In civilian practice, the incidence of firearm violence depends on the country. In high income countries, most cases are reported in the USA or South Africa. In these countries, gunshot wounds (GSW) represent 20% of death cases in trauma centers, more than motor vehicle collisions. The mortality in civilian practice occurs during the first 24 hours following GSW, mainly due to hemorrhage and traumatic brain injury, though long term effects on physical and psychological outcomes have also been shown. Some factors of mortality specific to GSW have been established: multiples wounds, homicide vs suicide attempt, impact zone, or firearm caliber. Few specific guidelines have been published concerning civilian GSW management. These cases are mostly treated in standard guidelines, such as hemorrhagic shock or traumatic brain injury guidelines. As in other trauma mechanisms, the "platinum ten minutes and golden hour" concept is applicable. In Europe, the incidence of civilian GSW is much lower and few European studies have been published recently. Penetrating injuries in Europe are less likely to be GSW, and are more often self-inflicted than in the USA. In addition, European studies are heterogeneous, due to the difference in populations, healthcare systems and GSW being grouped with stabbing wounds under the label "penetrating trauma". However, there is a global concern in Europe regarding a potential rise of GSW, with higher severity score than conventional trauma patients and often necessitate ICU admission. Studies analyzing data from different European countries show significantly different ICU admission rates for overall GSW, ranging from 17% up to 30%. Therefore, the investigators conducted a multicenter, retrospective study on four French University Hospitals aiming to describe the epidemiology (mortality and type of organ damage) and identify prognosis factors of civilian GSW admitted in ICU.
Study Type
OBSERVATIONAL
Enrollment
120
CHU de NIMES
Nîmes, France
Mortality
mortality rate at day 28 of patients admitted for Gunshot wounds
Time frame: day 28
Age
To identify if age is a prognosis factors of mortality of patients admitted for Gunshot
Time frame: Day 0
Sex
To identify if sex is a prognosis factors of mortality of patients admitted for Gunshot
Time frame: Day 0
Comorbidity
To identify if some comorbidities are some prognosis factors of mortality of patients admitted for Gunshot wounds (age, sex, comorbidity, type of gunshot, bullet impact zone, delay to reach hospital, biological parameters at ICU admission, use of antibiotics, blood transfusion, type of surgery, medical management, initiation of renal replacement therapy, length of ICU stay, ).
Time frame: Day 0
Type of gunshot
To identify if the type of gunshot is prognosis factors of mortality of patients admitted for Gunshot wounds
Time frame: Day 0
Bullet impact zone
To identify if the impact zone is a prognosis factors of mortality of patients admitted for Gunshot wounds
Time frame: Day 0
Delay to reach hospital
To identify if the delay to reach hospital is a prognosis factors of mortality of patients admitted for Gunshot wounds
Time frame: Day 0
biological parameters at ICU admission
To identify if some biological parameters at admission are prognosis factors of mortality of patients admitted for Gunshot wounds
Time frame: Day 0
antibiotics cure
To identify if an antibiotic cure at admission is a prognosis factors of mortality of patients admitted for Gunshot wounds
Time frame: Day 0
Blood transfusion
To identify if a blood transfusion is a prognosis factors of mortality of patients admitted for Gunshot wounds
Time frame: Day 0 to day 30
Type of surgery
To identify if surgery type is a prognosis factors of mortality of patients admitted for Gunshot wounds
Time frame: Day 0 to day 30
renal replacement therapy
To identify if initiation of renal replacement therapy is a prognosis factors of mortality of patients admitted for Gunshot wounds
Time frame: Day 0 to day 30
length of ICU stay
To identify if length of ICU stay is a prognosis factors of mortality of patients admitted for Gunshot wounds
Time frame: Day 0 to day 30
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