SELF-INFLICTED FIREARM INJURIES AS COMPARED TO THE ACCIDENTAL FIREARM INJURY; A COMPARATIVE ANALYTICAL STUDY TO DETERMINE THE COMMONEST SITE OF NON-SUICIDAL SELF-INFLICTED INJURIES

Objective: To determine the commonest site of non-suicidal self-inflicted firearm wound in comparison with accidental firearm wounds. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospitals Jhelum, Bannu & Kharian, from Nov 2014 to Nov 2018. Methodology: Sixty-four patients with firearm injuries were observed. All the participants were males between the ages of 18- 60 years. The injuries were determined to be either self-inflicted or accidental by an independent committee. The participants’ replies and responses were assessed by dividing them into five main domains by using quantitative software SPSS version 20. Variables involving demographic characteristics of participants such as age, occupation, marital and socioeconomic status, were associated with mental health variables such as psychological stress, previous history of self-harm and clinical psychiatric illness. Result: Fifteen subjects were found to have self-inflicted injuries and 50 had accidental injuries. There was a marked preference for left foot and left lower limb as a site for non-suicidal self-inflicted injuries (94.6%) as compared to other sites (left upper extremity 1.8%, chest 1.8% and right lower extremity 1.8%). Conclusions: Left lower limb and left foot was a more common site for self-injury as compared to the other sites.

Traumatic injuries in children and youth from Southern Brazil: A cross-sectional study

Objectives: The objective of the study was to identify the prevalence of firearm injuries (FI) and bladed weapon injuries (BWIs) in underage people and their respective outcomes. Methods: Using a retrospective observational design, data were recorded on patients who met the inclusion criteria receiving care in a public hospital between June 30, 2015, and June 30, 2018. Results: Ninety-one medical records were found, 76.9% of patients were males and 23.1% were females. Most injuries were caused by firearms (76%) and the remainder by bladed weapons (24%). The majority of patients were 12–18 years old (92.3%), while 7.7% were 6–12 years old. Male participants were the ones who most needed medical care (77%). Male adolescents in the older age group with injury-associated fractures (P = 0.015 and P = 0.032) accounted for the most common association in the sample, demonstrating greater susceptibility to fractures in these groups. Analysis of detailed location proved that BWIs BWIs were the leading cause of injuries to soft abdominal organs (P = 0.011). Conclusion: The occurrence of FI and BWIs in the pediatric population is significant and can imply death and tragic sequelae. Emergency services need to be prepared to provide care to these victims, particularly males and the 12–18 age range, as these are the most affected groups. Further studies should be conducted on this theme to gain a greater and better understanding of the etiology and repercussions of this type of injury in the lives of young patients.

Perceptions of firearm-related harm among US adults living in firearm-owning households: a nationally representative study

Decision-making on having firearms at home may be contingent on perceptions of the likelihood of their negative and positive outcomes. Using data from a nationally representative survey (n=4030) conducted during 30 July 2019 to 11 August 2019, we described how US adults living in firearm-owning households perceived the relative likelihood of firearm-related harm by injury intent (‘accidentally harm self or someone else with a gun’, ‘injure self on purpose with a gun’ and ‘injure someone else on purpose with a gun’) for groups at risk of compromised decision-making (children; adolescents and individuals with mental health issues, substance use disorders or cognitive impairment). We found that US adults living in firearm-owning households believe that unintentional firearm injuries are more likely than intentional self-inflicted or assault-related firearm injuries, despite evidence to the contrary. Prior evidence indicates that communicating risk in relative terms can motivate behaviour change; therefore, findings from this study might helpfully inform health communications around firearm safety.

