Could We Have Stopped the Bleed? An Examination of 5765 Homicide Autopsies Across 13 Years

J Am Coll Surg. 2025 Dec 3. doi: 10.1097/XCS.0000000000001695. Online ahead of print.

ABSTRACT

INTRODUCTION: Since 2015, the Stop the Bleed (STB) Campaign has trained over 3 million Americans in tourniquet application, wound packing, and extremity compression. Yet, population-level impact remains unclear. We performed a statewide evaluation of autopsy reports to quantify such deaths.

STUDY DESIGN: The Maryland Chief Medical Examiner’s office investigates all homicides statewide. We analyzed autopsies for all gunshot (GS) and stab wound (SW) homicide victims from 2005-2017. Homicides were categorized as isolated or non-isolated extremity injuries. We identified vascular injuries potentially amenable to STB. Multivariate logistic regressions stratified by mechanism compared odds of major vascular injury between isolated vs. non-isolated extremity injuries.

RESULTS: Among 5,765 victims (88% male, 82% Black, median age 28), 84% were GS and 16% SW. Extremity injuries occurred in 47% of GS and 35% of SW victims. Of those, 2.4% (n=55) of GS and 5.3% (n=17) of SW victims had isolated wounds. Major vascular injuries were more common in isolated vs. non-isolated extremity wounds (GS: 33% vs. 5.0%; SW: 59% vs. 9.5%). GS victims with isolated extremity wounds had 10-fold greater odds of vascular injury compared with those with non-isolated injuries (OR 10.1 [95% CI 5.8-17.5], P<0.01). The difference was not significant for SW victims (OR 3.7 [95% CI 0.5-17.1], P=0.11).

CONCLUSION: We found a significant burden of extremity wounds with major vascular injury amongst a large cohort of GS and SW homicide victims. GS victims with isolated extremity injuries were substantially more likely to sustain fatal vascular injury. These findings highlight isolated extremity wounds as a prime target for bystander hemorrhage control through STB interventions.

PMID:41701567 | DOI:10.1097/XCS.0000000000001695