Author(s)
Kayla B. Hicks, MD
Zainab Farzal, MD MPH
Christina Orantes, BA
Spencer Scott, BS
Trevor G. Hackman, MD
Affiliation(s)
University of North Carolina;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to identify trends in demographics for facial GSWs, common injury patterns and surgical interventions.
Objectives: Self-inflicted gunshot wounds (GSWs) have a large public health burden. The objective of this review was to analyze demographics, injury patterns, and outcomes of self-inflicted facial gunshot wounds.
Study Design: Systematic review.
Methods: A systematic search was performed using the PubMed database in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines querying publications from 1980 to 2022.
Results: Thirteen studies met inclusion criteria. These studies comprised 16,137 patients, including 85.6% males with an average age of 42.9 years. The most common weapon was a handgun, followed by shot-gun, rifle, and "other" long barrelled weapons. Many individuals were under the influence of alcohol (48.7%) or drugs (35.4%) at the time of injury, or carried an underlying psychiatric diagnosis (44.9%). GSWs most often resulted in injury to multiple facial bones, most commonly the mandible followed closely by the maxilla; surgical intervention included open reduction and internal fixation in most cases, and soft tissue reconstruction including locoregional and/or microvascular free flaps. 26.1% of patients required tracheostomy. Mean hospital length of stay was 13.1 days. Mortality for this sample was 51.5%.
Conclusions: As injury and death from firearms becomes more prevalent, awareness of effective intervention before and after injury becomes more important. This includes early identification and appropriate treatment for those at risk for self-inflicted GSWs, sensible firearm legislation to limit access to those in crisis, and development of best practices for medical and surgical intervention post-injury.