Penetrating chest injuries in the firearm era

Background: firearm wounds of the chest are now common at our institution. The management algorithm for firearm wounds has not been evaluated for this mode of injury. Methods: records of all patients with penetrating chest in juries admitted to an urban tertiary hospital over 1 year were retrieved an d analysed. Results: there were 473 stab and 116 firearm wounds. In compari son to stab injuries firearm wounds had significantly more normal X-rays (1 4 vs. 5%), fewer pneumothoraces (15 vs. 37%), and more contusions (43 vs. 2 %). The frequency of haemothoraces (34 vs. 23%) and haemopneumothoraces (36 vs. 35%) was similar in both groups. Stabbing caused all the 18 cardiac in juries. Associated abdominal injuries occurred in 8% of stab and 34% of fir earm injuries. Pneumothoraces due to firearms were uncommon and rarely requ ired drainage. More pneumothoraces were treated nonoperatively among firear m injuries in contrast to stabbing injuries where the opposite applied. The management of haemothorax and haemopneumothorax was similar in both groups that fulfilled the criteria for drainage. The rate of ICU admission was hi gher and the hospital-stay longer following firearm injuries. Fifty-nine pa tients died (10% of the total), 33 (28%) from the firearm injuries and 26 ( 6%) from stab-wounds. Early deaths were 1 and 3% for stabs and firearms, re spectively. Conclusions: patients with firearm injuries reaching hospital s uffered three times higher mortality and a longer ICU and hospital stay tha n those with stab injuries. However, early mortality was similar for both m odes of injury and validates the continued application of the stab wound de rived management algorithm to all modes of injury. (C) 2001 Elsevier Scienc e Ltd. All rights reserved.