Patterns and Factors for In-hospital Mortality of Gunshot Injury in Armed Forces Hospitals

ABSTRACT

PURPOSE: The frequency of gunshot injuries in Korea has recently increased, and treatment and evaluation of gunshot wounds are not confined to military medicine. Here, we evaluated patterns of gunshot injuries to determine factors affecting mortality. METHODS: This was a retrospective, multi-center study of gunshot injury in three tertiary military medical centers. The medical records of patients with gunshot injuries between January, 200X, and December, 200X, were reviewed. Injury severity was evaluated according to the Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma Score and Injury Severity Score (TRISS) indices. RESULTS: We recruited 37 patients, with most injuries in the head and neck (35.1%), with the brain showing the highest ISS score. The mean injury-to-hospital arrival time was 96.6 +/-58.2 minutes, and the hospital arrival-to-emergency operation time was 122.6+/-84.5 minutes. A total of 7 patients (18.9%) suffered severe injury, defined as ISS> or =16, and a Maximal Abbreviated Injury Scale (ABI)> or =4 was seen in 6 patients (16.2%). Mortality due to gunshot injury was 18.9%. In the survival group (n=30), the mean ISS was 5.9 +/-6.0, RTS was 7.5+/-1.1, and TRISS was 0.98+/-0.06. In the death group (n=7), mean ISS was 18.4+/-9.5 RTS was 1.1+/-1.4, and TRISS was 0.21+/-0.34. Brain injury, multiorgan injury, ISS> or =16, and maximal ABI> or =4 were significantly associated with death after gunshot injury. CONCLUSION: The head and neck were the most frequently injured sites, with attempted suicide contributing to more than 30% of gunshot injures in South Korea. Multi-organ injury was the most significant factor affecting mortality.