Clinical burden and predictors of hospitalization in extremity gunshot wounds: A single-center retrospective study

Background

This study aimed to retrospectively evaluate the clinical characteristics, temporal admission patterns, and clinical outcomes of patients with extremity gunshot wounds (GSW) presenting to a tertiary care teaching and research hospital.

Methods

A total of 123 patients presenting with GSWs affecting at least one extremity between January 2024 and December 2025 were retrospectively analyzed. Injury characteristics, interventions, and clinical outcomes were evaluated. Factors independently associated with hospital length of stay (LOS) and intensive care unit (ICU) admission were identified using negative binomial regression and multivariate logistic regression analyses, respectively.

Results

Of the patients, 116 (94.3%) were male, with a mean age of 29.9±11.9 years. The lower extremity was the most frequently affected region (69.1%), and 42 of 43 fractures (97.7%) were open fractures. The ICU admission rate was 26.0% (n=32), and in-hospital mortality was 4.1% (n=5). A total of 43.1% of admissions occurred between 18:00 and 23:59. In negative binomial regression, concomitant injury (incidence rate ratio [IRR]=6.93; 95% confidence interval [CI]: 3.82–12.57; p<0.001), fracture (IRR=5.02; 95% CI: 2.82–8.93; p<0.001), and reoperation (IRR=2.73; 95% CI: 1.44–5.16; p=0.002) were independently associated with length of hospital stay. In logistic regression, neurovascular injury (odds ratio [OR]=28.12; 95% CI: 7.60–104.09; p<0.001) and concomitant injury (OR=20.36; 95% CI: 5.62–73.81; p<0.001) independently predicted ICU admission.

Conclusion

Extremity GSWs predominantly affect young males and cluster during evening hours. Concomitant injury and fracture were independently associated with length of hospital stay, whereas reoperation was associated with prolonged hospitalization during the clinical course, while neurovascular injury and concomitant injury independently predict ICU admission.