INTERPRETATION OF FATAL, MULTIPLE, AND EXITING GUNSHOT WOUNDS BY TRAUMA SPECIALISTS

Firearm-related injuries are a leading cause of morbidity and mortalit y in the United States. Trauma care centers and trauma specialists (em ergency medicine, trauma surgery, and neurosurgery) provide emergency care for those injured and mortally wounded from firearms. Consequentl y, trauma specialists may be asked to address forensic questions regar ding gunshot wounds. Many firearm-related injuries are nonfatal and ul timately, fatal gunshot wounds can suffer from surgical alteration or, if the time interval between injury and death is prolonged, considera ble healing of entrance and exit wounds may occur. Thus, accurate init ial evaluation of firearm-related injuries is essential. We reviewed a ll firearm-related fatalities at our institution over the last five an d a half years. Our objective was to determine how accurately trauma s pecialists can differentiate entrance and exit wounds in fatal perfora ting (exiting) gunshot wounds and determine the number of penetrating or perforating projectiles in fatal multiple gunshot wounds. A total o f 271 fatal gunshot wound deaths were reviewed. Of these, we excluded all fatal penetrating (nonexiting) single gunshot wounds and fatalitie s not evaluated by trauma specialists. postmortem findings were compar ed with the medical records from those individuals seen in the emergen cy department and/or admitted to North Carolina Baptist Hospital (Leve l I trauma center). Forty six cases with fatal multiple or exiting gun shot wounds were identified. Twenty four (52.2%) were misinterpreted b y trauma specialists. Errors included inaccurate determination of the total number of multiple penetrating and/or perforating gunshot wounds and erroneous identification of entrance and exit wounds. Of the exit ing, single gunshot wounds 37% were misclassified and 73.6% of multipl e gunshot wounds were interpreted incorrectly. This study emphasizes t he need for trauma specialists to be cognizant of the potential for mi sinterpretation when multiple and exiting gunshot wounds are encounter ed and realize the medicolegal implications.