(53) Is the Type of Firearm a Risk Factor for Mortality in Craniomaxillofacial Gunshot Wounds Secondary to Firearm Homicides?

Abstract: Problem: Craniomaxillofacial GSWs result in substantial morbidity, often requiring surgical intervention with prolonged hospitalization.1-3 The type of firearm has been shown to influence mortality in craniomaxillofacial GSWs that were self-inflicted – relative to shotguns, handguns were 3.4 times more likely to result in a fatality.4 However, it is not known whether the type of firearm influences mortality in craniomaxillofacial GSWs secondary to homicides. The purpose of the following study was to determine whether firearm type was a risk factor for mortality in firearm homicides.

Methods: This is a retrospective cohort study using the 2010-2019 National Inpatient Sample (NIS) databases.5 All cases of firearm-related assault injuries using the corresponding ICD-9/ICD-10 codes were identified. Patients were excluded if 1) they did not suffer any craniomaxillofacial injuries 2) the type of firearm used in the assault was not specified. The primary predictor variable was firearm type (handgun, shotgun, hunting rifle, machine gun/military firearm). The primary outcome variable was mortality, which was a binary variable (mortality, no mortality). Univariate analysis (chi square and ANOVA) was conducted to determine associations between the predictor and outcome variables. Multivariate logistic regression was used to determine independent risk factors for mortality. A p value < 0.05 was deemed statistically significant.

Results: The final study sample included 2,037 patients. The mean age of the study sample was 31.42 years (SD, 13.80 years). Most patients were Black (49.5%) males (86.4%) within the first income quartile (51.3%). Firearm type was not a significant risk factor for mortality (p=0.410). Patient location was a significant risk factor for mortality (p < 0.05). Cranial vault fractures (OR 2.71; CI 1.53, 4.78) and cranial base fractures (OR 2.85; CI 1.78, 4.57) were significant risk factors for mortality. Patients with intracranial injury (OR 3.14; CI 2.09, 4.72) and patients who received ICP monitoring (OR 3.01; CI 1.14, 7.95) were each at increased risk for mortality. Relative to patients who did not receive respiratory ventilation, patients who received respiratory ventilation were at increased risk for mortality (Table 1).

Conclusion: The type of firearm was not a risk factor for mortality among patients who were hospitalized for craniomaxillofacial GSWs in our study. Several injury characteristics increased the risk of mortality. This included fractures of the cranial base and cranial vault as well as intracranial injury. Further, patients who received respiratory ventilation and ICP monitory were each at increased risk of mortality. There were several factors that decreased the risk of mortality in our study. This included patients who suffered fractures of the facial skeleton and patients who underwent surgical repair of craniomaxillofacial fractures.

References

1. Norris O, Mehra P, Salama A. Maxillofacial Gunshot Injuries at an Urban Level I Trauma Center-10-Year Analysis. J Oral Maxillofac Surg. 2015;73(8):1532-1539.
2. Hollier L, Grantcharova EP, Kattash M. Facial gunshot wounds: a 4-year experience. J Oral Maxillofac Surg. 2001;59(3):277-282.
3. Pereira C, Boyd JB, Dickenson B, Putnam B. Gunshot wounds to the face: level I urban trauma center: a 10-year level I urban trauma center experience. Ann Plast Surg. 2012;68(4):378-381.
4. Stanbouly D, Chuang SK. Self-inflicted craniomaxillofacial gunshot wounds by handguns are more deadly than those by shotguns: an NIS study. Oral Maxillofac Surg. 2023;27(1):79-87.
5. Quality AfHRa. Overview of the National (Nationwide) Inpatient Sample (NIS). https://www.hcup-us.ahrq.gov/nisoverview.jsp. Published 2021. Accessed June 23rd, 2021.