Classification of gunshot injuries in civilians

Gunshot injuries have become extremely prevalent among the United States civilian population because of increasing urban violence and the availability of handguns. However, the increasing prevalence of gunshot injuries in civilians dramatically contrasts with the paucity of scientific literature pertaining to the diagnosis, classification, and treatment of these injuries. The objective of the current study was to delineate the principal factors associated with gunshot injury severity in civilians, designate their importance in various injury patterns, and propose a new comprehensive classification system that may establish more uniform treatment approaches. The authors critically review existing gunshot injury classification systems with emphasis on the ballistic and clinical parameters that compose each system. The authors propose a new classification system based on five gunshot injury parameters: energy, vital structures involved, wound characteristics, fracture, and degree of contamination. This new classification scheme is applicable to all firearm injuries in civilians and assists with proper treatment selection. The proposed classification system is based on the authors' clinical experience in a Level I urban trauma center, and will require validation in a prospective clinical setting.