title: Outcomes related to the number and anatomic placement of gunshot wounds.
abstract: OBJECTIVE
  Firearm wounding patterns have changed, and patients more commonly present with multiple gunshot wounds (GSWs). We hypothesized that multiple GSW are associated with increased mortality risk and increased hospital length of stay (LOS).
  
  
  METHODS
  Medical charts were abstracted for patients with GSW during a 4-month period. GSW to each of six anatomic regions were quantified. Proportions, medians, and trends were compared, and relative risks of death were computed.
  
  
  RESULTS
  Among 111 patients, GSW per patient ranged from 1 to 12. Most (62%) patients sustained GSW to a single region. The median number of regions involved increased with the number of GSW (p < 0.01). Patients with multiple regions injured were more likely to die in the emergency department (16% vs. 12%, p < 0.05) or be admitted (72% vs. 52%, p < 0.01). Intensive care unit and hospital LOS increased (p < 0.05) with the number of regions involved.
  
  
  CONCLUSIONS
  Multiple GSW are associated with higher mortality, more intensive care unit days, and longer LOS. Changing wounding patterns seem to have increased morbidity and mortality associated with firearm injuries. These data have associated health policy implications.
authors.affiliation: Department of Emergency Medicine, Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Brendan.Carr@uphs.upenn.edu
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
authors.forename: Charles C
authors.initials: CC
authors.lastname: Branas
authors.forename: Mara
authors.initials: M
authors.lastname: Killen
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000401:mortality / Q000473:pathology*