Undertriage of Firearm-Related Injuries in a Major Metropolitan Area

Abstract

Undertriage of firearm-related injuries was much more prevalent than expected. Although the likelihood of dying during hospitalization was greater among patients treated in designated trauma centers, these patients were substantially in worse condition across all measures of injury severity. A smaller proportion of patients treated in designated trauma centers died during the first 24 hours of hospitalization. This study highlights the need for better regional coordination, especially with interhospital transfers, as well as the importance of assessing the distribution of emergency medical services resources to make the trauma care system more effective and equitable.

Network Distance and Fatal Outcomes among Gunshot Wound Victims

“…Based on prior research we expected to find some evidence linking the distance to a trauma center with victim survival (Crandall, et al, 2013;Sall et al, 2018;Circo 2019). Indeed, a wealth of studies have illustrated the importance that specialized trauma care plays for critically injured individuals (Lale, Krajewski, & Friedman, 2017). With improvements in medicine, surgery, and trauma care, gunshot wound victims have increasingly better outcomes (Manley, et al, 2018).…”

“…Many of these underserved areas were distributed on Chicago's South-East side, suggesting a need for increased access (Wandling, et al, 2016). A further follow-up study in Chicago found that nearly 30% of gunshot wound victims were treated in a non-designated trauma center -what the authors classified as "under-triage" (Lale, Krajewski, & Friedman, 2017). This research suggested that lack of access to appropriate care could lead to worse outcomes among victims.…”

“…These locations must meet a number of requirements including 24-hour coverage by surgeons and specialists, providing prevention to local communities, and treating a minimum number of severely injured patients each year (American Trauma Society, 2019). In cases of critical injuries, such as gunshot wounds, level 1 trauma centers are the preferred patient destination (Lale, Krajewski, & Friedman, 2017). A nationwide study found that patients treated at hospitals with level 1 trauma centers had lower inhospital mortality rates than similar patients at non-trauma center hospitals (MacKenzie, et al, 2006).…”

Serious games may improve physician heuristics in trauma triage

“…Moreover, feedback loops are often weak for emergency medicine physicians, who do not routinely get follow-up information on patient outcomes, particularly for those transferred to another facility for definitive management or aftercare ( 7 ). As evidence of these challenges, diagnostic errors persist despite decades of continuing medical education efforts ( 5 – 11 ).…”

“…However, undertriage occurs with representative cases as well. For example, Lale et al ( 9 ) found that 90% of Chicago-area patients with penetrating injuries (a feature representative of severe injury) taken to nontrauma centers were kept at that facility and not transferred to a higher level of care. As a result, successful interventions could improve performance all around.…”