Parameters to evaluate during the clinical assessment:
(1) shock or hemodynamically unstable
(2) arterial hemorrhage
(3) distal ischemia
(4) ankle-brachial index (ABI)
(5) proximity of the bullet trajectory to a major vascular structure
Surgery or CT angiography is done if any of the following are present
(1) shock or hemodynamically unstable
(2) arterial hemorrhage
(3) distal ischemia
(4) ankle-brachial index (ABI) < 0.90
If the bullet trajectory is close to a major vascular structure then duplex ultrasonography or CT angiogram is performed. The patient is admitted and anticoagulation started if there is evidence of a vascular thrombosis.
Anyone else could be discharged home after the wound has been cleaned and debrided:
(1) hemodynamically stable
(2) ABI >= 0.90
(3) bullet trajectory not close to a major vascular structure
Performance:
• For safe discharge home the sensitivity was 50%, the specificity 100%, the positive predictive value 100% and negative predictive value 98%.
Limitations:
• The study was done in an urban area with nonmilitary weapons.
