The Gun Violence Epidemic: Time for Perioperative Physicians to Act

Gerstein, Neal S.; Sanders, John C.; McCunn, Maureen; Brierley, Janet K.; Gerstein, Wendy H.; West, Sonlee D.; Tawil, Isaac; Kraai, Erik; Boyd, Nathan; Bronshteyn, Yuriy S.; Torgeson, Eli; Schulman, Peter

doi:10.1053/j.jvca.2018.03.002

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…1 More than 32 000 persons die and 67 000 persons are injured by firearms yearly, which is comparable to the number of deaths following motor vehicle collisions. [1][2][3] Firearm injury remains a costly public health epidemic in the United States; the 1-year total hospitalization costs of firearm injury readmission was $131 million, and approximately $48 billion were lost in medical and work loss costs annually in 2014. 1,4 Disparities are evident in firearm victimization, with young adults, males, and non-Hispanic Black persons being at the highest risk for violent firearm injury.…”

Section: Introductionmentioning

confidence: 99%

Race Impacts Outcomes of Patients With Firearm Injuries

Peluso

Cull

Abougergi

2020

The American Surgeon™

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Background To study the relationship between race and outcomes of patients with firearm injuries hospitalized in the United States. Methods The 2016 National Inpatient Sample was used. Patients were included if they had a principal diagnosis of firearm injury. Exclusion criteria were age <16 years and elective admissions. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (traumatic shock, prolonged mechanical ventilation, acute respiratory distress syndrome [ADRS], and ventilator-associated pneumonia [VAP]), and resource utilization (length of stay and total hospitalization charges and costs). Results The sample included 31 335 patients; 52% were Black and 29% were Caucasian. The mean age was 32 years and 88% were male. Black patients had lower odds of mortality (adjusted odds ratio (aOR): 0.41 (95% CI: 0.32-0.53), P < .01). However, compared with Caucasians, Blacks had higher mean total hospitalization charges (adjusted mean difference (aMD) : $14 052 (CI: $1469-$26 635), P = .03) and costs (aMD: $3248 (CI: $654-$5842), P = .01) despite similar mean length of stay (aMD: 0.70 (CI: −0.05-1.45), P = .07). Both racial groups had similar rates of traumatic shock (aOR: 0.91 (0.72-1.15), P = .44), prolonged mechanical ventilation (aOR: 0.82 (0.63-1.09), P = .17), ARDS (aOR: 1.18 (0.45-3.07), P = .74) and VAP (aOR: 1.27 (0.47-3.41), P = .63). Discussion Black patients with firearm injuries had a lower adjusted odds of in-hospital mortality compared with other races. However, despite having a similar hospital length of stay and in-hospital morbidity, -Black patients had higher total hospitalization costs and charges.

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Section: Introductionmentioning

confidence: 99%

Race Impacts Outcomes of Patients With Firearm Injuries

Peluso

Cull

Abougergi

2020

The American Surgeon™

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“…Moreover, the lack of gun-related injury prevention efforts among perioperative physicians has also been proposed as an area of improvement. 10,11 Healthcare professionals are frequently the first or only caregivers to come in contact with victims of firearm-related injury. As such, it is essential for physicians to identify patients at risk for recidivism.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with GSW recidivism had shorter unadjusted index LOS (5 [2-10] vs 8 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] days, P<0.001) and lower median index hospitalization cost ($18,000 [8,800-37,600] vs $28,800 [14,500-61,100], P<0.001), relative to others. Compared to those without recidivism, GSW-R had higher rates of non-home discharge (30.6 vs 25.9%, P<0.001).…”

Section: Outcomes Associated With Gsw Recidivismmentioning

confidence: 99%

National Trends and Resource Utilization Associated with Penetrating Trauma Recidivism

Cho

Mabeza

Bakhtiyar

et al. 2023

Preprint

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BACKGROUND While recurrent penetrating trauma has been associated with long-term mortality and disability, national data on factors associated with reinjury remain limited. We examined temporal trends, patient characteristics, and resource utilization associated with repeat firearm-related or stab injury across the US. METHODS The 2010-2019 Nationwide Readmissions Database was queried to identify all hospitalizations for penetrating trauma. Recidivism was defined as those returned for subsequent penetrating injury within 60 days. We quantified injury severity using the International Classification of Diseases Trauma Mortality Prediction model. Trends in recidivism, length of stay (LOS), hospitalization costs, and rate of non-home discharge were then analyzed. Multivariable regression models were developed to assess the association of recidivism with outcomes of interest. RESULTS Of an estimated 968,717 patients (28.4% Gunshot, 71.6% Stab), 2.1% experienced recidivism within 60 days of initial injury. From 2010 to 2019, trauma recidivism of gunshot wound increased in annual incidence while that of stab remained stable. Patients experiencing penetrating trauma recidivism were more commonly male, younger and insured by Medicaid. Patients with recidivism had shorter index LOS, lower median index hospitalization cost and higher rates of non-home discharge. After risk adjustment, penetrating trauma recidivism was associated with significantly higher hospitalization costs, shorter time before readmission, and increased odds of non-home discharge. In addition, comorbid conditions of hypothyroidism and psychoses were associated with greater likelihood of stab wound recidivism. CONCLUSION The trend in penetrating trauma recidivism has been on the rise for the past decade. National efforts to improve post-discharge prevention and social support services for patients with penetrating trauma are warranted and may reduce the burden of recidivism.

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“…At this point in the history of the United States, both intentional and unintentional gunshot injuries are both socioeconomically and psychologically devastating. In 2010, of deaths resulting from gun violence in high-income countries, 90% of the women, 91% of the children aged 0–14 years, and 92% of the young adults aged 15–24 years occurred in the United States 55. In 2015, the overall firearm death rate was 11.4 times higher in the US than in other high-income countries with the rate increasing between 2003 and 2015 12.…”

Section: Discussionmentioning

confidence: 99%

<p>Mass Casualty Shootings and Emergency Preparedness: A Multidisciplinary Approach for an Unpredictable Event</p>

Melmer¹,

Carlin²,

Castater³

et al. 2019

JMDH

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Mass casualty events (MCE) are an infrequent occurrence to most daily healthcare systems however these incidents are the causation for new hospital preparedness and the development of coordinated emergency services. The broad support and operational plans outside the hospital include emergency medical services, local law enforcement, government agencies, and city officials. Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a highvolume of injured patients. This MDT collaboration strengthens the emergency response to optimize the delivery of life-saving care during MCEs. This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.

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The Gun Violence Epidemic: Time for Perioperative Physicians to Act

Cited by 7 publications

References 9 publications

Race Impacts Outcomes of Patients With Firearm Injuries

Race Impacts Outcomes of Patients With Firearm Injuries

National Trends and Resource Utilization Associated with Penetrating Trauma Recidivism

<p>Mass Casualty Shootings and Emergency Preparedness: A Multidisciplinary Approach for an Unpredictable Event</p>

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