After the Shooting Stops

Jd, Richardson; Davidson, Debora A.; Fb, Miller

doi:10.1097/00005373-199611000-00004

Cited by 11 publications

(9 citation statements)

References 4 publications

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“…Firearm injury has a high risk of re-hospitalizations especially in patients with greater severity, which increases their likelihood of rehospitalizations. 36 A second limitation is the lack of detailed integrated information regarding emergency department visits, where they were treated and released without hospitalization. Of all the non-fatal firearm injuries, about 40% are treated and released in the emergency department, while the rest are hospitalized.…”

Section: Discussionmentioning

confidence: 99%

A multi-decade joinpoint analysis of firearm injury severity

Kalesan

Zuo

Xuan

et al. 2018

Trauma Surg Acute Care Open

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BackgroundNon-fatal firearm injuries constitute approximately 70% of all firearm trauma injuries in the United States. Patterns of severity of these injuries are poorly understood. We analyzed the overall, age-, sex- and intent-specific temporal trends in the injury severity of firearm hospitalizations from 1993 to 2014.MethodsWe assessed temporal trends in the severity of patients hospitalized for firearm using Nationwide Inpatient Sample (NIS) data over a 22 year period. Firearm hospitalization was identified using assault (E965x), unintentional (E922x), intentional self-harm (E955x), legal (E970) and undetermined (E985x) International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) codes. Injury severity was measured using the computed New Injury Severity Score (NISS). We used survey weighted means, SD and annual percent change (APC), and joinpoint regression to analyze temporal trends.ResultsA weighted total of 648 662 inpatient admissions for firearm injury were analyzed. Firearm injury severity demonstrated a significant annual increase of 1.4% (95% CI=1.3 to 1.6), and was driven by annual increases among young adults (APC=1.4%, 95% CI=1.3 to 1.5), older adults (APC=1.5%, 95% CI=1.3 to 1.6), female (APC=1.5%, 95% CI=1.3 to 1.6) and male (APC=1.4%, 95% CI=1.3 to 1.6) hospitalizations. The annual increase among assault/legal injuries was 1.4% (95% CI=1.3 to 1.5), similar to unintentional (APC=1.4%, 95% CI=1.3 to 1.6), intentional self-harm (APC=1.5%, 95% CI=1.4 to 1.6) and undetermined (APC=1.4%, 95% CI=1.3 to 1.6).ConclusionsThe severity of hospitalized firearm injuries increased significantly from 1993 to 2014. This annual increase reflects a move towards hospitalization of more serious injuries, and outpatient management of less serious injuries across the board, suggesting a mounting burden on the US healthcare system.Level of evidenceLevel IV.

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Section: Discussionmentioning

confidence: 99%

A multi-decade joinpoint analysis of firearm injury severity

Kalesan

Zuo

Xuan

et al. 2018

Trauma Surg Acute Care Open

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“…1 Besides high death toll firearm injuries cause significant morbidity, long-term physical and psychological disability for individuals, families, communities and societies. 2 In 1996, the World Health Assembly declared violence as a leading global public health problem high-lighting a need for implementing the global strategy to prevent it. 3 Firearms and their use are modifiable risk factors, 4 which if recognized and addressed, could help decrease the burden of violent deaths.…”

