The evaluation of cases admitted to Akdeniz University Hospital with firearm injuries between the years 2014-2023

Armament, which started with stones and sticks with the instinct of hunting and defense to meet the need for food since the beginning of human history, has become widespread individually and socially with the use of modern weapons and the increasing tendency to violence, causes many people to be injured and killed every day and causes social problems and constitutes a serious public health problem. Every year, more than 200.000 people in the world and more than 2.000 people in Turkish Republic lose their lives and more than 3000 people are injured by firearms in Turkish Republic. The aim of this study was to retrospectively examine the hospital information system records of the cases admitted to Akdeniz University Hospital with firearm injuries between 01 January 2014 and 31 December 2023; and to examine the demographic characteristics and injury findings of the cases from a medico-legal perspective and to compare the data in the light of the previously published reports. In this study, which was approved by the decision of Akdeniz University Faculty of Medicine Clinical Research Ethics Committee dated 11.01.2023 and numbered KAEK-20, 418 patients who were admitted to Akdeniz University Hospital between 2014 and 2023 due to firearm injuries were included in the study. Of the cases, 89.95% (n=376) were male and 10.05% (n=42) were female. The age group with the highest number of cases was 25-44 years with 51.67% (n=216). Employees and individuals who participate more in social life are mostly in the 25-40 age group. In this study, 44 of the cases (10.52%) were children under the age of 18, and 23 of them (52.29%) had injured accidentally. It was determined that 19 (82.60%) of these accidents and 5 (50.00%) of the homicidal shooting (n=10) caes had injured by long-barreled firearms It was found that the highest number of admissions was in 2023 with 56 (13.39%) cases and in 2022 with 55 (13.15%) cases whereas the lowest number of admissions was in 2020 with 26 (6.22%) cases.The cases were most frequently admitted in the fall season (n=119, 28.47%) and secondly in the summer season (n=111, 26.56%). It was found that 52.15% (n=218) of the cases were injured with short-barreled weapons such as pistols, 44.02% (n=184) with long-barreled weapons such as hunting rifles, shotguns. Unfortunately in 16 (3.83%) cases, there was no information about the lenght of barrel of firearm in the electronic files of hospital. Of the cases 60.28% (n=252) had criminal, 16.27% (n=68) had accidental and 4.55% (n=19) had suicidal origin. Unfortunately, in 18.90% (n=79) of the cases, the origin of injury was not specified in the medical documents. In injuries inflicted with both short-barreled and long-barreled weapons, criminal origin was the most common with a frequency of 60.28% (n=252). It was followed by accidental origin with a frequency of 16.27% (n=68), and the least common origin was suicide with 4.55% (n=19). It was found that 52.87% (n=221) of the cases were injured as a result of a shot fired from a long distance, 16.99% (n=71) from close range, 2.39% (n=10) from contact range, 0.48% (n=2) from near contact range, and 27.27% (n=114) of the cases' files had neither information about shooting distance nor findings that can be seen around the entrance wound such as cartridge residues, smoke or burns. In 93.06% of the cases, the first admitted service was the emergency department. It was determined that 73.20% (n=306) of the cases were hospitalized and the most common unit of hospitalization was Orthopedics and Traumatology service with a frequency of 35.29%. It was determined that 60.52% (n=253) of the cases were operated, and during surgery or with local incision, the bullets or pellets were removed from 26.60% (n=111) of the cases . Despite all sugical intervention, 54.31% (n=227) of the cases had metalic pieces of bullets or pellets remained in their bodies. The most common gunshot residue removed or left in the body was pellets. One or more internal organ injury occurred in 125 cases (30%). The most frequently injured internal organs were small intestine 22.80% (n=62), lungs 22.40% (n=61), and colon 21.30% (n=58). The most common injured body part was the lower extremities with 48.30% (n=202). Major vessel injuries occurred in 60 cases (14.35%), nerve injuries occurred in 70 cases (16.74%), and both major vessel and nerve damages were detected in 24 cases (5.74%). The most commonly injured vessel was the popliteal artery in 13 cases (22%). Twenty-three (5.50%) of the cases had cerebral hemorrhage; epidural hemorrhage was detected in 4 (17.40%) cases, subdural hemorrhage in 17 (73.90%) cases, subarachnoid hemorrhage in 17 (73.90%) cases, intracerebral hemorrhage in 16 (69.60%) cases and interventricular hemorrhage in 7 (30.40%) cases. Hemothorax, pneumothorax or hemo-pneumothorax was detected in 48 (44%) of 109 patients; in these cases the most common finding (n=48) is hemo-pneumothorax with 27 cases (56.30%). In 183 (43.80%) cases, the injury was life-threatening severity, while in 229 (54.80%) cases the injury was not life-threatening severety according to Turkish medicolegal procedures. In 416 (99.50%) of the cases, the injuries could not be treated with simple medical intervention, while in 2 (0.50%) cases the injuries could be treated with simple medical intervention. One of the 2 cases was wounded with a pellet gun and only abrasions were detected on his body, and the other had a 1 cm laceration on his left auricle, both of these injuries could be treated with simple medical intervention. It was determined that 54.50% (n=228) of the cases had bone fractures. According to Tukish medicolegal procedures, the effect of bone fractures on life functions was mild (1) in 6.20%, moderate (2-3) in 39% and severe (4-5-6) in 54.80% of the cases. The most frequently fractured bones were the lower extremity bones with 40.78% (n=93). This was followed by maxillofacial bones with 17.54% (n=40), upper extremity bones with 17.10% (n=39), thoracic bones with 14.03% (n=32), skull dome bones with 11.40% (n=26), pelvic bones with 11.40% (n=26), vertebrae with 6.14% (n=14) and cranial base bones with 2.19% (n=5). Bone fractures in more than one body region were present in 47 cases (20.61%; n=228). It is understood that in 52.63% of the cases (n=220), ethyl alcohol level was determined in the blood, and in 99 of these cases (45.0%; n=220) different levels of ethyl alcohol were detected in the blood. Of the 99 cases in which ethyl alcohol was detected in the blood, 66 (66.67%) were homicides. It was determined that the frequency of homicidal origin was increased in cases with ethyl alcohol detected in their blood, compared to those without. In order to differentiate entry and exit wounds, determine the distance and origin of gunshot wounds, the characteristics of the wound at the initial examination, the presence/absence of shooting products, and the whether the injured parts of the body clothed or non clothed at the event should be written in detail by the physicians who first examined the case. If the injured person is conscious, in order to answer questions that may arise during the judicial procedure in the future, the characteristics of the used weapon should also be questioned and informations about event should be noted. Considering that a firearm injuries mostly admitted to the emergency services, physicians working in emergency services have a great duty in this regard and regular training seminars can be organized on this subject. In order to reduce the number of injuries and deaths caused by firearms and the incidence of violence in society, emphasis should be placed on achieving disarmament worldwide and promoting the negative effects of firearms use. Considering that unlicensed weapons may be present in the civilian population in addition to the number of licensed handguns; increasing the inspections on the trade, procurement and possession of unlicensed weapons, and aggravating the penal sanctions to be imposed in case of detection; detailed psychiatric examinations and regular controls and tests should be mandatory in order to obtain a licensed weapon Before a person is given permission to obtain a gun licence, it should be mandatory to carry out a detailed psychiatric examination and regular control and tests, to obtain a detailed social research report including the person's own childhood family and current family structures, and the person's reputation for violence in his/her environment, his/her family', even relatives' opinions about the person, and his/her tendency to violence and his/her registered crime tendency should be examined. In addition to these measures, since public information activities can also contribute to the reduction of firearm related injuries and deaths, it would be appropriate to represent the various anti armament training videos and seminars suitable for all segments of society, both in the media and on social media resources. Keywords: Forensic Case, Medicolegal Cae, Firearm, Firearm Injury, Origin, Firing Distance, Pistol, Shotgun