Atypical gunshot injuries: A review of case reports and case series.

Background and aim: Gunshot injuries are important public health concerns that contribute significantly to disability and mortality, but atypical cases remain underexplored. This review synthesizes the published literature to identify factors that experts/authors use to classify gunshot injuries as atypical, intending to deepen insights and improve forensic interpretations and clinical outcomes.

Methods: Following a scoping review framework, we searched PubMed using keywords related to the terms "atypical," "gunshot," and "case report." We included peer-reviewed case reports and case series in English with no date restrictions. We excluded reviews, typical injury studies, animal studies, and non-English publications. Data were extracted into an Excel spreadsheet to identify patterns in injury characteristics and forensic/clinical implications.

Results: From the 390 records identified, 237 records spanning 1977-2024 were analyzed after screening. Cases were predominantly concentrated in North America and Europe. The classifications of atypical entities fall into four main categories or themes: unusual anatomical locations, aberrant wound patterns, unconventional weapons or ammunition, and unanticipated clinical presentations or complications and unique treatment.

Conclusions: These findings challenge standard ballistic and clinical assumptions and emphasize the need for enhanced forensic tools and individualized treatment approaches in the management of such patients. This scoping review addresses a critical gap by providing forensic experts with better interpretation frameworks and clinicians with refined care strategies.