements, mortality, and morbidity.


Assuntos
Escala de Gravidade do Ferimento , Ferimentos por Arma de Fogo , Pressão Sanguínea/fisiologia , Escala de Coma de Glasgow/estatística & dados numéricos , Humanos , Contagem de Leucócitos/estatística & dados numéricos , Taxa Respiratória/fisiologia , Estudos Retrospectivos , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/fisiopatologia
13.
J Vasc Surg ; 69(5): 1524-1531.e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31010517

RESUMO

OBJECTIVE: Firearm injuries have high morbidity and mortality. Presentation of injuries requiring concurrent vascular repair and its outcomes are unclear. Our study's objective was to characterize the injury details and to assess the associated mortality and morbidity after vascular repair. METHODS: The National Inpatient Sample was queried from 1993 to 2014 for all firearm injuries. International Classification of Diseases, Ninth Revision codes were used to identify firearm injuries and those who also underwent a vascular repair. Multivariable analysis was used to assess the effect of a concurrent vascular repair on outcomes. RESULTS: There were 648,662 firearm injuries identified; 63,973 (9.9%) involved a vascular repair. Overall, 88.7% of patients were male, and Medicaid was the most common insurance (40.2%). Intents were assault or legal intervention (60%), unintentional (24.2%), and suicide (8.6%). Patients undergoing vascular repair were younger, more often of black race and male sex, and on Medicaid insurance, with a lower household income and assault/legal intent (P < .005). Patients who underwent vascular repair had a higher frequency of abdomen/pelvis and extremity injuries as well as an elevated New Injury Severity Score (P < .005). Patients with vascular repair were more frequently treated at urban, teaching, and large hospitals (P < .005). Overall mortality rate was 2.2%; patients who underwent vascular repair had a higher mortality compared with those without (5.51% vs 1.98%; P < .001). Patients with vascular repair had higher rates of acute renal failure (3.1% vs 0.8%), venous thromboembolic events (0.5% vs 0.3%), pulmonary-related events (0.6% vs 0.28%), cardiac-related events (0.8% vs 0.2%), sepsis (1.4% vs 0.5%), and any complication (5.7% vs 2%; all P < .0001). Vascular repair was independently associated with mortality (odds ratio [OR], 2.68; 95% confidence interval [CI], 2.43-2.95; P < .0001). Age older than 46 years (OR, 2.01; 95% CI, 1.71-2.35; P < .0001), male sex (OR, 1.15; 95% CI, 1.05-1.25; P = .003), self-pay/no insurance (OR, 1.6; 95% CI, 1.47-1.75; P < .0001), suicide intent (OR, 3.73; 95% CI, 3.36-4.13; P < .0001), unintentional intent (OR, 1.12; 95% CI, 1.03-1.22; P < .0001), head/neck location (OR, 13.9; 95% CI, 12.5-15.6; P < .0001), Northeast region, and New Injury Severity Score >4 were independently associated with in-hospital mortality. Vascular repair was also independently associated with any complication (OR, 2.12; 95% CI, 1.98-2.28; P < .0001). CONCLUSIONS: Firearm injuries with vascular repair were independently associated with higher injury severity score and mortality. A majority of vascular repairs were performed for injury to the abdomen/pelvis and extremity with assault/legal intent, whereas head and neck injury and suicide intent were the least frequent.


Assuntos
Armas de Fogo , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Lesões do Sistema Vascular/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Vasculares/mortalidade , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/mortalidade , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
14.
J Trauma Acute Care Surg ; 87(3): 690-698, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30939579

RESUMO

The wound ballistics literature contains several misconceptions about the physical effects of penetrating projectiles in tissue and tissue simulants. These can adversely affect the proper management of gunshot injuries, particularly in view of the ongoing threat of terrorist and criminal acts using assault rifles against civilians. The understanding of the wounding effects by military rifle bullets can be founded on the concept of energy transfer to the wound as applied to high-energy missile trauma. A substantial component of high-energy transfer in assault rifle injuries is manifested by the dynamic phenomenon of temporary cavitation, which is extensively reviewed with respect to its impact on the wound production and the associated controversy surrounding its consequences in soft tissue wounds. Part of this controversy emanates from misinterpretation of experimental data regarding the magnitude of the temporary cavity induced by high-velocity projectiles and the different conceptions of the tissue response to cavitation. The interaction between the projectile and tissue can lead to tumbling and possibly to deformation and fragmentation of the bullet, all of which strongly influence the energy transfer characteristics affecting both the temporary cavitation and the size of the permanent wound channel. Awareness of these effects can enhance perception of clinical and radiological findings suggestive of the wounding mechanism by various projectiles. LEVEL OF EVIDENCE: Review/therapeutic, level V.


Assuntos
Armas de Fogo , Balística Forense , Medicina Militar , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/patologia , Humanos , Músculo Esquelético/lesões , Ferimentos por Arma de Fogo/terapia
16.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30835244

RESUMO

: media-1vid110.1542/5972298231001PEDS-VA_2018-1171Video Abstract BACKGROUND: Firearm-related fatalities are a top 3 cause of death among children in the United States. Despite historical declines in firearm ownership, the firearm-related mortality rate among young children has risen over the past decade. In this study, we examined changes in firearm ownership among families with young children from 1976 to 2016, exploring how such changes relate to recent increases in firearm-related mortality among 1- to 5-year-olds. METHODS: Individual-level data from the National Vital Statistics System were merged with household-level data from the General Social Survey to create national-level estimates of firearm-related child mortality and family firearm ownership from 1976 to 2016 (n = 41 years). Vector autoregression models were used to examine the association between firearm ownership and child mortality. RESULTS: The proportion of non-Hispanic white families with young children who owned firearms declined from 50% in 1976 to 45% in 2016 and from 38% to 6% among non-Hispanic African American families. The proportion of white families with young children who owned handguns, however, increased from 25% to 32%; 72% of firearm-owning families with young children now own a handgun. Increases in handgun ownership partially explained the recent rise in firearm-related white child mortality (B = 0.426), net of economic conditions, and sociodemographic characteristics of firearm-owning families. CONCLUSIONS: Changes in the types of firearms in the homes of US families may partially explain recently rising firearm-related mortality among young white children. These findings hold relevance for pediatricians and policy makers aiming to reduce firearm-related mortality and promote firearm safety in children's homes.


