title: Thoracoabdominal shotgun wounds: an evaluation of factors associated with the need for surgical intervention.
abstract: BACKGROUND
  Shotgun wound classification systems attempt to predict the need for surgical intervention based on the size of wounds, pellet spread, or distance from the weapon rather than clinical findings.
  
  
  METHODS
  A 5-year retrospective review of patients sustaining a thoracoabdominal shotgun wound was performed. Factors believed to be associated with the need for surgical intervention were examined using the Fisher exact test or an independent sample t test.
  
  
  RESULTS
  Sixty-four patients suffered a thoracoabdominal shotgun wound. Fifty-nine percent required surgical intervention. Factors significantly associated with the need for surgical intervention were a low revised trauma score and systolic and diastolic blood pressure (P < .05). Distance from attacker, wound patterns, pellet size, and pellet spread were not found to have an association.
  
  
  CONCLUSIONS
  Clinical indicators of hemorrhage and shock are associated with the need for surgical intervention, whereas pellet spread, pellet size, and distance from the attacker are not. This is a significant departure from traditional classification systems.
authors: Michael E DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. mcarrick@bcm.edu
authors: Matthew M
authors: MM
authors: Carrick
authors: C Anne
authors: CA
authors: Morrison
authors: D Jacob
authors: DJ
authors: Alexis
authors: Mark A
authors: MA
authors: Feanny
authors: Hoang Q
authors: HQ
authors: Pham
authors: Francis J
authors: FJ
authors: Welsh
authors: Michael A
authors: MA
authors: Norman
authors: Bradford G
authors: BG
authors: Scott
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000328:Adult; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008297:Male; D009104:Multiple Trauma; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D013908:Thoracotomy; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014505:Urban Population; D014948:Wounds, Gunshot / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery