Racial Disparities in Cranial Gunshot Wounds: Intent and Survival

Crutcher, Clifford; Fannin, Erin S.; Wilson, Jason

doi:10.1007/s40615-015-0187-7

Cited by 15 publications

(17 citation statements)

References 27 publications

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“…Despite these differences, neither age, race, nor intent was predictive of survival. Similarly, Crutcher et al 9 reported disparities in injury intent between races, but intent and race were not predictive of survival in this study either.…”

Section: Discussioncontrasting

confidence: 54%

Outcomes in patients with gunshot wounds to the brain

Robinson

Turco

Corsa

et al. 2019

Trauma Surg Acute Care Open

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IntroductionGunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR.MethodsWe performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation.Results825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation.ConclusionWe found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition.Level of evidenceLevel II.

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Section: Discussioncontrasting

confidence: 54%

Outcomes in patients with gunshot wounds to the brain

Robinson

Turco

Corsa

et al. 2019

Trauma Surg Acute Care Open

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“…Studies investigating firearm violence report a disproportionately large majority of injuries among non-Caucasian patients, immigrants, and those in low-income areas. 5,18,19 This contributes, among many other factors, to the lower life expectancy of African Americans males compared to that of Caucasian males. 20 This effect may be explainable by differing life experiences in children of different races.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of orthopaedic fractures due to firearms

Congiusta

Oettinger

Merchant

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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The majority of firearm injuries involve the extremities and have concomitant orthopaedic injuries. National data on the epidemiology of wounds caused by firearms may better inform physicians and identify areas of public health intervention. We conducted an analysis of a national database to describe the epidemiology of orthopaedic firearm injuries in the United States. The Nationwide Inpatient Sample 2001e2013 database was queried for adult patients with fractures excluding those of the skull using injury billing codes. Characterization of injury was determined using External Cause of Injury billing codes. Sociodemographic and geographic variables were reported. Chi square and multinomial logistic regression analyses were performed to identify predictors of type of firearm implicated in injury. 334,212 firearm injuries were reported in the database and about half had concomitant orthopaedic fractures. Most patients were between the ages 19 and 29, were African American, and were male. The most frequent circumstance of injury was assault/homicide, the most common firearm used was a handgun, and the most common fracture site was the femur. Patients without insurance and patients of lower income were most commonly afflicted. Knowing this distribution of the burden of this class of injury provides the opportunity to identify and intervene on behalf of at-risk populations, potentially reducing injuries by promoting firearm safety to these groups and advocating sensible practices to reduce inequitable outcomes caused by these injuries.

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“…In their investigation of epidemiological characteristics and racial differences in patients with gunshot wounds, they showed that race was not a predictor of survival outcome. 8 19%) 0 (0.00%) 0 (0.00%) 0 (0.00%) 0.672 Liver disease 0 (0.00%) 0 (0.00%) 0 (0.00%) 0 (0.00%) >0.99 Lymphoma 0 (0.00%) 0 (0.00%) 0 (0.00%) 0 (0.00%) >0.99 Metastatic cancer 1 (1.19%) 0 (0.00%) 0 (0.00%) 0 (0.00%) 0.672 Neurological disorder 7 (8.33%) 1 (1.20%) 0 (0.00%) 0 (0.00%) 0.043 Obesity 3 (3.57%) 2 (2.41%) 0 (0.00%) 0 (0.00%) 0.647 Paralysis 2 (2.38%) 0 (0.00%) 0 (0.00%) 0 (0.00%) 0.376 PVD 1 (1.19%) 0 (0.00%) 0 (0.00%) 0 (0.00%) 0.672 Psychosis 13 (15.48%) 2 (2.41%) 3 (7.32%) 0 (0.00%) 0.020 Renal failure 0 (0.00%) 1 (1.20%) 0 (0.00%) 0 (0.00%) 0.665 Rheumatoid arthritis 0 (0.00%) 0 (0.00%) 0 (0.00%) 0 (0.00%) >0.99 Tumor 1 (1.19%) 0 (0.00%) 0 (0.00%) 0 (0.00%) 0.672 Peptic ulcer disease 0 (0.00%) 0 (0.00%) 0 (0.00%) 0 (0.00%) >0.99 Valvular disease 0 (0.00%) 0 (0.00%) 0 (0.00%) 0 (0.00%) >0.99 Weight loss 2 (2.38%) 0 (0.00%) 1 (2.44%) 0 (0.00%) 0.543 CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; HTN = hypertension; PVD = peripheral vascular disease. Boldface type indicates statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…4 Gunshots rank among the top 2 most common causes of penetrating cranial wounds in the United States, next to stabbings. 8 Mortality rates of gunshot wounds to the head (GWH) are extremely high, with an estimated 90% of cases being fatal. Of patients who arrive to the hospital, approximately 50% die in the emergency department.…”

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confidence: 99%

Gunshot wounds to the head: racial disparities in inpatient management and outcomes

Chiu¹,

Fuentes²,

Mehta³

2019

Neurosurgical Focus

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OBJECTIVESeveral studies have indicated that racial disparities may exist in the management and outcomes of acute trauma care. One segment of trauma care that has not been as extensively investigated, however, is that of cranial trauma care. The goal of this study was to determine whether significant differences exist among racial and ethnic groups in various measures of inpatient management and outcomes after gunshot wounds to the head (GWH).METHODSIn this study, the authors used the Nationwide (National) Inpatient Sample (NIS) to investigate all-cause mortality, receipt of surgery, days from admission to initial intervention, discharge disposition, length of hospital stay, and total hospital charges of those with GWH from 2012 to 2016. A 1:1 propensity score–matched analysis was conducted to evaluate the effect of race on these endpoints, while controlling for baseline demographics and comorbidities.RESULTSA total of 333 patients met the inclusion and exclusion criteria: 148 (44.44%) white/Caucasian, 123 (36.94%) black/African American, 54 (16.22%) Hispanic/Latinx, and 8 (2.40%) Asian. African American patients were sent to immediate care and rehabilitation significantly less often than Caucasian patients (RR 0.17 [95% CI 0.04–0.71]). There were no significant differences in mortality, length of stay, rates of surgical intervention, or total hospital charges among any of the racial groups.CONCLUSIONSThe authors’ findings suggest that racial disparities in inpatient cranial trauma care and outcomes may not be as prevalent as previously thought. In fact, the disparities seen were only in disposition. More research is needed to further elucidate and address disparities within this population, particularly those that may exist prior to, and after, hospitalization.

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Racial Disparities in Cranial Gunshot Wounds: Intent and Survival

Cited by 15 publications

References 27 publications

Outcomes in patients with gunshot wounds to the brain

Outcomes in patients with gunshot wounds to the brain

Epidemiology of orthopaedic fractures due to firearms

Gunshot wounds to the head: racial disparities in inpatient management and outcomes

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