Babak Sarani1, E Reed Smith, Geoff Shapiro, Jeffry Nahmias, Lisbi Rivas, Robert McIntyre, Bryce R H Robinson, Paul J Chestovich, Richard Amdur, Eric Campion, Shane Urban, Ilya Shnaydman, Bellal Joseph, Jonathan Gates, John Berne, Jordan M Estroff. 1. From the Center for Trauma and Critical Care, Department of Surgery (B.S., L.R., R.A., J.M.E.), Department of Emergency Medicine (E.R.S.), and Emergency Medical Services Program (G.S.), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Surgery (J.N.), University of California, Irvine, Orange, California; Department of Surgery (R.M., E.C., S.U.), University of Colorado, Denver, Colorado; Department of Surgery (B.R.H.R.), Harborview Medical Center, University of Washington, Seattle, Washington; Department of Surgery (P.J.C.), University of Nevada, Las Vegas, Las Vegas, Nevada; Department of Surgery (I.S.), Ryder Trauma Center, University of Miami, Miami, Florida; Department of Surgery (B.J.), University of Arizona, Tucson, Arizona; Department of Surgery (J.G.), Hartford Hospital, Hartford, Connecticut; and Department of Surgery (J.B.), Broward Health, Miami, Florida.
Abstract
BACKGROUND: Firearm injury remains a public health crisis. Whereas there have been studies evaluating causes of death in victims of civilian public mass shootings (CPMSs), there are no large studies evaluating injuries sustained and treatments rendered in survivors. The purpose of this study was to describe these characteristics to inform ideal preparation for these events. METHODS: A multicenter, retrospective study of CPMS survivors who were treated at designated trauma centers from July 1, 1999 to December 31, 2017, was performed. Prehospital and hospital variables were collected. Data are reported as median (25th percentile, 75th percentile interquartile range), and statistical analyses were carried out using Mann-Whitney U, χ2, and Kruskal-Wallis tests. Patients who died before discharge from the hospital were excluded. RESULTS: Thirty-one events involving 191 patients were studied. The median number of patients seen per event was 20 (5, 106), distance to each hospital was 6 (6, 10) miles, time to arrival was 56 (37, 90) minutes, number of wounds per patient was 1 (1, 2), and Injury Severity Score was 5 (1, 17). The most common injuries were extremity fracture (37%) and lung parenchyma (14%). Twenty-nine percent of patients did not receive paramedic-level prehospital treatment. Following arrival to the hospital, 27% were discharged from the emergency department, 32% were taken directly to the operating room/interventional radiology, 16% were admitted to the intensive care unit, and 25% were admitted to the ward. Forty percent did not require advanced treatment within 12 hours. The most common operations performed within 12 hours of arrival were orthopedic (15%) and laparotomy (15%). The most common specialties consulted were orthopedics (38%) and mental health (17%). CONCLUSION: Few CPMS survivors are critically injured. There is significant delay between shooting and transport. Revised triage criteria and a focus on rapid transport of the few severely injured patients are needed. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.
BACKGROUND: Firearm injury remains a public health crisis. Whereas there have been studies evaluating causes of death in victims of civilian public mass shootings (CPMSs), there are no large studies evaluating injuries sustained and treatments rendered in survivors. The purpose of this study was to describe these characteristics to inform ideal preparation for these events. METHODS: A multicenter, retrospective study of CPMS survivors who were treated at designated trauma centers from July 1, 1999 to December 31, 2017, was performed. Prehospital and hospital variables were collected. Data are reported as median (25th percentile, 75th percentile interquartile range), and statistical analyses were carried out using Mann-Whitney U, χ2, and Kruskal-Wallis tests. Patients who died before discharge from the hospital were excluded. RESULTS: Thirty-one events involving 191 patients were studied. The median number of patients seen per event was 20 (5, 106), distance to each hospital was 6 (6, 10) miles, time to arrival was 56 (37, 90) minutes, number of wounds per patient was 1 (1, 2), and Injury Severity Score was 5 (1, 17). The most common injuries were extremity fracture (37%) and lung parenchyma (14%). Twenty-nine percent of patients did not receive paramedic-level prehospital treatment. Following arrival to the hospital, 27% were discharged from the emergency department, 32% were taken directly to the operating room/interventional radiology, 16% were admitted to the intensive care unit, and 25% were admitted to the ward. Forty percent did not require advanced treatment within 12 hours. The most common operations performed within 12 hours of arrival were orthopedic (15%) and laparotomy (15%). The most common specialties consulted were orthopedics (38%) and mental health (17%). CONCLUSION: Few CPMS survivors are critically injured. There is significant delay between shooting and transport. Revised triage criteria and a focus on rapid transport of the few severely injured patients are needed. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.
Authors: Matthew P Czaja; Chadd K Kraus; Su Phyo; Patrick Olivieri; Dalier R Mederos; Ivan Puente; Salman Mohammed; Ross P Berkeley; David Slattery; Thomas H Gildea; Claire Hardman; Brandi Palmer; Melissa L Whitmill; Una Aluyen; Jeffery M Pinnow; Amanda Young; Carly D Eastin; Nurani M Kester; Kaitlyn R Works; Andrew N Pfeffer; Aleksander W Keller; Adam Tobias; Benjamin Li; Brian Yorkgitis; Soheil Saadat; Mark I Langdorf Journal: JAMA Netw Open Date: 2022-05-02