This multicenter study describes firearm-related injuries managed at eight hospitals in the West Bank between 2020 and 2025. The analysis included 392 patients and represents a first large-scale multicenter epidemiological assessment from this region. The cohort was predominantly male (98.0%) and skewed toward youth, with a median age of 19.0 years (interquartile range 17.0–26.0). These demographics mirror published regional patterns in which firearm trauma disproportionately affects adolescents and young adults in conflict-affected settings.
The most common anatomical location of firearm wounds was the extremities, affecting 265 (67.6%) patients. Fractures were the most frequent associated injury overall, present in 152 (38.8%) patients. Vascular injuries were recorded in 54 (13.8%) patients. Hollow viscus gastrointestinal injuries, reflecting penetrating abdominal trauma, were documented in 45 (11.5%) patients. Although less frequent than extremity trauma, thoracoabdominal and vascular injuries were noted to carry more severe clinical courses and higher resource needs in this cohort.
More than half of the patients required at least one surgical procedure during their hospital stay. Orthopedic fixation and vascular repair constituted the majority of operative workload, consistent with the high rate of extremity fractures and vascular trauma reported. The study highlights the substantial surgical demand placed on participating centers, including the need for orthopedic and vascular surgical expertise, operating room capacity, and perioperative support.
During hospitalization, 81 (20.7%) patients required admission to an intensive care unit (ICU). Overall in-hospital mortality in the cohort was 3.3%. The authors report that functional dependence at discharge was common among survivors, indicating considerable ongoing disability and the need for post-discharge rehabilitation services. Specific transfusion volumes, length of ICU stay, and other granular resource metrics were reported in the full paper; summary data in the abstract emphasize the relevance of ICU and blood bank capacity for managing severe firearm trauma.
Multivariable regression analyses identified clinical predictors associated with higher acuity outcomes. Elevated heart rate at presentation was independently associated with ICU admission (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.05, p < 0.001). Presence of abdominal injury was also independently predictive of ICU admission (OR 3.81, 95% CI 1.64–8.87, p = 0.002). For in-hospital mortality, the authors report that increasing age (OR 0.93, 95% CI 0.87–0.99, p = 0.024) and elevated heart rate (OR 0.93, 95% CI 0.90–0.97, p = 0.001) were independently associated with death during hospitalization. These findings underscore the prognostic importance of simple physiological measures on presentation and specific anatomic injury patterns.
Although extremity injuries comprised the majority of firearm wounds, thoracoabdominal and vascular injuries accounted for disproportionate severity, greater ICU utilization, and more complex surgical needs. The authors emphasize several system-level implications for conflict-affected, resource-limited settings: strengthening orthopedic and vascular surgical capacity; expanding ICU bed availability; augmenting blood bank and transfusion resources; and developing structured rehabilitation services to address the high rate of functional dependence at discharge. These recommendations reflect the study's intent to guide resource allocation and trauma system preparedness in the West Bank context.
The source article is presented as the primary data repository for this analysis: the authors state that all relevant data are within the paper and supporting information files. The abstract and accompanying sections summarized here provide key cohort-level findings; additional granular details (for example exact counts of specific operative procedures, transfusion volumes, and lengths of stay) are available in the full text and supporting files. The study is observational and descriptive, reflecting experiences across eight hospitals without external funding and with declared absence of competing interests.
This multicenter West Bank series of 392 firearm-injured patients highlights a young, predominantly male affected population, frequent extremity fractures, and a meaningful burden of thoracoabdominal and vascular injuries that drive ICU admissions and complex surgical care. In-hospital mortality was reported at 3.3%, and functional dependence at discharge was common. The authors call for targeted reinforcement of orthopedic and vascular surgical services, expanded critical care and transfusion capacity, and investment in rehabilitation to mitigate the long-term disability burden described in this conflict-affected setting.