Thoracoabdominal shotgun wounds: an evaluation of factors associated with the need for surgical intervention

Am J Surg. 2009 Jul;198(1):64-9. doi: 10.1016/j.amjsurg.2008.07.055.


Background: Shotgun wound classification systems attempt to predict the need for surgical intervention based on the size of wounds, pellet spread, or distance from the weapon rather than clinical findings.

Methods: A 5-year retrospective review of patients sustaining a thoracoabdominal shotgun wound was performed. Factors believed to be associated with the need for surgical intervention were examined using the Fisher exact test or an independent sample t test.

Results: Sixty-four patients suffered a thoracoabdominal shotgun wound. Fifty-nine percent required surgical intervention. Factors significantly associated with the need for surgical intervention were a low revised trauma score and systolic and diastolic blood pressure (P < .05). Distance from attacker, wound patterns, pellet size, and pellet spread were not found to have an association.

Conclusions: Clinical indicators of hemorrhage and shock are associated with the need for surgical intervention, whereas pellet spread, pellet size, and distance from the attacker are not. This is a significant departure from traditional classification systems.

Publication types

  • Comparative Study

MeSH terms

  • Abdominal Injuries / diagnosis*
  • Abdominal Injuries / mortality
  • Abdominal Injuries / surgery
  • Adult
  • Decision Making*
  • Female
  • Follow-Up Studies
  • Humans
  • Laparotomy*
  • Male
  • Multiple Trauma*
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Texas / epidemiology
  • Thoracic Injuries / diagnosis*
  • Thoracic Injuries / mortality
  • Thoracic Injuries / surgery
  • Thoracotomy*
  • Trauma Centers
  • Trauma Severity Indices
  • Urban Population
  • Wounds, Gunshot / diagnosis*
  • Wounds, Gunshot / mortality
  • Wounds, Gunshot / surgery