Evaluation of Gunshot Wounds to the Extremities: Correlation of Red Cross Wound Score and Initial Response to Management

Purpose: Gunshot wounds to the extremities are a major cause of death and disability. The Red Cross Wound Score (RCWS) is a simple classification system that is thought to fairly assess severity of injury, influence surgical management and a good predictor of outcome in gunshot wounds. This study aims to evaluate the correlation between the Red Cross Wound Score RCWS and initial response to management. Methodology: This was a prospective study recruiting all consenting patients who suffered gunshot wounds to any extremity and presented at the University of Port Harcourt Teaching Hospital (UPTH). The study was conducted over a 12-month period between October 2018 and September 2019. Data on demographics, anatomical region of the body involved, type of gun time between injury and hospital presentation were obtained using a proforma. Analysis of extracted data was done by the aid of SPSS for Windows version 20. Findings: A total of 106 wounds from 82 patients were analyzed; seventy males (85.4%) and 12 females. AK 47 rifles and locally fabricated pistols were the wounding weapons in 32.9% and the left leg (28.3%) was the most injured extremity. Fifty-two wounds (49%) were grade 3, 44 (41.5%) wounds grade 2 and 10 wounds (9.4%) grade 1. There was a positive association between RCWS grade 3 wounds and limb length discrepancy and joint stiffness. Vascular injuries were seen in 6 patients (0.07%). Wound infection (46.2%), joint stiffness (41.5%) and shortening (34%) were the common complications in the study. The study showed that young adult males suffered more gunshot wounds than females. Most of the wounds were RCWS grade 3 and there was a positive association between RCWS grade 3 wounds and limb length discrepancy and joint stiffness. Patients with longer mean presentation time had a higher infection rate. Recommendations: The Red Cross wound classification should be adopted as a useful scoring system. Also, patients with gunshot injuries should present earlier to the hospital to reduce complications.