GUNSHOT WOUNDS - 10-YEAR EXPERIENCE OF A RURAL, REFERRAL TRAUMA CENTER

The 10-year experience of a Level II trauma center with 122 gunshot wo unds referred from a large rural area was analyzed to illustrate diffe rences from the experience of urban centers. Most frequent causes of i njury were attempted suicide in 38 (31%) patients, hunting mishaps in 32 (26%), unintentional accidents in 29 (24%), and intentional assault in 18 (15%). Of weapons specified, rifles were documented in 48 (39%) instances, shotguns in 25 (21%), and handguns in 24 (20%). Body regio ns injured were the trunk in 47 (39%) patients, head in 35 (29%), lowe r extremity in 31 (25%), and upper extremity in 29 (24%). Twenty-five patients (20%) died as a result of their injuries. The cause of death was brain injury in 18 (72%), exsanguination from truncal wounds in 5 (20%), myocardial infarction in 1 (4%), and multiple organ failure in 1 (4%). We conclude that the distributions of cause and type of gunsho t wounds are unique in a rural setting. These differences have profoun d consequences in designing effective prevention programs for our area and support the design of more efficient trauma systems for rural Nor th America.