TY - JOUR
T1 - Nationwide trends in mortality following penetrating trauma
T2 - Are we up for the challenge?
AU - Sakran, Joseph V.
AU - Mehta, Ambar
AU - Fransman, Ryan
AU - Nathens, Avery B.
AU - Joseph, Bellal
AU - Kent, Alistair
AU - Haut, Elliott R.
AU - Efron, David T.
N1 - Funding Information:
J.V.S., A.M., R.F., A.B.N., B.J., A.K., C.J., D.F., and D.T.E. have no disclosures. E.R.H. has the following disclosures: 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.” 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). E.R.H. receives royalties from Lippincott, Williams & Wilkins for a book - "Avoiding Common ICU Errors." A paid consultant and speaker for the “Preventing Avoidable Venous Thromboembolism— Every Patient, Every Time” VHA/Vizient IMPERATIV® Advantage Performance Improvement Collaborative. A paid consultant and speaker for the Illinois Surgical Quality Improvement Collaborative “ISQIC.” 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.”
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - BACKGROUND Despite a focus on improved prehospital care, penetrating injuries contribute substantially to trauma mortality in the United States. We therefore analyzed contemporary trends in prehospital mortality from penetrating trauma in the past decade. METHODS We identified patients in the The National Trauma Data Bank from 2007 to 2010 ("early period") and 2011 to 2014 ("late period") with gunshot wounds (GSW) and stab wounds (SW), who were treated at hospitals that recorded dead-on-arrival statistics. Multivariable logistic regressions assessed differences in body locations of trauma, prehospital mortality, and in-hospital mortality between the early and late periods. Models accounted for hospital clusters and adjusted for age, pulse, hypotension, New Injury Severity Score, Glasgow Coma Scale, and number of injured body parts. RESULTS From 2007 to 2014, 437,398 patients experienced penetrating traumas, with equal distributions of GSW and SW. There were unadjusted differences in prehospital mortality (GSW: early, 2.0% vs. late, 4.9%; SW: early, 0.2% vs. late, 1.1%) and in-hospital mortality (GSW: early, 13.8% vs. late, 9.5%; SW: early, 1.8% vs. late, 1.0%) by both mechanisms. After adjustment, patients in the late period relative to those in the early period had significantly higher odds of prehospital death (GSWs: adjusted odds ratio [aOR], 4.54; 95% confidence interval [CI], 3.31-6.22; SWs: aOR, 8.98; 95% CI, 5.50-14.67) and lower odds of in-hospital death (GSWs: aOR, 0.85; 95% CI, 0.80-0.90; SWs: aOR, 0.81; 95% CI, 0.71-0.92). Sensitivity analyses assessing GSWs and SWs by locations of body injury found similar results. Additionally, patients in the late period were more likely to experience penetrating injuries to the face, spine, and lower extremities. CONCLUSION In the United States, the prevalence of penetrating traumas remains a nationwide burden. The odds of prehospital mortality has increased over fourfold for GSWs and almost ninefold for SWs. Examining violence intensity, along with improvements in hospital care and data collection, may explain these findings. LEVEL OF EVIDENCE Prognostic and epidemiological, level IV.
AB - BACKGROUND Despite a focus on improved prehospital care, penetrating injuries contribute substantially to trauma mortality in the United States. We therefore analyzed contemporary trends in prehospital mortality from penetrating trauma in the past decade. METHODS We identified patients in the The National Trauma Data Bank from 2007 to 2010 ("early period") and 2011 to 2014 ("late period") with gunshot wounds (GSW) and stab wounds (SW), who were treated at hospitals that recorded dead-on-arrival statistics. Multivariable logistic regressions assessed differences in body locations of trauma, prehospital mortality, and in-hospital mortality between the early and late periods. Models accounted for hospital clusters and adjusted for age, pulse, hypotension, New Injury Severity Score, Glasgow Coma Scale, and number of injured body parts. RESULTS From 2007 to 2014, 437,398 patients experienced penetrating traumas, with equal distributions of GSW and SW. There were unadjusted differences in prehospital mortality (GSW: early, 2.0% vs. late, 4.9%; SW: early, 0.2% vs. late, 1.1%) and in-hospital mortality (GSW: early, 13.8% vs. late, 9.5%; SW: early, 1.8% vs. late, 1.0%) by both mechanisms. After adjustment, patients in the late period relative to those in the early period had significantly higher odds of prehospital death (GSWs: adjusted odds ratio [aOR], 4.54; 95% confidence interval [CI], 3.31-6.22; SWs: aOR, 8.98; 95% CI, 5.50-14.67) and lower odds of in-hospital death (GSWs: aOR, 0.85; 95% CI, 0.80-0.90; SWs: aOR, 0.81; 95% CI, 0.71-0.92). Sensitivity analyses assessing GSWs and SWs by locations of body injury found similar results. Additionally, patients in the late period were more likely to experience penetrating injuries to the face, spine, and lower extremities. CONCLUSION In the United States, the prevalence of penetrating traumas remains a nationwide burden. The odds of prehospital mortality has increased over fourfold for GSWs and almost ninefold for SWs. Examining violence intensity, along with improvements in hospital care and data collection, may explain these findings. LEVEL OF EVIDENCE Prognostic and epidemiological, level IV.
KW - Penetrating trauma
KW - gunshot wounds
KW - in-hospital mortality
KW - prehospital mortality
KW - stab wounds
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U2 - 10.1097/TA.0000000000001907
DO - 10.1097/TA.0000000000001907
M3 - Article
C2 - 29613947
AN - SCOPUS:85059094092
VL - 85
SP - 160
EP - 166
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 1
ER -