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Citation
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Sarani B, Smith ER, Shapiro G, Nahmias J, Rivas L, McIntyre RJ, Robinson BRH, Chestovich PJ, Amdur R, Campion E, Urban S, Shnaydman I, Joseph B, Gates J, Berne J, Estroff JM. J. Trauma Acute Care Surg. 2020; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Firearm injury remains a public health crisis. Whereas there have been studies evaluating causes of death in victims of civilian public mass shootings (CPMS), there are no large studies evaluating injuries sustained and treatments rendered in survivors. The purpose of this study is to describe these characteristics in order to inform ideal preparation for these events.
METHODS: A multicenter, retrospective study of CPMS survivors who were treated at designated trauma centers from 7/1/1999 to 12/31/2017 was performed. Pre-hospital and hospital variables were collected. Data are reported as medican (25, 75 interquartile range) and statistical analyses were carried out using Mann-Whitney U, Chi-Square, and Kruskal-Wallis tests. Patients who died prior to discharge from the hospital were excluded.
RESULTS: Thirty one events involving 191 patients were studied. 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%). 29% 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 ICU, 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: IV, Therapeutic/Care Management.
Language: en |