Necessity breeds invention: a study of outpatient management of low velocity gunshot wounds.
BACKGROUND
Since the late 1980s, the emergency department (ED) at the Mater Hospital, Belfast, has implemented a policy of treating conservatively patients who sustain low velocity gunshot wounds to the lower limbs. Wounds are cleaned and minimally debrided under local anaesthetic in the ED. Patients are given oral antibiotics, and reviewed 48 hours later at the ED review clinic.


OBJECTIVE
To investigate the outcome of outpatient ED management of low velocity gunshot wounds to the lower limbs.


METHODS
This was a retrospective, observational study from January 2000 to September 2004 inclusive. Notes were retrieved of those patients who had gunshot wound mentioned in the triage text. Patients were included if they presented with a low velocity gunshot wound to the lower limbs. Demographics and treatment regimen were recorded.


RESULTS
In total, 90 patients sustained low energy injuries to the lower limb, with 70.5% of wounds involving the skin and soft tissue only. Most patients (n = 67) were treated as outpatients, which included 80% of unilateral injuries and 46.6% of bilateral injuries presented. There were 56 patients reviewed at clinic. Three patients developed minor complications


CONCLUSIONS
Irrigation and minimal debridement in the outpatient setting is an acceptable method of treatment for low energy gunshot wounds to the lower limbs, without orthopaedic or vascular involvement.
Byrne
A
A
Accident and Emergency Department, Mater Hospital, Belfast, UK. aoifebyrne@yahoo.com
Curran
P
P
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D006801:Humans; D007869:Leg Injuries / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D012189:Retrospective Studies; D016896:Treatment Outcome; D014946:Wound Infection / Q000209:etiology / Q000517:prevention & control; D014948:Wounds, Gunshot / Q000628:therapy*
D000900:Anti-Bacterial Agents