C. S. Hendrix1, M. Matecki1, S. Maghami1, K. Mahendran1, R. Mitchell2, F. Diaz2, J. Estroff1, E. R. Smith3, G. Shapiro3, B. Sarani1 1George Washington University School Of Medicine And Health Sciences,Surgery,Washington, DC, USA 2George Washington University School Of Medicine And Health Sciences,Pathology,Washington, DC, USA 3George Washington University School Of Medicine And Health Sciences,Emergency Medicine,Washington, DC, USA
Introduction: Approximately 30,000 people die from gunshot wounds (GSW) annually in the United States. However, there are no reports of the injury patterns and exact causes of death in this cohort. The purpose of this study is to elucidate cause of death due to gun-related violence. We hypothesize that the mechanism of death following urban GSW is the same as has been reported following civilian public mass shooting events (CPMS).
Methods: The autopsy reports of all gun related deaths in Washington, DC were reviewed from January 1, 2016 to December 31, 2017. Demographic data including age, gender, race, manner of death, type of firearm used, number and anatomic location of GSWs, and organ(s) injured were abstracted. Each GSW was catalogued by body region: head, neck, chest/upper back, abdomen/lower back and extremity. The organ injury resulting in death was noted.
Results:182 autopsy reports were reviewed. The median age was 28 years old and 91% were male. There were 167 (92%) homicides, 13 (7%) suicides, and 0.5% accidental or unknown deaths. Handguns were implicated in 180 (98.9%) events. The median number of GSW per victim was 3 (25, 75 IQR 2, 7). Of 367 total GSW, 109 (30%) were to the chest/upper back, 85 (23%) to the head, 77 (21%) to an extremity, 70 (19%) to the abdomen/lower back, and 26 (7%) to the neck. The leading 5 mechanisms of death were injury to the brain (39%), lung parenchyma (37%), heart (27%), thoracic aorta (19%), and liver (19%) (Figure 1). 59% were transported to a trauma center. Patients with head wounds were significantly less likely (45% v 55%, p=0.003) and patients with abdominal wounds were significantly more likely (45% v 29%, p=0.03) to be transported to a trauma center. Transported patients were younger (26 v 31 years, p=0.011). There were 39 thoracotomies, 15 laparotomies, 7 vascular repairs, and 5 craniectomies performed.
Conclusion:Compared to previous reports regarding CPMS, there was little difference noted in the mechanism of death between urban GSW and CPMS events in this single city study. Over 50% of urban GSW are to the head/chest. Whereas gunshots to the extremity are common, they are rarely fatal. Based on the organs injured, rapid transport to a trauma center remains the best option for mitigating death following all GSW events.
