---
title: "Firearm injuries in the West Bank: multicenter epidemiology, injury patterns, management, and outc"
id: "plos-one-19-firearm-injuries-in-a-conflict-affected-region-a-multicenter-study-of"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-19-firearm-injuries-in-a-conflict-affected-region-a-multicenter-study-of"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358566"
published_at: "2026-09-22T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Firearm injuries in the West Bank: multicenter epidemiology, injury patterns, management, and outc
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-19-firearm-injuries-in-a-conflict-affected-region-a-multicenter-study-of
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358566)
- **Published At:** 2026-09-22T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This multicenter retrospective study reports on **392** patients with firearm injuries treated across eight hospitals in the West Bank between 2020 and 2025. - The cohort was overwhelmingly male (98.0%) with a median age of 19.0 years (IQR 17.0–26.0), highlighting the impact on adolescents and young adults. - **Extremity injuries** were the most frequent anatomic location, affecting **265 (67.6%)** patients; fractures were the most common associated injury (152 patients, 38.8%). - Thoracoabdominal and **vascular injuries** were less common but associated with greater severity and resource needs; vascular trauma occurred in 54 patients (13.8%) and hollow viscus gastrointestinal injuries in 45 patients (11.5%). - More than half of patients required at least one operative intervention; orthopedic fixation and vascular repair were the dominant procedures performed. - During hospitalization, **81 (20.7%)** patients required ICU admission and overall in-hospital mortality was **3.3%**. - Functional dependence at discharge was common among survivors, indicating substantial post-discharge rehabilitation needs. - Multivariable analyses identified elevated heart rate on presentation as independently associated with ICU admission (OR 1.04, 95% CI 1.02–1.05, p < 0.001) and abdominal injury as a predictor of ICU admission (OR 3.81, 95% CI 1.64–8.87, p = 0.002). - Increasing age and elevated heart rate were independently associated with in-hospital mortality (age OR 0.93, 95% CI 0.87–0.99, p = 0.024; heart rate OR 0.93, 95% CI 0.90–0.97, p = 0.001) as reported in the source. - Authors conclude that despite predominance of extremity trauma, thoracoabdominal and vascular injuries drive higher resource utilization; they recommend strengthening **orthopedic** and **vascular surgical** capacity, expanding ICU and blood bank resources, and developing rehabilitation services.
## Clinical Analysis & Structured Key Points
Firearm injuries in a conflict affected region: A multicenter study of epidemiological trends, injury patterns, management, and outcomes in the West Bank of Palestine | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Firearm injuries represent a major source of trauma in conflict‑affected regions, yet multicenter data from Palestine remain scarce. This multicenter study provides the first large epidemiological analysis of firearms injuries across eight hospitals in the West Bank, encompassing 392 patients treated between 2020 and 2025. The cohort was overwhelmingly male (98.0%) and predominantly young, with a median age of 19.0 years [17.0–26.0]. Extremity injuries were most common, affecting 265 (67.6%) patients, while thoracoabdominal and vascular injuries, though less frequent, were associated with disproportionately severe outcomes. Fractures were the most frequent associated injury, affecting 152 patients (38.8%), followed by vascular trauma in 54 patients (13.8%) and hollow viscus gastrointestinal injuries in 45 patients (11.5%). Surgical interventions were required in more than half of patients, with orthopedic fixation and vascular repair dominating the workload. During hospitalization, 81 (20.7%) patients required intensive care unit (ICU) admission, while in‑hospital mortality was 3.3%. Functional dependence at discharge was common, affecting more than half of survivors. Multivariable regression showed that elevated heart rate at presentation was independently associated with ICU admission (OR: 1.04, 95% CI: 1.02–1.05, p 100 bpm). Hemodynamic instability was defined as heart rate 120 bpm, systolic blood pressure <90 mmHg, or diastolic blood pressure <60 mmHg. Neurological status was assessed separately using the Glasgow Coma Scale [ 17 ], categorized as ≥13, 9–12, 3–8, or not recorded. Injury variables were classified by anatomical region and by injury type. Associated injuries and fractures were also classified by anatomical region and by injury type. Management variables included wound management, bullet/foreign body removal, fracture stabilization/fixation, and surgical interventions were also collected. Outcome variables included ICU admission, blood transfusion, antibiotic administration, length of hospital stay, discharge disposition, functional status at discharge, and mortality status (alive/deceased). Functional status at discharge was assessed based on documentation in medical records and categorized into three groups: “independent” (patients discharged with preserved mobility and self‑care capacity without the need for assistance), “dependent” (patients discharged with impaired mobility, need for caregiver support, or functional limitations requiring rehabilitation services), and “deceased.” This pragmatic categorization reflects routine clinical documentation practices in the participating hospitals and was used to capture functional outcomes in the absence of standardized assessment instruments. Data collection Data were abstracted using a standardized, customized collection form developed specifically for this study ( S2 Table ). The form captured demographics, injury characteristics, physiological parameters, comorbidities, interventions, and outcomes. A structured variable dictionary accompanied the form, defining each variable and its coding framework to ensure reproducibility. Data abstraction was performed retrospectively from EMRs by trained research team members who were final year medical students. Abstractors underwent orientation to the standardized protocol and variable dictionary to ensure consistent interpretation across hospitals. Systematic data cleaning procedures were applied to harmonize category labels, standardize anatomical and procedural terminology, and perform logical consistency checks (e.g., alignment between recorded procedures and number of surgeries). Missing data were preserved as a distinct category (not recorded) rather than reclassified, minimizing misclassification bias and maintaining transparency. The approach was informed by methodologies commonly used in retrospective trauma research and relied on routinely documented clinical records generated during standard patient care. Statistical analysis Data were coded, cleaned, and analyzed using IBM SPSS Statistics for Windows, version 26. Categorical variables were summarized as frequencies (n) and percentages (%), while continuous variables were reported as median with interquartile range [Q1, Q3]. Bivariate analyses were conducted to explore associations between baseline characteristics, injury patterns, management procedures, and clinical outcomes. For categorical comparisons, Pearson’s chi-square test was applied, with Fisher’s exact test used when expected cell counts were <5. For continuous outcomes compared between two groups, Mann-Whitney U tests were used. For comparisons across more than two groups, Kruskal-Wallis tests were employed. To identify factors independently associated with ICU admission and in‑hospital mortality, multivariable logistic regression models were constructed. Candidate variables were selected a priori through a two‑step process: (1) screening for statistical significance in bivariate analyses (p < 0.10), and (2) evaluation of clinical relevance based on prior trauma literature. Specifically, age and pulse rate on arrival were included because they are consistently reported as strong predictors of mortality and ICU utilization [ 2 , 6 , 9 , 10 ]. Chest trauma and abdominal trauma were entered separately into the models, as both regions are recognized in global and regional firearm injury studies as major determinants of severity and resource demand [ 2 , 6 , 9 , 10 , 12 – 14 ]. Other variables (e.g., limb injuries, soft tissue injuries, minor fractures) were excluded because they did not reach statistical significance in univariate analyses, lacked established evidence of independent prognostic value, or were collinear with included predictors. Given the small number of deaths (n = 13), the mortality model was deliberately restricted to a parsimonious set of variables to minimize overfitting. This strategy ensured th
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