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Assessing the severity of truncal gunshot wounds: a nation-wide analysis from Finland.

BACKGROUND AND AIMS
Gunshot wounds of the chest and abdomen are potentially life-threatening, but there is a great variation in their actual severity emphasising the importance of accurate severity assessment for prehospital decision-making, clinical management and outcome prediction. The purpose was to analyse the severity of truncal gunshot injuries from a nation wide data base during a 5-year period with comparison to a previous 5-year period, and to assess the ability of the New Injury Severity Score (NISS) in comparison with the "old" Injury Severity Score (ISS) in predicting short-term morbidity.


MATERIAL AND METHODS
Based on the National Hospital Discharge Register, 199 patients admitted for truncal gunshot wounds in Finland during 1990-4 were identified and their hospital records analysed.


RESULTS
Of the 199 truncal gunshot wounds, 146 (73%) were caused by low, 16 (8%) by high-energy bullets and 37 (19%) by shotgun blasts. Sixty-seven patients (34%) had wounds, which did not enter the thoracic or abdominal cavity. Nonoperative management including wound surgery and placement of a chest tube was possible in 86% of the thoracic wounds, 13% of the thoracoabdominal and 19% of the abdominal wounds. The overall mortality and morbidity rates were 2% and 23%, respectively. In comparison to the previous 5-year period, there was a 47% increase in total and 67% increase in truncal gunshot wound admissions. The presence of cavitary penetration (positive predictive value 31% and negative predictive value 93% for morbidity), the ISS and the NISS scores were all statistically significant (p = 0.000 in all categories) predictors of hospital morbidity and length of stay.


CONCLUSIONS
The admission rate for gunshot wounds in Finland is increasing. A large proportion of patients can be managed nonoperatively and the overall outcome is very good. Both ISS and NISS scores can be used to predict hospital morbidity and length of stay with little benefit in replacing ISS with NISS. The assessment of cavitary penetration is useful and has a high negative predictive value for short-term morbidity.