Management of uncomplicated soft tissue gunshot wounds
Date First Published:
March 1, 2000
Last Updated:
May 15, 2001
Report by:
Kevin Mackway-Jones, Consultant (Manchester Royal Infirmary)
Search checked by:
Magnus Harrison, Manchester Royal Infirmary
Three-Part Question:
In [a young adults with an uncomplicated gunshot to soft tissue only] is [entry and exit wound care better than formal surgical debridement] in [preventing wound infection]?
Clinical Scenario:
A 24 year old man is brought to the emergency department by his friends having been shot in the leg. Examination of the thigh reveals a through and through wound with no bone, nerve or major vessel involvement. You wonder whether simple entry and exit wound cleaning with or without antibiotics or surgical debridement is the best treatment.
Search Strategy:
Medline 1966-03/00 using the OVID interface.
Search Details:
[[({exp firearms OR gun$.mp} AND {exp wounds and injuries OR wound$.mp}) OR exp wounds, gunshot OR gunshot$.mp] AND {exp exp irrigation OR lavage.mp OR exp debridement OR debridement.mp OR debride$.mp} AND {exp antibiotics OR antibiotic$.mp}] LIMIT to human AND english.
Outcome:
77 papers found of which 75 irrelevant or of insufficient quality for inclusion. The two remaining papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Experience of low velocity gunshot innjuries: a more conservative approach in selected cases Ritchie AJ and Harvey CF. 1990, UK | 64 patients (116 wounds) with gunshot and blast injuries GA for exploration and pull-through (61) vs minimum debridement under LA and saline wash (55). Both groups had antibiotics for 3 days. | Controlled clinical trial | Infection rate | No significant difference | Not randomised |
| Hospital stay | 8.5 days vs 3.6 days. | ||||
| Infection in minor gunshot wounds Ordog GJ, Sheppard GF, Wasserberger JS et al. 1993, USA | 3390 of 3684 patients with minor gunshot wounds. | Cohort | Overall infection rate | 1.80% | |
| Infection rate by antibiotic prescription | 40% of patients were given antibiotics. 56% of infections were in patients with antibiotics, 44% in patients without. | ||||
| Complicating factors | Multiple injuries |
Author Commentary:
There are no randomised trials in this area. The largest study has identified complicationg factors but does not directly answer the question posed.
Bottom Line:
Simple soft tissue gunshot wounds without complicating factors can be managed with minimum wound debridement and antibiotics.
References:
- Ritchie AJ and Harvey CF.. Experience of low velocity gunshot innjuries: a more conservative approach in selected cases
- Ordog GJ, Sheppard GF, Wasserberger JS et al.. Infection in minor gunshot wounds