Ateşli Silah Yaralanmalarında Mortaliteyi Öngören Epidemiyolojik ve Klinik Faktörler: Seviye-1 Travma Merkezinden Retrospektif Bir Çalışma

Öz

Amaç: Ateşli silah yaralanmaları dünya genelinde önemli bir travma morbidite ve mortalite nedenidir. Bu çalışmanın amacı, ateşli silah yaralanmalarının epidemiyolojik ve klinik özelliklerini değerlendirmek ve hastane içi mortaliteyi öngören faktörleri belirlemektir. Materyal ve Metot: Bu retrospektif kohort çalışmaya, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi’ne 1 Ocak–31 Aralık 2024 tarihleri arasında ateşli silah yaralanması nedeniyle başvuran hastalar dahil edildi. Hastaların demografik verileri, yaralanma mekanizması, anatomik yaralanma bölgeleri, travma skorları, vital bulguları, laboratuvar değerleri, uygulanan girişimler ve klinik sonuçları değerlendirildi. Hastane içi mortalite ile ilişkili faktörleri belirlemek amacıyla univaryant lojistik regresyon analizleri yapıldı ve olasılık oranları (OR) hesaplandı. Bulgular: Toplam 119 hasta çalışmaya dahil edildi (ortalama yaş: 33,3 ± 12,8 yıl; %89,1 erkek). Genel hastane içi mortalite oranı %9,2 idi. Hayatını kaybeden hastalar arasında kadın cinsiyet ve intihar girişimi daha yaygındı. Univaryant analizlerde kadın cinsiyet (OR: 6,286), intihar girişimi (OR: 40,125), düşük Glasgow Koma Skoru (OR: 0,490), düşük Revize Travma Skoru (OR: 0,113) ve yüksek Travma Şiddet Skoru (OR: 1,323) mortalite ile ilişkili bulundu. Baş-boyun ve göğüs yaralanmaları daha yüksek mortalite, cerrahi girişim ihtiyacı ve kan transfüzyonu ihtiyacı ile ilişkiliydi. Sonuç: Ateşli silah yaralanmalarında vital bulgular, travma skorları ve anatomik yaralanma bölgelerinin erken değerlendirilmesi prognostik açıdan önemli bilgiler sağlayabilir. Mortalitenin ötesinde, bu hastalardaki yüksek yatış ve cerrahi müdahale oranları, ateşli silah yaralanmalarının sağlık sistemine olan ciddi yükünü de ortaya koymaktadır.

Anahtar Kelimeler

• Acil bakım
• ateşli silah yaralanmaları
• mortalite
• travma skoru
• yaralanma şiddeti

Epidemiological and Clinical Predictors of Mortality in Firearm Injuries: A Retrospective Study from a Level-1 Trauma Center

Abstract

Objective: Firearm-related injuries remain a significant cause of trauma morbidity and mortality worldwide. This study aimed to evaluate the epidemiological and clinical characteristics of firearm injuries and identify predictors of in-hospital mortality. Materials and Methods: This retrospective cohort study included patients presenting with firearm injuries to Marmara University Pendik Training and Research Hospital during the period spanning from January 1 to December 31, 2024. Data on demographics, injury mechanism, anatomical injury sites, trauma scores, vital signs, laboratory findings, interventions, and outcomes were collected. Univariate logistic regression analyses were performed to identify factors associated with mortality, along with their odds ratios (OR). Results: A total of 119 patients were included (mean age: 33.3 ± 12.8 years; 89.1% male). The overall in-hospital mortality rate was 9.2%. Non-survivors were more likely to be female and have suicide-related injuries. Univariate analysis revealed that female gender (OR: 6.286), suicide intent (OR: 40.125), lower Glasgow Coma Scale (OR: 0.490), lower Revised Trauma Score (OR: 0.113), and higher Injury Severity Score (OR: 1.323) were independent predictors of mortality. Head/neck and chest injuries were associated with higher mortality and increased need for surgery and blood transfusion. Conclusions: Early assessment of vital signs, trauma scores, and anatomical injury sites can provide valuable prognostic information in firearm-related trauma. Beyond mortality, the high rates of hospitalization and surgical intervention highlight the broader burden of firearm injuries on healthcare systems.

