A literature search was performed using the following databases: PubMed, Web of Science, Ovid MEDLINE®, and The Defense Technical Information Center, as well as the Cochrane Database of Systematic Reviews. Searches were limited to those published in English. Search terms included, but were not limited to, the following: ballistics, penetrating injury, gunshot, firearms, emergency, emergency department, trauma, physics, biophysics, forensics, and forensic documentation. The search was further refined by defining the specific area of injury. The search returned 4200 abstracts, which were reviewed by the authors for relevance. The bibliographies of the relevant articles were also reviewed for additional publications. Various trauma-related guidelines were identified through www.guidelines.gov. The American College of Radiology (ACR) Appropriateness Criteria® of imaging modalities used in trauma were also reviewed.

Prospective randomized trials of treatment for gunshot wounds are inherently difficult to perform. Many of the studies with large patient numbers are observational or retrospective. Much of the trauma literature is based on case reports and case series.

The Advanced Trauma Life Support® (ATLS®) protocols were also reviewed. The 8th (and most recent) revision of ATLS® included extensive literature review as well as expert opinion, and much of the evidence for recent changes comes from the emergency medicine literature.⁷