Neurobehavioural outcomes of penetrating and tangential gunshot wounds to the head

OBJECTIVE

The objective of this study was to compare penetrating and tangential gunshot wounds to the head with regards to demographic, neurobehavioural and clinical outcome measures.

METHODS

Twenty-nine patients with penetrating gunshot wounds (P-GSW) and 11 patients with tangential gunshot wound (T-GSW) to the head admitted to an acute neurotrauma service were compared using standardized neurobehavioural and clinical outcome measures.

RESULTS

The mean GCS was 10.5 +/- 0.79 for the P-GSW group and 13.4 +/- 0.72 for the T-GSW group. The mean AIS-CNS for the P-GSW group was 5.00 +/- 0 and for the T-GSW group was 3.7 +/- 0.27. Significance was found on Digit Span (p < 0.05) and Block Design (p < 0.009) subtests. Outcomes between the two groups were similar, except for significant differences were found for acute length of stay (LOS) (P-GSW was 47.72 +/- 13.2 and T-GSW group was 13.0 +/- 1.3, p = 0.005) and for acute care charges (P-GSW group was $150,533 +/- 23,834 and T-GSW group was $70,712 +/- 16,587, p = 0.05).

CONCLUSIONS

Initially, a penetrating gunshot wound is a more severe and costly injury than a tangential gunshot wound to the head, however T-GSW possess significant deficits and, if the patient survives past the acute phase of recovery, the two groups have similar functional outcomes. Future standard classification, neuropsychological, and clinical outcome measures.

When criminals are shot: A survey of Washington, DC, jail detainees

INTRODUCTION

Criminals are at high risk of being victims of violence, but little is known about their victimization.

METHODS

A screen of Washington, DC, detainees found that 1 in 4 had been wounded in events that appear unrelated to their incarceration. Extensive interviews were conducted with 79 men entering the city jail from March through June 1997; the men reported 93 prior events in which they had been shot within the past 5 years.

RESULTS

Eighty-three percent had personally witnessed someone being shot, and 46% had a family member killed with a gun. In the incidents in which they were shot, most were victims of robberies, assaults, and crossfires. The shootings were serious -- 35% were hit by more than 1 bullet, more than 90% went to the hospital, and 40% still had some disability from the wounds. These detainees report being shot by other criminals rather than by law-abiding citizens. Ninety percent would prefer to live in a world without easy access to firearms.

CONCLUSION

These young men live in a violent world of gunplay. The overwhelming majority would prefer that firearms were not so readily available.

[An epileptic syndrome in patients with the sequelae of gunshot craniocerebral wounds]

To study the specific features of the epileptic syndrome after present-day gunshot cranial wounds (GCW), as well as risk factors of its occurrence, 56 victims were examined prospectively (within at least a year after their admission). The epileptic syndrome developed in 18 (32.1%) patients within 1 to 15 months following GCW; there were prevalent generalized convulsive (in 13 of the 18 patients) and focal (in 12 of the 18 ones) seizures. One type of seizures was noted in 7 patients, two or three ones were in 11. The polymorphism of seizures and a disparity of their psychopathological structure to the side of brain lesion were typical for left-handers. As compared to other patients, epileptics were more commonly found to have: 1) frontoparietal lesion; 2) multiple bony defects of the vault of the skull; 3) enlargement of the lateral ventricle of the brain on CT scans; 4) primary coma for > 2 hours and other depressed consciousness syndromes for > 1 day; 5) signs of left-handedness. The findings suggest that there is a need for studies of the functional asymmetry of the brain to gain a better insight into the problem.

