2022 Trauma/Critical Care Presentations

Geoffrey Anderson1; Erik Roedel2; Robert Conrad3; Delbrynt Mitchao4; Monica Wong4; Kenji Inaba4; 1Brigham & Women's Hospital; 2Madigan Army Medical Center; 3Tripler Army Medical Center; 4LA County + USC (University Of Southern California)

Introduction: The design of contemporary body armor consists of a Kevlar vest, covering part of the upper thorax, with or without ceramic plates centered over the chest and back. The design is based on tradition and usability, without the input of data related to the lethality of gunshot wounds (GSWs).

Objective: We sought to investigate the location and organ damage associated with lethal ballistic trauma to inform a more intelligent design for body armor.

Methods: We accessed the institutional database to capture all patients between 2000-2019 who died from GSWs within 24 hours of arrival. We performed chart review to determine location of the GSWs and organs injured. We then had 2 surgical residents determine which wounds were the likely cause of death. If the residents could not determine the lethal injury, then 2 trauma surgeons were the arbiters. Finally, we consulted with active police and military officers to determine which of the lethal GSWs would have been prevented by current body armor design.

Results: We collected data on 1019 patients and 1726 GSWs. 94% were male with a mean age of 29. 91% had an ISS of > 15. The mean number of lethal GSWs per patient was 1.6. The most lethal place to be shot was the chest, with 35% of the deaths, followed by the head (19%), abdomen (12%), lower extremity (12%), and back (11%). The most common lethal organ injury was the lung (19%), followed by the heart (13%), brain (12%), liver (10%), aorta (7%), IVC (6%), kidney (5%), face (5%), vertebrae/spine (4%) and pulmonary vessels (4%). Of the non-head GSWs, 21% would not have been prevented by current body armor design.

Conclusion: For patients sustaining fatal GSWs, the location of the injuries varies widely across body regions. The location of these fatal injuries should be a consideration in rational body armor design.