Epidemiology of Gunshot Wounds Injuries Admitted in ICU in France (GSW_in_ICU)

Epidemiology of Gunshot Wounds Injuries Admitted in Intensive Care Unit in France: a Retrospective Multicenter Observational Study

In civilian practice, the incidence of firearm violence depends on the country. In high income countries, most cases are reported in the USA or South Africa. In these countries, gunshot wounds (GSW) represent 20% of death cases in trauma centers, more than motor vehicle collisions.

The mortality in civilian practice occurs during the first 24 hours following GSW, mainly due to hemorrhage and traumatic brain injury, though long term effects on physical and psychological outcomes have also been shown.

Some factors of mortality specific to GSW have been established: multiples wounds, homicide vs suicide attempt, impact zone, or firearm caliber.

Few specific guidelines have been published concerning civilian GSW management. These cases are mostly treated in standard guidelines, such as hemorrhagic shock or traumatic brain injury guidelines. As in other trauma mechanisms, the "platinum ten minutes and golden hour" concept is applicable.

In Europe, the incidence of civilian GSW is much lower and few European studies have been published recently. Penetrating injuries in Europe are less likely to be GSW, and are more often self-inflicted than in the USA. In addition, European studies are heterogeneous, due to the difference in populations, healthcare systems and GSW being grouped with stabbing wounds under the label "penetrating trauma".

However, there is a global concern in Europe regarding a potential rise of GSW, with higher severity score than conventional trauma patients and often necessitate ICU admission. Studies analyzing data from different European countries show significantly different ICU admission rates for overall GSW, ranging from 17% up to 30%.

Therefore, the investigators conducted a multicenter, retrospective study on four French University Hospitals aiming to describe the epidemiology (mortality and type of organ damage) and identify prognosis factors of civilian GSW admitted in ICU.

Study Overview

• Status: Completed
• Conditions: Gunshot Wound

• Study Type: Observational
• Enrollment (Actual): 120

Contacts and Locations

Study Locations

• France
  • Nimes, France, 30029
    • CHU de Nimes

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients who were admitted for gunshot wound care in ICU between 1st of January 2015 and June 30th 2021 at Nîmes University Hospital, Marseille North University Hospital, Montpellier DAR_A University Hospital, Toulon Military Teaching Hospital.

Description

Inclusion Criteria:

• Admission for gunshot wound care in ICU between 1st of January 2015 and June 30th 2021 at Nimes University Hospital, Marseille North University Hospital, Montpellier University Hospital, Toulon Military Teaching Hospital.
• Patient ≥ 15 years old

Exclusion Criteria:

• Patient < 15 years old
• Patient who objected to the use of their data.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Gunshot wounds admitted in ICU; patient with Gunshot wounds admitted to ICU

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mortality	mortality rate at day 28 of patients admitted for Gunshot wounds	day 28

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Age	To identify if age is a prognosis factors of mortality of patients admitted for Gunshot	Day 0
Sex	To identify if sex is a prognosis factors of mortality of patients admitted for Gunshot	Day 0
Comorbidity	To identify if some comorbidities are some prognosis factors of mortality of patients admitted for Gunshot wounds (age, sex, comorbidity, type of gunshot, bullet impact zone, delay to reach hospital, biological parameters at ICU admission, use of antibiotics, blood transfusion, type of surgery, medical management, initiation of renal replacement therapy, length of ICU stay, ).	Day 0
Type of gunshot	To identify if the type of gunshot is prognosis factors of mortality of patients admitted for Gunshot wounds	Day 0
Bullet impact zone	To identify if the impact zone is a prognosis factors of mortality of patients admitted for Gunshot wounds	Day 0
Delay to reach hospital	To identify if the delay to reach hospital is a prognosis factors of mortality of patients admitted for Gunshot wounds	Day 0
biological parameters at ICU admission	To identify if some biological parameters at admission are prognosis factors of mortality of patients admitted for Gunshot wounds	Day 0
antibiotics cure	To identify if an antibiotic cure at admission is a prognosis factors of mortality of patients admitted for Gunshot wounds	Day 0
Blood transfusion	To identify if a blood transfusion is a prognosis factors of mortality of patients admitted for Gunshot wounds	Day 0 to day 30
Type of surgery	To identify if surgery type is a prognosis factors of mortality of patients admitted for Gunshot wounds	Day 0 to day 30
renal replacement therapy	To identify if initiation of renal replacement therapy is a prognosis factors of mortality of patients admitted for Gunshot wounds	Day 0 to day 30
length of ICU stay	To identify if length of ICU stay is a prognosis factors of mortality of patients admitted for Gunshot wounds	Day 0 to day 30

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire de Nīmes
• Investigators: Principal Investigator: Loic ROUGERIE, CHU Nimes; Study Director: Laurent MULLER, Md, PhD, CHU Nimes

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Actual): June 30, 2021
• Study Completion (Actual): June 30, 2021

Study Registration Dates

• First Submitted: August 16, 2021
• First Submitted That Met QC Criteria: January 25, 2022
• First Posted (Actual): February 4, 2022

Study Record Updates

• Last Update Posted (Actual): February 4, 2022
• Last Update Submitted That Met QC Criteria: January 25, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds, Penetrating; Wounds and Injuries; Wounds, Gunshot
• Other Study ID Numbers: LOCAL/2021/LR-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No