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Original Research

Open Access

Stray bullet injuries in a tertiary care center


1Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon

DOI: 10.22514/SV121.102016.18 Vol.12,Issue S1,October 2016 pp.106-110

Published: 10 October 2016

*Corresponding Author(s): 'AFIF MUFARRIJ E-mail:

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Background. A stray bullet injury is de-fined as an accidental firearm injury oc-curring outdoors by an anonymous at-tacker. Stray bullet injuries are rare, but not uncommon in certain parts of the world. In Pakistan, 165 patients with stray bullet injuries were recorded between 2006 and 2010.

Objectives. In Lebanon, gunshots may oc-cur during politicians’ speeches, funerals and after exam results are published. No studies to date have looked at the details and consequences of these gunshot inju-ries.

Methods. A retrospective chart review of patients presenting to an emergency de-partment (ED) in Beirut, Lebanon, from 2010 to 2015, with clear stray bullet inju-ries was conducted. Variables included: demographics, injured body part, admis-sion to hospital, number of days in hospi-tal, length of stay in the ED, mortality, past medical history, emergency severity index, and consequences of injury including sur-gery.

Results. Out of 154 bullet injuries, 12 stray bullet injuries were recorded. Injuries of the lower extremity were most common, followed by the head, shoulder/thorax, abdomen/pelvis and upper extremity. Sur-gery was needed in 7 patients (58.3%). The median length of stay was 3.08 hours in the ED and 4.78 days in hospital. There were no recorded deaths. Consequences of each stray bullet injury are presented.

Conclusion. Stray bullet injuries are com-monly reported on in news and media outlets. This is the first study in Lebanon and the region to document cases of stray bullet injuries presenting to the ED. Bet-ter laws and educational policies need to be implemented to help discourage this practice.

Key words

stray bullets, emergency depart-ment, injured body part, consequences of stray bullets, hospital admissions, severity of injury, surgical intervention, Lebanon

Cite And Share

NICHOLAS BATLEY,RINAD BAKHTI,RANA BACHIR,'AFIF MUFARRIJ. Stray bullet injuries in a tertiary care center. Signa Vitae. 2016. 12(S1);106-110.


1. World Health Organization. International statistical classification of diseases and related health problems. World Health Organiza-tion; 2004.

2. Al-Tarshihi MI, Al-Basheer M. The falling bullets: post-Libyan revolution celebratory stray bullet injuries. Eur J Trauma Emerg Surg 2014 Feb;40(1):83-5.

3. Ali SA, Tahir SM, Makhdoom A, Shaikh AR, Siddique AJ. Aerial firing and stray bullet injuries: a rising tide. Iran Red Crescent Med J 2015;17(4):26179.

4. Wintemute GJ, Claire BE, McHenry VS, Wright MA. Epidemiology and clinical aspects of stray bullet shootings in the United States. J Trauma Acute Care Surg 2012 Jul;73(1):215-23.

5. Haag L. Shooting incident reconstruction. Academic press; 2006.

6. Maiden N. Ballistics reviews: mechanisms of bullet wound trauma. Forensic Sci Med Pathol 2009;5(3):204-9.

7. Hartink AE. The complete encyclopedia of automatic army rifles. Hackberry Press; 2001. p. 119-20.

8. Kjellgren GLM. The Practical Range of Small Arms. The American Rifleman; 1970.

9. Shuker ST, Sadda R. Craniomaxillofacial falling bullet injuries and management. J Oral Maxillofac Surg 2010 Jul;68(7):1593-601.

10. Ordog GJ, Wasserberger J, Balasubramanium S. Wound ballistics: theory and practice. Ann Emerg Med 1984 Dec;13(12):1113-22.

11. El Hassan, J. Stray bullets are no cause for celebration [Online]. 2013 Sep 5. Available from: URL:

12. Eitel DR, Travers DA, Rosenau AM, Gilboy N, Wuerz RC. The emergency severity index triage algorithm version 2 is reliable and valid. Acad Emerg Med 2003 Oct;10(10):1070-80.

13. Ordog GJ, Dornhoffer P, Ackroyd G, Wasserberger J, Bishop M, Shoemaker W, et al. Spent bullets and their injuries: the result of fir-ing weapons into the sky. J Trauma 1994 Dec;37(6):1003-6.

14. Malik AM, Alkadi A, Talpur KA, Qureshi JN. The incidence, pattern and outcome of stray bullet injuries. A growing challenge for surgeons. Pak J Med Sci 2013 Sep;29(5):1178-81.

15. Centers for Disease Control and Prevention. New Year’s Eve injuries caused by celebratory gunfire—Puerto Rico, 2003. Morb Mortal Wkly Rep 2004;53:1174–5.

16. National Health Statistics Report in Lebanon [Online]. 2012. Available from: URL:

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