August 2019 #PRSJournalClub Wrap-Up: Survival Following Self-Inflicted Gunshots to the Face

by Rami S. Kantar, MD, M.P.H.
Surgery Resident
The University of Maryland Medical System/R. Adams Cowley Shock Trauma Center


The August edition of #PRSJournalClub provided an excellent discussion of an important PRS article entitled “Survival Following Self-Inflicted Gunshots to the Face” byElegbede, Wasicek, Mermulla, Dunlow, Rasko, Liang, Grant and Nam.This #PRSJournalClub discussion on the #PRSJournal Facebook page enabled a broad audience from around the world to ask questions and interact directly with the authors. The article can be read for free here.

In the study, Elegbede et al. evaluate factors associated with survival in patients who sustain self-inflicted gunshot injuries to the face. In order to do this, the authors performed a 10 year (2007 to 2016) retrospective review of patients who presented  with facial gunshot wounds to The University of Maryland Medical System world famous R Adams Cowly Shock Trauma Center, a Level I trauma center in Baltimore, Maryland. Patient preoperative, perioperative, and postoperative data were analyzed to determine predictors of survival following these injuries. The authors found that the mortality rate was 26% in their series of 69 patients. Importantly, they also demonstrated that penetrating brain injuries (Odds Ratio: 17; < 0.0001) and older age were independent predictors of mortality. This was highlighted by the significant difference in mortality rates between patients who were younger than 65 years of age, compared to those who were older than 65 years of age (17 % vs. 73%; p= 0.0001). The authors also found that placement of a gastrostomy tube resulted in a significant reduction in hospital length of stay (25 %; = 0.0003). The findings of the authors are extremely relevant in guiding clinical decision making by reconstructive surgeons who encounter these injuries. Knowledge that the majority of patients with facial self-inflicted gunshot injuries will survive, especially if they have no penetrating brain injuries and are young, provides prognostic guidance to clinicians treating these patients.

The article was first discussed by the current Resident Ambassadors to the PRS Editorial Board, Raj Parikh, MD, Lily Mundy, MD and Kyle Sanniec, MD, and the special guest moderator Justin Sacks, MD, MBA. Listen to the podcast discussion below:

An engaging and thought-provoking online discussion also took place on the #PRSJournal Facebook page over a two-day period (August 17-18), where established plastic surgeons and residents were able to ask questions, and get answers from the authors of the article themselves! Don’t worry if you missed it! A summary of the interesting discussion is provided here. 

We hope you enjoy the top highlights from the discussion and look forward to seeing you at the next #PRSJournalClub on Facebook

Sincerely,
Rami

This August #PRSJournalClub article (as well as other Journal Club selections from August), selected classic pairings and videos, and the entire Facebook Q&A are archived on PRSJournal.com here.

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