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Correlation between the Amount of Clothing a Person is Wearing while Sustaining a Ballistic Injury and Wound Infection Rates

Rachel Lovely, Rob Behm, Gabriel Ologun, Andrew Trecartin, Alexander Johnston, Katherine Loomba, Mollie Behm, Tiffany Lau and Jason Granet

Introduction: The extremities are the most common area of the body to be injured from gunshot wounds (GSWs). If there are no vascular or orthopedic injuries, an operation is typically not indicated. As a bullet travels through tissue, it not only creates a cavity but also creates a vacuum both as it enters and exits. This vacuum allows debris to enter the tissue cavity and contaminate the wound. We hypothesize that a non-operative wound caused by a bullet traveling through layers of clothing will have a higher infection rate than a wound caused by a bullet that did not travel through clothing.

Methods: Patients who suffered a GSW between the years 1992 and 2017 were identified with the institutional trauma registrar at our level II rural trauma center. Patients included were those injured within our seasonal time periods; winter (November, December, January and February) and summer (May, June, July and August). Patients who did not fall into these seasonal categories, had incomplete chart documentation or failed to follow-up were excluded. Time of year was used as a surrogate for how much clothing a person was wearing when they were injured. Chart reviews were performed to identify all non-operative extremity wounds and infection rates within 30 days.

Results: A total of 233 patients were initially captured with 133 meeting inclusion criteria. Of the 76 patients included in the winter and the 57 included in the summer, the number of non-operative extremity injuries were 11 and 10 respectively. A total of 2 infections (18%) occurred in the winter while no infections (0%) occurred in the summer (p=0.48).

Conclusion: A higher infection rate was associated with non-operative ballistic wounds to the extremities during the winter months when patients are typically wearing more clothing compared to the summer months. This difference was not statistically significant.