title: Despite the increasing use of nonoperative management of firearm trauma, shotgun injuries still require aggressive operative management.
abstract: BACKGROUND
  The energy dissipation between gunshot and shotgun blasts is very different. Injuries from shotgun blasts vary depending on the distance of the victim from the shooter, the choke of the shotgun, the pellet load, and the wad of the ammunition. We postulated that gunshot and shotgun blasts create different injury patterns that dictate different treatment plans.
  
  
  METHODS
  Medical records of patients with gunshot and shotgun trauma were reviewed from 1998 through 2007 at our university-based trauma center. Statistical comparisons were made via Fisher's test or t-test calculations.
  
  
  RESULTS
  We evaluated 2833 patients injured by firearms; of these 61 had shotgun wounds (2.2%). The remainder sustained gunshot wounds. Mortality between shotgun and gunshot trauma patients was similar (7% versus 9%, respectively, P=0.8). There was no difference in the mean Injury Severity Score (ISS) (13.7+/-1.6 versus 12.9+/-0.2; P=0.6). Overall, 61% of patients underwent operative intervention after shotgun injuries versus 36% of patients with gunshot wounds (P<0.0001). Patients surviving shotgun injuries had a longer length of stay (10.1+/-2.0 d versus 5.9+/-0.21, P<0.05).
  
  
  CONCLUSIONS
  Although the injury severity was similar, injuries from shotguns required more operations and resource utilization. Shotgun blasts can create impressive superficial injuries as well as significant deep organ damage. An aggressive operative approach to managing shotgun trauma is advantageous.
authors: Department of Surgery, University of California, San Francisco-East Bay, Alameda County Medical Center, Oakland, CA 94602, USA. kristopher.dozier@ucsfmedctr.org
authors: Kristopher C
authors: KC
authors: Dozier
authors: Marvin A
authors: MA
authors: Miranda
authors: Rita O
authors: RO
authors: Kwan
authors: Elizabeth L
authors: EL
authors: Cureton
authors: Javid
authors: J
authors: Sadjadi
authors: Gregory P
authors: GP
authors: Victorino
mesh_terms: D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D012189:Retrospective Studies; D014948:Wounds, Gunshot / Q000601:surgery*