{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:09:33Z","timestamp":1790100573331,"version":"4.0.1"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Firearm injuries represent a major source of trauma in conflict\u2011affected 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\u201326.0]. 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\u2011hospital 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\u20131.05, p\u2009&lt;\u20090.001). Abdominal injuries were also significant predictors of ICU admission (OR: 3.81, 95% CI: 1.64\u20138.87, p\u2009=\u20090.002). Increasing age (OR: 0.93, 95% CI: 0.87\u20130.99, p\u2009=\u20090.024) and elevated heart rate (OR: 0.93, 95% CI: 0.90\u20130.97, p\u2009=\u20090.001) were independently associated with in\u2011hospital mortality. This study shows that while extremity injuries dominate the epidemiological profile of firearm trauma in the West Bank, thoracoabdominal and vascular injuries were associated with greater resource demands and more severe outcomes. The findings underscore the urgent need to strengthen orthopedic and vascular surgical capacity, expand ICU and blood bank resources, and develop rehabilitation services.<\/jats:p>","DOI":"10.1371\/journal.pone.0358566","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:30:51Z","timestamp":1790098251000},"page":"e0358566","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Firearm injuries in a conflict affected region: A multicenter study of epidemiological trends, injury patterns, management, and outcomes in the West Bank of Palestine"],"prefix":"10.1371","volume":"21","author":[{"given":"Hala","family":"Alkhoury","sequence":"first","affiliation":[{"name":"An-Najah National University","place":["Nablus, Palestine"],"department":["Department of Medicine, Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0564-9946","authenticated-orcid":true,"given":"Mira","family":"Hallak","sequence":"additional","affiliation":[{"name":"An-Najah National University","place":["Nablus, Palestine"],"department":["Department of Medicine, Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Shakshir","sequence":"additional","affiliation":[{"name":"An-Najah National University","place":["Nablus, Palestine"],"department":["Department of Medicine, Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iyad","family":"Maqboul","sequence":"additional","affiliation":[{"name":"An-Najah National University","place":["Nablus, Palestine"],"department":["Department of Medicine, Faculty of Medicine and Health Sciences"]},{"name":"An-Najah National University Hospital","place":["Nablus, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Jaber","sequence":"additional","affiliation":[{"name":"An-Najah National University","place":["Nablus, Palestine"],"department":["Department of Medicine, Faculty of Medicine and Health Sciences"]},{"name":"An-Najah National University Hospital","place":["Nablus, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2403-610X","authenticated-orcid":true,"given":"Ramzi","family":"Shawahna","sequence":"additional","affiliation":[{"name":"An-Najah National University","place":["Nablus, Palestine"],"department":["Department of Physiology, Pharmacology, and Toxicology, Faculty of Medicine and Health Sciences"]},{"name":"An-Najah National University Hospital","place":["Nablus, Palestine"],"department":["Clinical Research Center"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"issue":"7","key":"pone.0358566.ref001","doi-asserted-by":"crossref","first-page":"110763","DOI":"10.1016\/j.injury.2023.04.050","article-title":"A global perspective on gun violence injuries","volume":"54","author":"JM Wolf","year":"2023","journal-title":"Injury"},{"issue":"6","key":"pone.0358566.ref002","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1097\/SCS.0000000000009268","article-title":"A nationwide analysis of gunshot wounds of the head and neck: morbidity, mortality, and cost","volume":"34","author":"JM Menezes","year":"2023","journal-title":"J Craniofac Surg"},{"key":"pone.0358566.ref003","doi-asserted-by":"crossref","first-page":"966507","DOI":"10.3389\/fpubh.2022.966507","article-title":"Global burden and trends of firearm violence in 204 countries\/territories from 1990 to 2019","volume":"10","author":"Z Ou","year":"2022","journal-title":"Front Public Health"},{"key":"pone.0358566.ref004","first-page":"1","author":"A Mittal","year":"2024"},{"issue":"3","key":"pone.0358566.ref005","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/TA.0000000000002290","article-title":"Wound ballistics of military rifle bullets: An update on controversial issues and associated misconceptions","volume":"87","author":"PK Stefanopoulos","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"key":"pone.0358566.ref006","first-page":"293","article-title":"Gunshot wounds: Ballistics, pathology, and treatment recommendations, with a focus on retained bullets","volume":"14","author":"GR Baum","year":"2022","journal-title":"Orthop Res Rev"},{"issue":"3","key":"pone.0358566.ref007","doi-asserted-by":"crossref","first-page":"100178","DOI":"10.1016\/j.jorep.2023.100178","article-title":"Management of gunshot fractures to the extremities - 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