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Shotgun Wounds: Nationwide Trends in Epidemiology, Injury Patterns, and Outcomes from US Trauma Centers

  • Morgan Schellenberg
    Correspondence
    Corresponding Address: Morgan Schellenberg, md, mph, frcsc, Division of Trauma and Surgical Critical Care, LAC + USC Medical Center, University of Southern California, 2051 Marengo St, Inpatient Tower, C5L100, Los Angeles, CA 90033
    Affiliations
    Division of Trauma and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California
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  • Natthida Owattanapanich
    Affiliations
    Division of Trauma and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California
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  • Camilla Cremonini
    Affiliations
    Division of Trauma and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California
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  • Patrick Heindel
    Affiliations
    Division of Trauma and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California
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  • Geoffrey A. Anderson
    Affiliations
    Division of Trauma and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California
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  • Damon H. Clark
    Affiliations
    Division of Trauma and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California
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  • Demetrios Demetriades
    Affiliations
    Division of Trauma and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California
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  • Kenji Inaba
    Affiliations
    Division of Trauma and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, California
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      Abstract

      Background

      Shotguns represent a distinct form of ballistic injury because of projectile scatter and variable penetration. Due in part to their rarity, existing literature on shotgun injuries is scarce.

      Objective

      This study defined the epidemiology, injury patterns, and outcomes after shotgun wounds at a national level.

      Methods

      Patients with shotgun injury were identified from the National Trauma Data Bank (2007–2014). Transferred patients and those with missing procedure data were excluded. Demographics, injury data, and outcomes were collected and analyzed. Categorical variables are presented as number (percentage) and continuous variables as median (interquartile range).

      Results

      Shotgun wounds comprised 9% of all firearm injuries. After exclusions, 11,292 patients with shotgun injury were included. The median age was 29 years (21–43) and most were male (n = 9887, 88%). Most injuries occurred in the South (n = 4092, 36%) and among white patients (n = 4945, 44%). The median Injury Severity Score was 9 (3–16). Overall in-hospital mortality was 14% (n = 1341), with 669 patients (7%) dying in the emergency department. Assault was the most common injury intent (n = 6762, 60%), followed by accidental (n = 2081, 19%) and self-inflicted (n = 1954, 17%). The lower and upper extremities were the most commonly affected body regions (n = 4071, 36% and n = 3422, 30%, respectively), while the head was the most severely injured (median Abbreviated Injury Scale score 4 [2–5]).

      Conclusions

      In the United States, shotgun wounds are an infrequent mechanism of injury. Shotgun wounds as a result of interpersonal violence far outweigh self-inflicted and accidental injuries. White men in their 20s in the southern parts of the country are most commonly affected and thereby delineate the high-risk patient population for injury by this mechanism at a national level.

      Keywords

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