Keywords

• Emergency care
• firearm injuries
• injury severity
• mortality
• trauma score

Kaynakça

1. Naghavi M, Marczak LB, Kutz M, et al. Global mortality from firearms, 1990-2016. JAMA. 2018;320(8):792-814. doi:10.1001/jama.2018.10060
2. Centers for Disease Control and Prevention WONDER. National center for health statistics mortality data on CDC WONDER. https://wonder.cdc.gov/mcd.html. Accessed: June 12, 2025.
3. Karbakhsh M, Rajabali F, Zheng A, Pike I. The epidemiology and deprivation profile of firearm-related injuries and deaths in British Columbia, Canada. Health Promot Chronic Dis Prev Can. 2025;45(6):286-298. doi:10.24095/hpcdp.45.6.03
4. Karaca MA, Kartal ND, Erbil B, et al. Evaluation of gunshot wounds in the emergency department. Ulus Travma Acil Cerrahi Derg. 2015;21(4):248-255. doi:10.5505/tjtes.2015.64495
5. Cao Y, Lu H, Duan P, Wang D, Wei G. Global, regional, and national burdens of interpersonal violence in young women aged 10-24 years from 1990 to 2019: A trend analysis based on the global burden of disease study 2019. Front Psychol. 2023;14:1241862. doi:10.3389/fpsyg.2023.1241862
6. Yasuntimur A, Öğünç Gİ. Individual armament and violence: The current status of firearm violence. Güvenlik Bilimleri Dergisi. 2022;11(1):167-200.
7. Aydogdu Umac G, Cetinkaya R, Ozel M, Balsak H, Yilmaz S. Evaluation of pediatric gunshot wounds and emergency department dynamics in high-volume incidents. Ulus Travma Acil Cerrahi Derg. 2025;31(2):167-177. doi:10.14744/tjtes.2025.35961
8. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-1457.

9. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29(5):623-9. doi:10.1097/00005373-198905000-00017
10. Baker SP, O'Neill B, Haddon Jr W, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma Acute Care Surg. 1974;14(3):187-196.
11. Kaufman EJ, Wiebe DJ, Xiong RA, Morrison CN, Seamon MJ, Delgado MK. Epidemiologic trends in fatal and nonfatal firearm injuries in the US, 2009-2017. JAMA Intern Med. 2021;181(2):237-244. doi:10.1001/jamainternmed.2020.6696
12. Songür Kodik M, Bakalım Akdöner Ö, Özek ZC. An evaluation of firearm injuries in the emergency department. Cureus. 2021;13(12):e20555. doi:10.7759/cureus.20555
13. Danış F, Baranoglu Kılınç Y. Retrospective evaluation of adolescent patients presenting to the emergency department with suicidal attempt. Anatolian J Emerg Med. 2024;7(3):108-111.
14. Simbawa JH, Jawhari AA, Almutairi F, et al. The association between abnormal vital signs and mortality in the emergency department. Cureus. 2021;13(12):e20454. doi:10.7759/cureus.20454
15. Long B, Keim SM, Gottlieb M, Carlson J, Bedolla J, Reisdorff EJ. Can I discharge this adult patient with abnormal vital signs from the emergency department? J Emerg Med. 2024;67(5):e487-e493. doi:10.1016/j.jemermed.2024.05.009
16. Mohammed Z, Saleh Y, AbdelSalam EM, Mohammed NBB, El-Bana E, Hirshon JM. Evaluation of the Revised Trauma Score, MGAP, and GAP scoring systems in predicting mortality of adult trauma patients in a low-resource setting. BMC Emerg Med. 2022;22(1):90. doi:10.1186/s12873-022-00653-1
17. Arslan Erduhan M, Doğan H, İlhan B. Relationships of the frailty index and geriatric trauma outcome score with mortality in geriatric trauma patients. Turk J Trauma Emerg Surg. 2023;29(4):486-492.
18. Baum GR, Baum JT, Hayward D, MacKay BJ. Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets. Orthop Res Rev. 2022 Sep 5;14:293-317. doi:10.2147/ORR.S378278
19. Ertekin A. Analysis of patients admitted to the emergency department with gunshot wounds. J Surg Med. 2021;5(5):482-485.
20. Efeoglu Sacak M, Akoglu H, Onur O, Denızbası A. Comparison of the predictive utility of Revised Trauma Score, Emergency Trauma Score, and Glasgow Coma Scale-Age-Pressure scores for emergency department mortality in multiple trauma patients. Marmara Med J. 2020;33(3):107-112.
21. Poyiadji N, Beauchamp N, Myers DT, Krupp S, Griffith B. Diagnostic imaging utilization in the emergency department: Recent trends in volume and radiology work relative value units. J Am Coll Radiol. 2023;20(12):1207-1214. doi:10.1016/j.jacr.2023.06.033
22. Abhisheka B, Biswas SK, Purkayastha B, et al. Recent trend in medical imaging modalities and their applications in disease diagnosis: a review. Multimed Tools Appl 2024;83:43035-43070. doi:10.1007/s11042-023-17326-1
23. Kudu E, Altun M, Danış F, Karacabey S, Sanri E, Denizbasi A. Validating the falls decision rule: Optimizing head CT use in older adults with ground-level falls. CJEM. 2025. doi:10.1007/s43678-025-00937-y
24. Dunne CL, Elzinga JL, Vorobeichik A, et al. Systematic review of Interventions to reduce computed tomography usage in the emergency department. Ann Emerg Med. 2022;80(6):548-560. doi:10.1016/j.annemergmed.2022.06.001
25. Kwee RM, Toxopeus R, Kwee TC. Imaging overuse in the emergency department: The view of radiologists and emergency physicians. Eur J Radiol. 2024;176:111536. doi:10.1016/j.ejrad.2024.111536