Factors associated with parenting among incarcerated juvenile offenders

In regard to the injured offender, research indicates that violent victimization represents only one facet of a constellation of associated risks and consequences, including promiscuity and adolescent parenthood. A relationship between firearm injuries and self-reported promiscuity among incarcerated juvenile offenders has previously been noted. The present study was an attempt to gain additional insight into the larger consequences of violent injuries. Information pertaining to the fathering of children was collected from 258 incarcerated male adolescents from the Richmond, Virginia, metropolitan area during a two-year period. It was hypothesized that adolescent parenting would be associated with firearm injuries. The results indicated that 20% of the juvenile offenders fathered at least one child. Analyses revealed a significant relationship between firearm injuries and increased prevalence of adolescent parenting. Continued involvement in illegal activities, as indicated by a second commitment to a juvenile correctional center, also was associated with increased prevalence of adolescent parenting, while race and involvement in drug selling or violent offending were not. The social and economic implications of these findings, particularly in terms of the health care and social service delivery systems, are discussed.

Medical care solicitation by criminals with gunshot wound injuries: a survey of Washington, DC, jail detainees

BACKGROUND

The best estimates of nonfatal gunshot wounds in the United States come from hospital emergency room data and may miss, among other things, wounded individuals who do not seek medical treatment. Criminals may be those least likely to rely on professional care for their wounds. This study provides evidence of whether medical care is solicited by criminals after gunshot wounds. In addition, the circumstances of the injury events are described.

METHODS

A case series of 79 detainees at a Washington, DC, jail who had previously been shot in 93 separate incidents were interviewed using a standardized questionnaire. Data were obtained concerning the age and race of the victim, the location of the wound, and the length of hospital stay.

RESULTS

In 92% of the incidents, respondents reported going to the hospital; one-third of those shot were hospitalized for more than 1 week. More than half (54%) had been hit in the head or torso, and 40% had a current disability attributable to the wound.

CONCLUSION

Among these "criminals," the vast majority reported that they obtained professional care for their gunshot wounds. Such evidence suggests that individuals previously thought unlikely to enter the medical care system after a firearm injury usually do so. Statistics on medically treated nonfatal gunshot wounds probably do not substantially underestimate the actual number of nonfatal shootings.

Prospective psychosocial, interpersonal, and behavioral predictors of handgun carrying among adolescents

OBJECTIVES

This study identified behavioral and psychosocial/interpersonal factors in young adolescence that are associated with handgun carrying in later adolescence.

METHODS

A sample of 2200 high school students was surveyed at 9th grade and again at 12th grade.

RESULTS

Multivariate logistic regression analyses indicated that measures of risk-taking preference, depression, stress, temper, and drug use assessed while the students were in 9th grade were predictive of handgun carrying in 12th grade for both male and female students.

CONCLUSIONS

These findings suggest the need for a comprehensive approach to prevention that focuses on both individual and interpersonal factors associated with adolescents' decision to carry a handgun.

Psychiatric interviews with pediatric gunshot patients

PROBLEM

To understand the life experiences of gunshot-injured children to obtain information about predisposing factors to injury.

METHODS

A pilot study of 16 hospitalized children (14 males, 2 females) between the ages of 11 and 15 who sustained gunshot injuries. Each child was psychiatrically assessed on a medical inpatient unit after sustaining a gunshot injury to assess the rate of acute stress disorder and other comorbid psychiatric diagnoses.

FINDINGS

Findings showed gunshot-injured children had a 56% rate of acute stress disorder, and 68% had a past psychiatric history.

CONCLUSIONS

Gunshot-injured children require psychiatric intervention to minimize the long-term effects of acute stress disorder. Further research is needed to clarify the relationship of gunshot-injury and dysfunctional behavior and develop effective treatment options.

