Authors
Truhan A.P.1, Samohvalov I.M.2, Isakov V.D.3, Suprun T.Yu.2, Yakovenko O.O.3, Kuraev P.I.2
1 432 Main military clinical medical center, Minsk, Belarus
2 Military Medical Academy named after S.M. Kirov, St. Petersburg
3 Bureau of forensic medical examination, St. Petersburg
Abstract
Backgraund: Gunshot wounds occupy one of the fundamental positions in field surgery. Currently, there is an increase in the occurrence of gunshot wounds in peacetime, which requires additional study of this problem.
Aims: To study the differences between the incoming patients with gunshot wounds in the medical organizations of a metropolis in peacetime from gunshot wounds in wartime.
Materials and methods: Study design is a multicenter retrospective continuous study. Object of study – patients with gunshot bullet wounds. The main group consisted of patients who applied to health care facilities in St. Petersburg in 2016–2018 (results of forensic medical examinations at the Bureau of forensic medical examination). Comparison group – the wounded, delivered to the stages of medical evacuation during the counter-terrorist operation in the North Caucasus in 1999–2002 (computer database of the Department of field surgery of the Military Medical Academy named by S.M. Kirov). An objective assessment of the severity of damage was carried out using the VPH-P scale. The results were processed on a personal computer using the programs Microsoft Office Excel and Statistica. The Pearson (χ2) and Mann-Whitney (U-test) criteria were applied. Differences were considered significant at a significance level of p<0,05.
Results: In the main group (141 patients) light injuries predominated (62,4%), in the comparison group (409 wounded) there were more severe injuries (52,3%). This is due to the prevailing use in the main group of firearms of limited destruction (80,9%) and higher damaging properties of military weapons. The proportion of combined trauma in the main group (22,0%) was significantly lower than in the comparison group (33,5%) (p = 0,011). This is due to the greater kinetic energy of combat firearm wounding shells, as well as the frequent use of automatic weapons.
In both groups, damage to the extremities was most often detected (48,9% and 55,7%; p = 0,162). In the main group head wounds (31,2%) were more common (p<0.001). In the comparison group chest wounds were more common (30,6%) (p=0,009). The differences are related to the deliberate infliction of wounds in these anatomical areas in order to inflict a mortal wound in the conditions of using individual means of armor protection and different distances of firing.
Mortality in gunshot wounds (moderate and severe) was higher in wounded wartime, which is associated with the forced features of the organization of surgical care during hostilities. Mortality with extremely severe gunshot wounds was higher in peacetime (76,9%), which was primarily due to damage to vital organs at close range.
Conclusions: The widespread use of firearms of limited destruction in peacetime requires special training of surgeons, taking into account its diagnosis and treatment.
Keywords: patients with wounds, non-lethal weapons, limited firearms.
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