A. R. McDowell1, G. Ortega2,3, A. Obirieze2, N. R. Changoor2,3, F. Wilks1, T. R. Jones1, D. H. Ford3, A. Haider4, M. Williams2,3, E. E. Cornwell2,3 1Howard University College Of Medicine,Washington, DC, USA 2Howard University College Of Medicine,Clive O. Callender Howard-Harvard Outcomes Research Center/ Department Of Surgery,Washington, DC, USA 3Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 4Brigham And Women’s Hospital,Center for Surgery and Public Health,Boston, MA, USA
Introduction: Since 2000, firearms account for approximately 30,000 deaths per year as reported by the CDC. In 2004, the Violent Crime Control and Law Enforcement Act expired which removed the federal ban on firearms or magazines capable of holding more than ten rounds of ammunition. During this era, previous studies have stated that firearm death trends remaining constant have not been influenced by trauma care improvements. However, there was not an assessment of the lethality of injury when presented to a trauma center in these studies. Our objective is to analyze the outcomes of trauma patients with firearms based on the lethality of injury in the National Trauma Data Bank (NTDB).
Methods: A retrospective review was performed using the NTDB from years 2003 to 2010 specifically, for patients with penetrating injuries. Patients were stratified into 3 groups based on mechanism: stab wounds (SW), single GSW (sGSW) and multiple GSW (mGSW). SW was used as a reference in comparison to GSW. Multivariate logistic regression models were utilized adjusting for a patient’s age, sex, race, insurance status, injury severity score, Abbreviated Injury Scale for the head, thorax and abdomen and the presence of hypotension on arrival to the hospital.
Results: A total of 246,184 patients were identified. Of these patients, 47.7% presented with SW, 39.3% presented with sGSW, and 12.9% presented with mGSW. The proportion of patients who survived the Emergency Department (ED) from 2003 to 2010 with SW and sGSW decreased from 1.3% to 0.9% and 11.6% to 7.6%, respectively. However, the proportion of patients who presented with multiple GSWs increased from 10.7% to 12%. The proportion of patients who were dead on arrival (DOA) to level 1 trauma centers, from 2003 to 2010, increased in patients with SW (from 0.1% to 0.2%), sGSW (from 0.9% to 2.1%), and mGSW (from 1.3% to 2%). Compared to 2003, patients who presented with a sGSW who presented to level 1 trauma centers and survived through the emergency department had a decreased risk-adjusted odds of mortality ranging from 24-38% between 2005 to 2010 (See Table 1). In contrast, patients with mGSWs that presented to level 1 trauma centers and survived through the ED had increased odds of mortality of 28%, 49% and 24% in 2004, 2005 and 2007, respectively when compared to 2003 (See Table 1) but no significant difference in the odds of mortality in 2006, 2008, 2009, and 2010.
Conclusion: Crude mortality of patients who presented with SW and sGSW improved over the seven-year period. sGSW patients had an overall decreased mortality rate after surviving through the ED. There was no increase in survival seen in patients with multiple GSW who survived the ED over the past several years, at Level 1 trauma centers.