Assuntos
Armas de Fogo , Propriedade/normas , Propriedade/tendências , Segurança/normas , Ferimentos por Arma de Fogo/mortalidade , Criança , Pré-Escolar , Armas de Fogo/legislação & jurisprudência , Humanos , Lactente , Mortalidade/tendências , Propriedade/legislação & jurisprudência , Segurança/legislação & jurisprudência , Ferimentos por Arma de Fogo/diagnóstico
18.
Can J Cardiol ; 35(2): 229.e11-229.e13, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30760433

RESUMO

Pulmonary hypertension is a known complication of high-flow arteriovenous fistulas (AVFs). We present a case of a 58-year-old man who sustained a gunshot wound 6.5 years before presentation for worsening pulmonary hypertension (PH). After diagnostic workup, the PH was attributed to a gunshot-related AVF. Exercise capacity and echocardiographic parameters improved after successful ligation of the AVF. This case highlights a rare and correctable cause of PH that requires careful investigation and multidisciplinary expertise for treatment.


Assuntos
Fístula Arteriovenosa/complicações , Nádegas/lesões , Artéria Femoral/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Ferimentos por Arma de Fogo/complicações , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirurgia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Humanos , Hipertensão Pulmonar/diagnóstico , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Vasculares/métodos , Ferimentos por Arma de Fogo/diagnóstico
19.
Sud Med Ekspert ; 62(1): 8-12, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30724886

RESUMO

The objective of the present study was to reveal the objective topographic and morphological features of entry holes in the cloths produced by the hunting smoothbore weapon shots from different distances using various ('cylinder' and 'choke') adjustable muzzle adapters and the regular cartridges loaded with shotgun pellets in a closing container wad and without it. The study has demonstrated the influence of the specific constructive features of the muzzle adapters and differently loaded cartridges on the mechanisms of damages caused by the gunshots from different distances.


Assuntos
Armas de Fogo , Balística Forense , Têxteis , Ferimentos por Arma de Fogo/diagnóstico , Humanos
20.
J Vasc Surg ; 70(1): 224-232, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30786987

RESUMO

OBJECTIVE: Vascular injury is a leading cause of death and disability in military and civilian settings. Most wartime and an increasing amount of civilian vascular trauma arises from penetrating mechanisms of injury due to gunshot or explosion. The objective of this study was to provide a comprehensive examination of penetrating lower extremity arterial injury and to characterize long-term limb salvage and differences related to mechanisms of injury. METHODS: The military trauma registries of the United States and the United Kingdom were analyzed to identify service members who sustained penetrating lower limb arterial injury (2001-2014). Treatment and limb salvage data were studied and comparisons made of patients whose penetrating vascular trauma arose from explosion (group 1) vs gunshot (group 2). Standardized statistical testing was used, with Bonferroni corrections for multiple comparisons. RESULTS: The cohort consisted of 568 combat casualties (mean age, 25.2 years) with 597 injuries (explosion, n = 416; gunshot, n = 181). Group 1 had higher Injury Severity Score (P < .05) and Mangled Extremity Severity Score (P < .0001), required more blood transfusion (P < .05), and had more tibial (P < .01) and popliteal (P < .05) arterial injuries; group 2 had more profunda femoris injuries (P < .05). Initial surgical management for the whole cohort included vein interposition graft (33%), ligation (31%), primary repair with or without patch angioplasty (16%), temporary vascular shunting (15%), and primary amputation (6%). No difference in patency of arterial reconstruction was found between group 1 and group 2, although group 1 had a higher incidence of primary (13% vs 2%; P < .05) and secondary (19% vs 9%; P < .05) amputation. Similarly, longer term freedom from amputation was lower for group 1 than for group 2 (68% vs 89% at 5.5 years; Cox hazard ratio, 0.30; P < .0001), as was physical functioning (36-Item Short Form Health Survey data; mean, 39.80 vs 43.20; P < .05). CONCLUSIONS: The majority of wartime lower extremity arterial injuries result from an explosive mechanism that preferentially affects the tibial vasculature and results in poorer long-term limb salvage compared with those injured with firearms. The mortality associated with immediate limb salvage attempts is low, and delayed amputations occur weeks later, affording the patient involvement in the decision-making and rehabilitation planning. We recommend assertive attempts at vascular repair and limb salvage for service members injured by explosive and gunshot mechanisms.


Assuntos
Amputação , Artérias/cirurgia , Traumatismos por Explosões/cirurgia , Procedimentos Endovasculares , Extremidade Inferior/irrigação sanguínea , Enxerto Vascular , Ferimentos por Arma de Fogo/cirurgia , Adulto , Amputação/efeitos adversos , Amputação/mortalidade , Conflitos Armados , Artérias/lesões , Artérias/fisiopatologia , Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/mortalidade , Traumatismos por Explosões/fisiopatologia , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Humanos , Escala de Gravidade do Ferimento , Ligadura , Salvamento de Membro , Medicina Militar , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Reino Unido , Estados Unidos , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodos , Enxerto Vascular/mortalidade , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/mortalidade , Ferimentos por Arma de Fogo/fisiopatologia , Adulto Jovem
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