Two cases show need for high level of suspicion when stories don't match clinical findings
FRIDAY, Feb. 20 (HealthDay News) -- Emergency-department personnel should be alert to the possibility that some patients may conceal the fact that their injuries were caused by gunfire, according to a letter published in the Feb. 21 issue of The Lancet.
Hazem B. Fallouh, M.D., of St. Thomas Hospital in London, U.K., and colleagues described two cases who presented to the emergency department with injuries that were not initially suspected to be caused by gunfire. In both cases, radiograph studies led to an incidental diagnosis of gunshot wounds despite the patients' insistence that no gunfire had been involved.
The first patient said he suffered blunt facial trauma during a fight. But a plain neck radiograph showed that he had a comminuted fracture of the mandible, and a subsequent chest radiograph and CT scans of the head, neck and chest confirmed that he been shot. The second patient said he suffered a left-sided chest wound after falling onto a blunt object. But a radiological examination of the chest showed a 5 mm foreign body. Both patients were admitted for overnight observation, but the second patient left the hospital and took the records with him after learning that the police had been notified.
"In an attempt to avoid police involvement, victims might deny any link with firearms, especially if there is involvement in gangs or criminal activity," the authors write. "A high index of suspicion for ballistics injury might help in reaching a diagnosis obscured by a vague history inconsistent with clinical findings; further imaging might be appropriate."
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