The number of gunshot wounds does not predict injury severity and mortality

Am Surg. 2009 Jan;75(1):44-7; discussion 48.


It is presumed that as the number of gunshot wounds (GSWs) increases, so do the Injury Severity Score (ISS) and mortality risk. We hypothesized that the number of bullet wounds relates to ISS and death; however, a single GSW to the head is ominous. We reviewed the charts of all GSW patients admitted to a trauma center from 2004 to 2006 (n = 531). We analyzed patient demographics, ISS, and mortality. There was no correlation with the number of GSWs with either ISS or mortality. There was only a 0.3 per cent increased risk of death for each additional GSW (r2 = 0.12). Patients with a single GSW versus multiple GSWs had no difference in mortality (9.1 vs 8.4%, P = 0.8). A single GSW to the head carried a 50 per cent mortality risk. For those who sustained both head and body GSWs, each additional GSW did not increase mortality (r2 = 0.007). Our study shows that the number of GSWs has no affect on mortality or ISS. Internal triage and management of gunshot victims should not be affected by the categorization of patients as having a single versus multiple GSWs.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Head Injuries, Penetrating / etiology
  • Head Injuries, Penetrating / mortality*
  • Head Injuries, Penetrating / therapy
  • Humans
  • Injury Severity Score*
  • Male
  • Middle Aged
  • Multiple Trauma / mortality*
  • Multiple Trauma / pathology
  • Multiple Trauma / therapy
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Triage / methods*
  • Wounds, Gunshot / complications
  • Wounds, Gunshot / mortality*
  • Wounds, Gunshot / pathology
  • Young Adult