TY  - JOUR
PY  - 2019//
TI  - Patients with gunshot wounds to the torso differ in risk of mortality depending on treating hospital
JO  - Updates in surgery
A1  - Grigorian, Areg
A1  - Nahmias, Jeffry
A1  - Chin, Theresa
A1  - Allen, Angela
A1  - Kuncir, Eric
A1  - Dolich, Matthew
A1  - Joe, Victor
A1  - Lekawa, Michael
SP  - 561
EP  - 567
VL  - 71
IS  - 3
N2  - Previous studies have had conflicting results when comparing risk of mortality in patients with gunshot wounds (GSWs) treated at Level-I and II trauma centers. However, the populations studied were restricted geographically. We hypothesized that patients presenting after a GSW to the torso at Level-I centers would have a shorter time to surgical intervention (exploratory laparotomy or thoracotomy) and a lower risk of mortality, compared to Level-IIs in a national database. The Trauma Quality Improvement Program (2010-2016) was queried for patients presenting to Level-I or II trauma center after a GSW to the torso. A multivariable logistic regression analysis was performed. From 17,965 patients with GSWs, 13,812 (76.8%) were treated at Level-Is and 4153 (23.2%) at Level-IIs. There was no difference in the injury severity score (ISS) (p = 0.55). The Level-I cohort had a higher rate of laparotomy (38.9% vs. 36.5%, p < 0.001) with a shorter median time to laparotomy (49 vs. 55 min, p < 0.001) but no difference in rate (p = 0.14) and time to thoracotomy (p = 0.62). After adjusting for covariates, only patients undergoing thoracotomy (OR = 0.66, CI = 0.47-0.95, p = 0.02) or those undergoing non-operative management (NOM) (OR = 0.85, CI = 0.74-0.98, p = 0.03) at a Level-I center had lower risk for death, compared to Level-II. Patients with torso GSWs managed with thoracotomy or NOM at a Level-I center have a lower risk of mortality, compared to a Level-II. Future prospective studies examining variations in practice, resources available and surgeon experience to account for these differences are warranted.<p />  <p>Language: en</p>
LA  - en
SN  - 2038-131X
UR  - http://dx.doi.org/10.1007/s13304-019-00657-w
ID  - ref1
ER  -