Management of gunshot wounds at a Sydney teaching hospital

Background: Injuries caused by firearms account for only a small percentage of trauma admissions and deaths in Australia but are frequently the subjec t of media and public attention. The present study examines the epidemiolog y and management of firearm injuries presenting to St Vincent's Hospital, w hich is located at the edge of the central business district of Sydney. Methods: The medical records of all patients presenting to St Vincent's wit h a gunshot wound (GSW) from January 1988 to December 1998 were analysed. A dditional details were acquired from New South Wales State Coroner's Court reports and media archives, especially major newspapers. Results: Seventy-four patients presented to St Vincent's Hospital with 103 GSW. The age (mean +/- SD) was 31 +/- 11 years. Sixty-seven patients (91%) were male. Alcohol was identified as a factor in 24 cases (32%) while other drugs were indicated in four cases (5%). Ten patients (14%) had intentiona lly self-inflicted wounds, seven (9%) had accidental wounds and 57 (77%) ha d wounds that were caused by crime-related violence. Sixty patients (81%) u nderwent operation for their injury. Thirty complications were seen in 18 p atients (24%). Eleven patients (15%) died. The length of hospital stay (mea n +/- SEM) was 18 +/- 9 days. Conclusions: The incidence of trauma due to firearms has not increased at S t Vincent's hospital in the period 1988-98. Most GSW were inflicted in the setting of criminal violence, with a high proportion due to handguns. Patie nts were mostly young men, and alcohol or other drugs were frequently invol ved. Outcomes are comparable to other centres managing large volumes of pen etrating trauma.