The Impact of the Method of Gunshot Injury: War Injuries vs. Stray Bullets vs. Civilian Fighting.

OBJECTIVE: To analyze the impact of the method of Gunshot Injury (GSI) (i.e. war injuries, stray bullets, and civilian fighting) on patient morbidity and mortality. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Biostatistics Department of Al-Jalaa Hospital in Benghazi, Libya, from January to December 2011. METHODOLOGY: Patients' records were analyzed with the method of gunshot injury as a classifying/comparative parameter. Age, gender, site of injury, receiving department, ICU admission, city of origin, length of stay, morbidity and mortality were determined and compared between the different methods of GSI. RESULTS: During the conflict, 1761 gunshot injuries were treated at the hospital. The method of injury was recorded for 62% (n=1096) of the cases and were classified under war injuries (72.2%, n=791), stray bullets (14.1%, n=155), and civilian fighting (13.7%, n=150). Nearly all the patients being treated for civilian fighting (98%, n=147) were males, (stray bullets, 82.6%, n=128, and war injuries 98.4%, n=778). Women were significantly less involved in a war injury (1.6%, n=13, p < 0.001). Stray bullets affected the younger age groups i.e. ² 19 years (26.5%, n=41) more than either fighting injuries (8%, n=12) or war injuries (11.8%, n=93, p < 0.001). Civilian fighting injuries (83.3%, n=125) mostly involved the 20-39 years age group (p < 0.001). Fighting wounds and stray bullets were more common in an urban (82.7%, n=124) rather than rural setting (p < 0.001); the same was true for stray bullets (76.8%, n = 119). The number of GSI's showed a close relationship with major events in society (i.e. military campaigns, celebration and civilian unrest). Significantly higher mortality rates were observed in civilian fighting injuries (7.7%, n=12, p=0.003) and stray bullets (10%, n=15, p=0.003) compared to general GSI's (5.2%, n=91) and war injuries (4.4%, n=35). CONCLUSION: Surgeons and general physicians need to be aware that GSI's differ in their salient features and outcome based on the method of injury.