Section: Introductionmentioning

confidence: 99%

Firearm injuries presenting to a tertiary care hospital of Karachi, Pakistan

Nasrullah¹,

Razzak²

2009

J Inj Violence Res

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Abstract:Background: Violence is a public health problem in low and middle income countries. Our study attempted to define the circumstances, risk groups, extent and severity of firearm-related injuries in patients coming to the Aga Khan University Hospital (AKUH) Karachi, Pakistan. Methods: This was a retrospective study conducted in the department of Emergency Medicine (EM) at AKUH Karachi, Pakistan. Past medical records of all patients who were injured by firearms and were presented to the AKUH Emergency Department (ED) from June 2002 till May 2007 were reviewed. Data were recorded on the basic demographics of injured, length of hospital stay, body parts injured and the outcome (alive vs. dead). Results: Total of 286 patients with firearm injuries were identified. Majority of them were males (92%; n=264). More than half of the patients (63%) were in the age group of 21-40 years. Upon arrival to the hospital 85% (n=243) of patients had Glasgow Coma Scale (GCS)>= 13. The mean injury severity score (ISS) was found to be 6 (SD ±4). The length of hospital stay of patients ranged from 0 to 54 days with a mean of 7 days. Lower limb were the most affected body parts (30%, n=86) followed by abdomen pelvis (27%, n=77). Seven percent (n=21) of the patient who were brought to the hospital were labeled as "deceased on arrival". Most of the injuries were caused during the act of robbery (40%, n=103) in the city. Conclusions: Robbery was the most common cause of firearm injuries. Lower limb, abdomen and pelvis were the most affected body regions. Educational efforts, and individual, community and societal approaches are needed to alleviate firearm-related injuries.

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“…Thirty-eight percent (13/34) of all studies reported vascular injuries [ 12 , 15 , 17 – 19 , 24 , 32 , 36 , 38 – 40 , 42 ]. Patients with reported vascular injuries after CPMSs ranged from 8 to 29% (Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…Patients with reported vascular injuries after CPMSs ranged from 8 to 29% (Table 3 ). Vascular procedures, in general, included direct arterial and/or venous repair [ 15 , 21 ]. There was no specific data on more advanced vascular reconstructions [ 15 , 19 , 21 , 32 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of hemorrhage and vascular injuries in civilian public mass shootings

Nyberger

Strömmer

Wahlgren

2023

Scand J Trauma Resusc Emerg Med

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Background Civilian public mass shootings (CPMSs) are a major public health issue and in recent years several events have occurred worldwide. The aim of this systematic review was to characterize injuries and mortality after CPMSs focusing on in-hospital management of hemorrhage and vascular injuries. Method A systematic review of all published literature was undertaken in Medline, Embase and Web of Science January 1st, 1968, to February 22nd, 2021, according to the PRISMA guidelines. Literature was eligible for inclusion if the CPMS included three or more people shot, injured or killed, had vascular injuries or hemorrhage. Results The search identified 2884 studies; 34 were eligible for inclusion in the analysis. There were 2039 wounded in 45 CPMS events. The dominating anatomic injury location per event was the extremity followed by abdomen and chest. The median number of operations and operated patients per event was 22 (5–101) and 10.5 (4–138), respectively. A total of 899 deaths were reported with a median mortality rate of 36.1% per event (15.9–71.4%) Thirty-eight percent (13/34) of all studies reported on vascular injuries. Vascular injuries ranged from 8 to 29%; extremity vascular injury the most frequent. Specific vascular injuries included thoracic aorta 18% (42/232), carotid arteries 6% (14/232), and abdominal aorta 5% (12/232). Vascular injuries were involved in 8.3%-10% of all deaths. Conclusion This systematic review showed an overall high mortality after CPMS with injuries mainly located to the extremities, thorax and abdomen. About one quarter of deaths was related to hemorrhage involving central large vessel injuries. Further understanding of these injuries, and structured and uniform reporting of injuries and treatment protocols may help improve evaluation and management in the future. Level of Evidence Systematic review and meta-analysis, level III.

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After the Shooting Stops

Abstract: Despite a well-functioning trauma system that maximized survival from devastating injury, considerable long-term morbidity and disability persists. Efforts at prevention of mass casualties seem to be the only potential solution.

Cited by 11 publications

References 4 publications

A multi-decade joinpoint analysis of firearm injury severity

A multi-decade joinpoint analysis of firearm injury severity

Firearm injuries presenting to a tertiary care hospital of Karachi, Pakistan

A systematic review of hemorrhage and vascular injuries in civilian public mass shootings

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