Gunshot wounds to the head - Common errors of clinicians in diagnosing direction and range of fire

Background: Evaluating direction and range of fire based on gunshot wound characteristics requires theoretical and/or practical training in terminal ballistics. Clinicians specializing in trauma, surgery and neurosurgery are sometimes called upon to assess direction of fire without prior knowledge or experience in the field. Descriptions of gunshot wounds and determination of bullet direction are documented in medical records. When data from hospital records concerning cases of gunshot wounds to the head were compared with autopsy findings, numerous discrepancies were found with often tragic consequences. Objective: To describe possible inconsistencies between evaluations of gunshot wounds by clinicians and autopsy results and interpretation of medical records by forensic pathologists, as well as provide basic tools to facilitate a more accurate description of injuries by physicians. Patients: Three cases of shooting victims treated in medical facilities, two patients underwent autopsy and the third case was re-evaluated by a forensic pathologist based on medical records. Conclusions: Clinicians often base their diagnosis of direction of fire solely on the size of the head wounds, without taking into consideration additional characteristics, such as the range of fire, powder residue and others. Misdiagnosis of the direction and range of fire has long term psychological and legal consequences. Summary: Clinicians are therefore advised to avoid determining direction and range of fire without prior experience and expertise in the field and, if needed, to consult forensic pathologists proficient in terminal ballistics.