Gunshot injuries in Lebanon: Does intent affect characteristics, injury patterns, and outcomes in victims?

Abstract

Introduction: Lebanon lacks a national database of gunshot injuries (GSIs), which limits injury prevention initiatives. Objectives: This study examines patient characteristics, injury patterns, and clinical outcomes in GSI victims and evaluates the impact of intent on clinical outcomes with the aim of improving awareness among emergency department (ED) physicians about the importance of inquiring about intent to predict prognosis. Materials and Methods: We conducted a retrospective cohort study of GSI victims presenting to the ED of a tertiary care center in Beirut, Lebanon. Descriptive and bivariate analyses were done to identify differences based on intent. Results: A total of 83 patients were included, 59% with intentional GSI, 22% with unintentional GSI, and 19% with unspecified intent. They were mostly males (89.2%), with a mean age of 31.7 years, and mostly presenting during summer seasons. Females were more commonly victims of unintentional GSI. All victims sustaining multiple GSIs were in the intentional group. When compared to unintentional GSI, intentional and unspecified GSIs were found to result in more ICU admissions (46.9%, 31.3%, and 16.7%,P = 0.096), significantly longer hospital stays (18.2, 26.3, and 5.6 days;P = 0.001) and higher mortality (11.6%, 18.2%, and 6.7%;P = 0.747). The rates of surgical procedures were similar between the three groups although more victims of intentional and unspecified GSI underwent multiple surgeries. Conclusion: GSIs have different features, resource utilization, and clinical outcomes depending on the intentionality of injuries. All GSI victims suffer from substantial morbidity and mortality, but intentionally harmed victims sustain more severe injuries with worse outcomes. © 2019 Journal of Emergencies, Trauma, and Shock.