Violent mass shootings in Sweden from 1960 to 1995: profiles, patterns, and motives

During the past few decades, violent mass shooting in Sweden has increased rapidly. In the 36 years between 1960 and 1995, fourteen such occasions were recorded, during which 32 people were killed and 57 were wounded. The 14 offenders were men between the ages of 17 and 61 years. In the 20 years from 1960 to 1979, five shootings were committed by five offenders, leaving 10 dead and 13 wounded; in the 16 years between 1980 and 1995, there were nine different shootings committed by nine offenders, with 22 dead and 44 wounded. Seven of the shootings were classified as mass shootings, six as spree shootings, and one as a serial shooting. In all but four of these cases, the firearms used were illegal weapons. The four legal firearms belonged to an unemployed young laborer, an officer, a former United Nations (U.N.) soldier, and a member of the Swedish military volunteer corps. Of those killed, 68.8% were strangers to the offender; among the wounded, the corresponding figure was 89.5%. Profiles of the offenders and of the victims were studied. The psychiatric diagnoses among the offenders and the measures taken to prevent the increase in mass shooting in Sweden are presented.

7:10 am, Nov. 8, 1994. Interview by Anne Mullens

Dr. Garson Romalis, a Vancouver physician who performed abortions, was shot and severely wounded by an unknown assailant 3 years ago. In this article he tells Anne Mullens about the incident and its aftermath. The shooting, which has since been linked with the attempted murder of 2 other abortion providers, has not changed Romalis' views on the importance of the procedure. Today his major concern is that young physicians will be too frightened to provide an essential and legal service. He is working to convince medical students of the need to continue providing abortions.

[Psychological profile of suicide using firearms to the face. Review of the literature. Our experiences at the university hospital center at Caen]

We studied the psychological feature of subjects who attempted suicide with firearms. This retrospective study included 36 cases of "facial suicide" treated at the Caen University Hospital since 1981 and data in the literature. An analysis of the different parameters showed in several cases, that this population is different from the others, particularly hospitalized drug overdose suicide patients. Two notions were particularly remarkable in these patients: history of patients psychiatric disorders were very rare and recurrent suicide attempts.

Chronic pain in a victim of attempted homicide

This Medical Psychology Forum focuses on the problem of chronic pain in a patient with a neurologic deficit incurred when he became the victim of an attempted homicide. Murderous anger, wishes for revenge and intolerance of helplessness and passivity proved closely intertwined with the patient's awareness of pain and his capacity to bear it. The use of a dorsal column stimulator to “mask” the pain and the role of personality factors in his adjustment to disability are discussed.

Psychiatric-orthopedic liaison in the hospital management of the amputee war casualty

The authors, then military physicians, collaborated over a year and a half on the evolution of a psychiatric-orthopedic liaison in the hospital management of amputee war casualties. From a situation of minimal professional contact, the authors initiated a program leading to a strong working relationship between the psychiatrist and nonpsychiatrist members of the orthopedic team. The psychiatrist's regular presence during ward rounds as well as his availability to talk with staff on an informal basis helped to diminish some of the usual mistrust and misunderstanding of psychiatry so common in general hospital settings. Brief examples highlight how the sharing of raw clinical data by the psychiatrist and team members can teach the staff psychiatric principles and increase their awareness and skills in dealing with the emotional side of patient care.

Development and factor analysis of a measure of youth attitudes toward guns and violence

Administered the Attitudes Toward Guns and Violence Questionnaire (AGVQ) to 1,619 students in Grades 3, 5, 6, 7, 9, 11, and 12 from four demographically diverse school systems. Fifty-two of the 61 items exhibited satisfactory part-whole correlation and correlation with a validity criterion. Factor analysis revealed four main factors: Aggressive Response to Shame, Comfort With Aggression, Excitement, and Power/Safety. The instrument was reduced to 23 items by deleting items with high cross-loadings. Construct validity was similar for the longer and shorter versions. Youth who self-reported owning a gun produced scores 1.5 SD higher than nonowners. Low scores were associated with a 1 in 125 chance of gun ownership, and high scores were associated with a 1 in 3 chance. Congruency coefficients indicated similar factor structure for the present sample and a separate sample of 5th-, 7th- and 9th-grade students. These results indicate that the AGVQ is a reliable and valid measure of violence-related attitudes in young people.

