More prehospital deaths may mean increased intensity in violence

April 16, 2018

A new Johns Hopkins Medicine analysis of national trauma data shows that trauma patients were four times more likely to die from gunshot wounds and nearly nine times more likely to die from stab wounds before getting to a trauma center in 2014, compared with rates in 2007.

A report of the findings, published April 3, in the Journal of Trauma and Acute Care Surgery, suggests that the increase in prehospital mortality means violence is intensifying.

"The data we found suggest that a greater proportion of patients injured by penetrating trauma are dying in the prehospital setting compared to a decade ago," says Joseph V. Sakran, M.D., M.P.A., M.P.H., director of emergency general surgery at The Johns Hopkins Hospital and the paper's senior author. Sakran is an expert in gun violence research and is himself a former victim of gun violence.

"One must ask the question if what the data show with respect to the injury pattern is secondary to an increase in the intensity of violence. When looking at gun violence, the scientific community must approach this like any other public health crisis and develop a data-driven approach to combat these preventable deaths and injuries," he adds.

For the study, Sakran and colleagues examined prehospital mortality trends in patients at least 15 years old from 2007-2010 (the "early period") and 2011-2014 ("late period") who sustained gunshot wounds and stab wounds. Data were obtained from the National Trauma Data Bank, the largest collection of trauma registry data in the nation, amassed from 752 hospitals that record dead-on-arrival statistics.

From 2007-2014, there were 437,398 penetrating wound trauma victims, the majority of whom (35.4 percent) were 15-24 years old. Among the 36,297 who died, gunshot wounds contributed to 88 percent of deaths, while stab wounds accounted for 12 percent.

Most of the patients experienced penetrating trauma to only one body part (65.2 percent), followed by two body-part injuries (20.7 percent); and most common injury locations were the upper extremities (32.0 percent), thorax (29.2 percent) and abdomen (28.2 percent).

After adjusting for factors such as injury severity, hypotension and other clinically relevant factors, the research team found that patients in the late period had higher odds of prehospital death (four times higher for gunshot wounds and nearly nine times higher for stab wounds) and lower odds of in-hospital deaths. The overall mortality of gunshot and stab wounds remained stagnant, but the location of death (prehospital versus in-hospital) appears to have changed.

A potential explanation, Sakran says, may relate to a more lethal injury pattern, such as perpetrators being in closer proximity to their victims, increased number of shots or stabs, or perpetrators targeting specific body parts that will cause the most lethal damage--i.e., shooting to kill.

The researchers warn that correlation does not imply causation, and the increased prehospital deaths may be explained by a number of other factors, such as lack of access to a Level I trauma center or differences in prehospital interventions. Because of this, Sakran says, researchers need to examine markers of these findings in a more robust manner, such as merging data from police departments, medical examiners' office and hospitals.

"This is a perfect example of why we need federal research dollars, which would allow us to investigate such findings and develop solutions that are specifically tailored to this problem," Sakran adds.

When Sakran was 17 and attending a high school football game, a fight broke out, and someone in the crowd pulled out a gun. A stray bullet went through Sakran's throat, rupturing his windpipe. The experience inspired him to become a trauma surgeon to help provide victims with a second chance at life.
-end-
Other authors on this paper include Ambar Mehta, Ryan Fransman, Avery B. Nathens, Alistair Kent, Elliott R. Haut and David T. Efron, of the Johns Hopkins University School of Medicine; and Bellal Joseph, of the University of Arizona College of Medicine, Tucson.

COI: Elliott R. Haut is primary investigator of a grant (1R01HS024547-01) from the Agency for Healthcare Research and Quality (AHRQ) titled "Individualized Performance Feedback on Venous Thromboembolism Prevention Practice;" co-investigator of a grant (1R21HL129028-01A1) from the National Institutes of Health National Heart, Lung, and Blood Institute (NIH-NHLBI) titled "Analysis of the Impact of Missed Doses of Venous Thromboembolism Prophylaxis;" and the primary investigator of contracts with The Patient-Centered Outcomes Research Institute (PCORI) titled "Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care Via Health Information Technology" (CE-12-11-4489); and "Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis" (DI-1603-34596). Haut also receives royalties from Lippincott, Williams & Wilkins for the book Avoiding Common ICU Errors and is a paid consultant and speaker for the "Preventing Avoidable Venous Thromboembolism-- Every Patient, Every Time" VHA/Vizient IMPERATIV® Advantage Performance Improvement Collaborative. Haut is a paid consultant and speaker for the Illinois Surgical Quality Improvement Collaborative "ISQIC" and a paid author of a paper commissioned by the National Academies of Medicine titled "Military Trauma Care's Learning Health System: The Importance of Data Driven Decision Making," which was used to support the report titled "A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury."

Johns Hopkins Medicine

Related Mortality Articles from Brightsurf:

Being in treatment with statins reduces COVID-19 mortality by 22% to 25%
A research by the Universitat Rovira i Virgili (URV) and Pere Virgili Institut (IISPV) led by LluĂ­s Masana has found that people who are being treated with statins have a 22% to 25% lower risk of dying from COVID-19.

Mortality rate higher for US rural residents
A recent study by Syracuse University sociology professor Shannon Monnat shows that mortality rates are higher for U.S. working-age residents who live in rural areas instead of metro areas, and the gap is getting wider.

COVID-19, excess all-cause mortality in US, 18 comparison countries
COVID-19 deaths and excess all-cause mortality in the U.S. are compared with 18 countries with diverse COVID-19 responses in this study.

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.

Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.

What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.

COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.

Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.

Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.

Read More: Mortality News and Mortality Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.