Genitourinary Trauma Due to Gunshot Wounds Produces High Rate of Associated Injuries
By Jill Stein
Medscape Medical News
June 1, 2010 (San Francisco, California) — Most civilians who sustain a gunshot wound (GSW) to the genitourinary tract develop at least 1 nongenitourinary organ system injury, according to data released at the American Urological Association 2010 Annual Scientific Meeting.
"Our results mean that the practicing urologist must maintain a high degree of suspicion about associated injuries in all patients who sustain a gunshot wound to the genitourinary system," principal investigator Jerilyn M. Latini, MD, assistant professor of urology at the University of Michigan in Ann Arbor, told Medscape Urology.
"The management of genitourinary injuries must be staged with surgical exploration of other organs, depending on patient status and the severity of associated injuries," she said. "For example, major hollow viscus or vascular injuries must be addressed emergently with coordinated management of the associated genitourinary injuries."
Dr. Latini and colleagues reviewed a level?1 trauma center registry to identify all patients who sustained any trauma as a result of a GSW over a recent 12-year period. They identified 2941 civilian patients with GSWs. Patients were 30 years old, on average, and most were men. The mean Injury Severity Score (ISS) was 22.2?± 15.4 (range, 1?- 75). The incidence of genitourinary GSWs increased over the study period.
"After motor vehicle collisions, gunshot wounds are the leading cause of death among young males in the United States. Dr. Latini reported, adding that "the direct medical costs and indirect costs due to loss of productivity represent a significant health and economic burden."
"The incidence of civilian gunshot wounds is increasing in the United States, Africa, and some European countries," she added.
To date, most of the literature on GSWs to the genitourinary system has involved reports from wartime/military combat, she said.
In this study, sex, age, race, ISS, genitourinary injury location, associated injuries involving any organ system, management, and outcomes were obtained from the trauma registry at the Henry Ford Health System in Detroit, Michigan, along with medical records and autopsy reports.
All patients were evaluated and managed with standard trauma protocols.
Of the 2941 patients, 309 (10.5%) sustained genitourinary trauma with or without associated injuries.
The most common genitourinary GSW injuries involved the kidneys (55%), scrotum (21%), bladder (19%), testis (12%), and penis (8%); some involved more than 1 genitourinary organ.
Overall, 284 of the 309 patients with genitourinary trauma (92%) experienced at least 1 nongenitourinary organ system injury. Nongenitourinary GSW injuries involved the abdominal organs in 68% of patients, the chest in 39%, orthopedic/lower extremities in 31%, orthopedic upper extremities in 23%, the vascular system in 15% (with aorta and/or vena cava involvement in 11%), head/neck in 15%, and the spinal cord in 13%.
The severity of nongenitourinary GSW injuries varied, depending on the organ affected. For example, the liver was most commonly involved when the kidney was the site of the GSW, and the ureter was most often involved when there was a small bowel injury.
Most genitourinary GSWs were managed surgically, with a mean of 2.2 ± 2.0 surgeries per patient.
Overall, 84 patients (27%) died. The cause of death was usually associated nongenitourinary injuries. Fifty patients (16%) were dead on arrival at the hospital.
Dr. Latini emphasized that a comprehensive multidisciplinary approach to the evaluation and management of civilian GSW patients is required. "By multidisciplinary, I am referring to a coordinated approach to managing multitrauma patients among the trauma surgeons in all subspecialty areas," she explained.
Dr. Latini has disclosed no relevant financial relationships.
American Urological Association (AUA) 2010 Annual Scientific Meeting: Abstract?1230. Presented on May?31, 2010.