Firearm Injuries to the Wrist and Hand in Children and Adults: An Epidemiologic Study

Background: Gunshot wounds (GSWs) to the wrist and hand are a major health and economic burden in the United States. There are few studies examining the circumstances and epidemiological factors surrounding these injuries. This study assesses the epidemiological factors, as well as the shooting circumstances, injury details, and surgical management of wrist and hand GSWs in children and adults. Methods: Medical records and radiographs were reviewed for all patients with ballistic injury to the wrist or hand treated at an urban academic level 1 trauma center from 2016 to 2019. Fisher exact and Pearson χ2 tests were used to assess differences between groups. Results: Two hundred forty-nine victims (29 children, 220 adults) with complete documentation were identified. Among 180 victims with known shooting circumstances, 132 (70%) were shot by another person and 110 (65%) were injured by intentional gunfire. Eighty-seven victims (35%) suffered a concurrent GSW to another body region. Metacarpal fracture was the most commonly diagnosed bony injury (37%), followed by proximal phalanx fracture (25%). One hundred twenty-nine victims (52%) underwent surgery following their injuries. Nerve discontinuity was diagnosed in 27 victims (11%), while 20 victims (8%) had vascular disruption. There was no significant difference between children and adult victims’ type of fracture, concurrent injuries, rates of surgery, or in the most common fracture fixation method. Conclusions: Most wrist and hand GSW victims were injured due to intentional, non-self-inflicted gunfire. Most patients present with hand fractures, and fortunately, nerve and vascular disruptions are uncommon.

A 10-Year Review of Spatio-Temporal Patterns of Firearm Injury in a Rural Setting

Introduction West Virginia (WV) had the ninth highest rate of firearm mortality of all states in the United States according to the CDC in 2018. Gun violence in WV has been a steady problem over the last decade. The rural population is more vulnerable to unintentional firearm injuries and suicides. Previously published literature from urban settings has demonstrated a link between firearm injuries and modifiable situational variables such as crime, unemployment, low income, and low education. There are very few studies that have utilized geospatial analytic techniques as a tool for injury mapping, surveillance, and primary prevention in rural and frontier zones of the United States. Methods We performed a 10-year retrospective single-institution review of firearm injuries at a rural WV level 1 trauma center between January 2010 and December 2019. The AIS World Geocoding Service was then used to identify specific areas of emerging firearm-related injuries within the service area. Results Specific hot spots of emerging firearm injury were identified in both intentional and unintentional populations. These were located in geographically distinct areas of the WV unincorporated rural and frontier population. These rural WV hotspots were associated with the modifiable variables of crime, unemployment, lower income, and lower education level. Conclusions Emerging hot spots of firearm injury in rural and frontier locations were associated with modifiable social determinants. These areas represent an opportunity for targeted injury prevention efforts addressing these disparities. Further prospective study of these findings is warranted.

Characterizing Firearms-Related Injuries and Craniofacial Fractures: A TQIP Study

Background: Interest in firearm injuries (FAIs), from medical and public health perspectives continues to grow. Few studies have analyzed the relationship of FAIs, craniofacial fractures, and traumatic brain injuries (TBIs). Methods: FAIs were isolated from national data from the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) 2014 to 2016 using external cause encodings. Pertinent demographic, injury, and hospital characteristics were extracted to characterize trends and statistically significant outcomes. Results: Thirty-two thousand eight hundred ninety-three (out of 829 805 cases) FAIs were captured, with a majority of patients being male and non-Hispanic/Latino Black. Multivariate linear regression revealed that race/ethnicity, age, hospital size, hospital region, intent of injury, and ISS significantly contributed to risk of mortality, increased hospital length of stay (LOS), and intensive care unit (ICU) duration. Five thousand nine hundred ten (18.0%) FAIs had at least 1 craniofacial fracture, and among these 75.1% (4441) incurred a traumatic brain injury (TBI). Mortality rate among patients with craniofacial FAI was 43.8% (2586/5910), compared to 9.7% (2618/26 983) without. Delayed surgical repair significantly increased hospital LOS ( P < .01), but not mortality ( P = .09). Conclusion: FAIs with craniofacial injury have significantly higher mortality rates than those without craniofacial injury. FAI-associated craniofacial injuries are frequently associated with TBI which is associated with significant morbidity and mortality. Such findings pose important public health and economic implications.