Accidental firearm injury in childhood--a predictor of social and medical outcome?

This paper reports register data on a consecutive series of 141 children and teenagers hospitalized due to firearm injuries during a 21-year period in a community with restrictive firearm laws. Most of the injuries were minor and hospitalization was short. Shot by an air gun resulting in an eye injury was the most frequent reason for hospitalization. The patients hospitalized due to firearm injuries were compared with a control group composed of 141 individuals matched pair-wise for sex and age. The total morbidity during the follow-up period of on average 10 years was higher among patients compared with controls concerning both somatic diseases and injuries. All cases of severe psychopathology were found in the patient group. Criminality was higher among patients compared with controls and the former were younger at the time of the first crime compared with the latter. This study indicates that, irrespective of firearm laws, young people suffering from firearm injuries, even if the injury is classified as accidental, run a higher risk of becoming psychosocially disadvantaged and criminal as adults. This makes preventative measures highly necessary not only from a societal point of view, but also to avoid individual suffering in this high-risk group of youngsters.

Development and factor analysis of a measure of youth attitudes toward guns and violence

Administered the Attitudes Toward Guns and Violence Questionnaire (AGVQ) to 1,619 students in Grades 3, 5, 6, 7, 9, 11, and 12 from four demographically diverse school systems. Fifty-two of the 61 items exhibited satisfactory part-whole correlation and correlation with a validity criterion. Factor analysis revealed four main factors: Aggressive Response to Shame, Comfort With Aggression, Excitement, and Power/Safety. The instrument was reduced to 23 items by deleting items with high cross-loadings. Construct validity was similar for the longer and shorter versions. Youth who self-reported owning a gun produced scores 1.5 SD higher than nonowners. Low scores were associated with a 1 in 125 chance of gun ownership, and high scores were associated with a 1 in 3 chance. Congruency coefficients indicated similar factor structure for the present sample and a separate sample of 5th-, 7th- and 9th-grade students. These results indicate that the AGVQ is a reliable and valid measure of violence-related attitudes in young people.

Free radial forearm flap to the foot after a shotgun injury: the day I became a patient

This is a personal account of a General Practitioner who suffered a shotgun injury to his right foot. Reconstruction involved the use of a free radial forearm flap to fill a defect distal to the heel. The case is illustrated and the feelings of the patient described.

Psychiatric morbidity in medical and surgical patients evacuated from the Persian Gulf War

Acute treatment records of all medical and surgical patients evacuated to Walter Reed Army Medical Center in Washington, D.C., from the Persian Gulf theater (N = 161) were examined to better understand the relationship of injury to psychiatric symptoms. A total of 110 (68 percent) sustained a traumatic injury. They were significantly more likely to have an axis I disorder or psychiatric symptoms of concern than participants in the Persian Gulf War who did not sustain traumatic injuries but who were evacuated for medical conditions. The results indicate that traumatically injured veterans are at greater risk of psychiatric symptoms than veterans who are not injured and that they should be referred for psychiatric evaluation.

[Aspects relevant for abdominal surgery of attempted suicide]

In this retrospective study of 24 patients who were treated at our clinic during the last 22 years after having attempted suicide, we evaluated aspects concerning abdominal- and transplantation surgery. There was a predominance of "hard" (70%) versus "soft" (30%) methods for suicide attempt. Intra-abdominal injuries resulting from attempted suicide by stabbing or shooting should lead to laparotomy-the prognosis is then good. Surgical treatment after intoxication, especially caustic ingestion, depends on endoscopic and clinical findings. The highly increased rates of suicide in patients with end-stage renal disease can be reduced significantly by kidney transplantation. The risk of suicide after transplantation is further diminished with improved immunosuppressive treatment. Only in a few cases there is an indication for liver transplantation-in some cases of fulminant hepatic failure caused by self-administered paracetamol overdose. Auxiliary liver transplantation may then be considered.