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Program

WSU Medical School

Training Level

Medical Student

Institution

Wayne State University

Abstract

Background: Firearm injuries contribute substantially each year to premature death, illness, and disability nationally. Previous studies have suggested seasonal variability in total trauma admissions, however there is limited data that specifically examines firearm injury. We hypothesize that when compared to all other trauma, firearm injury demonstrates seasonal variation with increased incidence in summer. Additionally, we anticipate poorer outcomes for firearm injury as measured by length of stay, days in intensive care (ICU), complications, days intubated, mortality, and final disposition. Methods This is retrospective study conducted at an academic, regional, Level 1 Trauma Center in Detroit from 2013-2017. The data were obtained from a trauma registry and chart review. Inclusion criteria were trauma patients that were admitted, died, or transferred out of the hospital. Patients transferred in were excluded from this study. Patients sustaining a firearm injury were compared to all other traumas admitted in this time period (N=5039, firearm n =580). To describe statistical significance (p<0.01), chi-square tests were utilized for nominal data and independent samples t-tests were utilized for continuous data.ResultsOf the 5039 trauma patients in this period, 580 patients sustained a firearm injury (11.5%). Compared to all other trauma, patients with a firearm injury were more likely to be male, black, intoxicated, uninsured, and younger. On arrival, patients were found to have a significantly lower GCS, higher ISS, lower systolic blood pressure and lower heart rate. Though seasonal variation was observed when examining firearm injury in isolation, there was no significant difference when compared to all other injury (p=0.12). Compared to those with non-firearm injuries, patients who sustained firearm injury are approximately four times as likely to require intubation in the ER or at the scene of injury and were twice as likely to require operation during admission. These patients were also twice as likely to have a complication compared to other trauma patients and twice as likely to have a hospital acquired infection (HAI). Mortality, length of stay, total days in ICU and ventilator-free days were also higher. Patients were less likely to be discharged home without assistance and more likely to be discharged home with home health or to an acute care facility, rehabilitation or jail. Conclusion: Although this study did show seasonal variation in trauma by firearm when examined in isolation, this variation was not significant when compared to all other traumas presenting to the hospital. In other words, trauma admissions are higher overall in warmer months; however, the rise in firearm trauma was proportional to all other trauma. Additionally, firearm injury has significantly worse outcomes in terms of hospital indicators and patient disability when compared to other accidental trauma. This includes significantly higher rates of intubation, mortality, days in ICU, complications including HAIs, and a lower likelihood to be discharged home without assistance. This study may have implications for allocation of resources, injury prevention, and improvement of overall patient care.

Presentation Date

5-2019

Firearm Injury in Detroit: Examining Seasonal Variability and Outcomes

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