S.R. Lee1, A.W. Lee1, M.J. Erickson2, J. Song2, S.E. Wolf2 1University Of Texas Medical Branch, John Sealy School Of Medicine, Galveston, TX, USA 2University Of Texas Medical Branch, Surgery Department, Galveston, TX, USA
Introduction: Traumatic injuries are a major public health issue, being the leading cause of death in the U.S. for people under 45. Blunt, sharp, and firearm injuries are the primary causes in trauma forensics. Advancements in medical care, injury prevention, and regional trauma systems have improved survival rates, but there is limited information on outcomes for survivors. This study examines patient outcomes for blunt, sharp, and firearm injuries over 20 years using the TriNetX database. We hypothesize that increased survival rates correlate with a rise in post-trauma morbidities.
Methods: De-identified data were collected from the TriNetX Research network in June 2024. Patients aged 18-90 were categorized by injury type (blunt, sharp, firearm) from January 1, 2004, to December 31, 2023. The dataset included 1,205,350 blunt, 710,875 sharp, and 144,562 firearm injury cases. Trends were analyzed by stratifying the data into 20 consecutive one-year intervals. Mortality, blood transfusions, traumatic shock, hypovolemic shock, and acute post-hemorrhagic anemia were recorded annually. Statistical analysis was performed using One Way Repeated ANOVA and post-hoc Tukey Test, with significance defined as p < 0.05.
Results:
The study included 1,205,350 blunt, 710,875 sharp, and 144,562 firearm injury cases. The average patient age was 42±19 for blunt, 44±18 for sharp, and 40±15 for firearm injuries. Firearm injuries predominantly affected males (83%) and African Americans (51%), while blunt and sharp injuries showed more demographic variability. Mortality rates were similar across all injury types (2-4%). However, acute post-hemorrhagic anemia was highest in firearm injuries (14%), compared to blunt (3%) and sharp (4%) injuries. Traumatic shock incidence was 1% for blunt and sharp injuries and 5% for firearm injuries.
Over the past two decades, all three injury types have increased significantly, with firearm injuries rising by 10.5-fold and both sharp and blunt injuries by 8-fold. The average age of firearm and sharp injury patients decreased by 21% and 14%, respectively. Mortality rates significantly decreased from 12% for firearm injuries in 2004 to less than 1% in 2023. Blood transfusions increased 5.5-fold for firearm injuries, with a doubling observed for sharp and blunt injuries. Traumatic shock and hypovolemic shock incidences also doubled for firearm injuries. Acute post-hemorrhagic anemia increased 6-fold for firearm injuries.
Conclusion: The study reveals that despite improved survival rates, there has been a significant increase in shock-related morbidities and blood transfusion rates, particularly for firearm injuries. These findings underscore the importance of developing strategies to not only reduce mortality but also improve the quality of life for trauma survivors. Future research should focus on optimizing trauma care protocols and addressing long-term recovery, especially for firearm injuries.