20814Department of Surgery, Clive O. Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA.
483907Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Am Surg. 2021 Jan;87(1):39-44. doi: 10.1177/0003134820949515. Epub 2020 Sep 11.
Trauma center care and survival have been improving over the past several years. However, yearly firearm-related deaths have remained near constant at 33 000. One challenge to decreasing gunshot mortality is patients presenting with complex injury patterns from multiple gunshot wounds (GSWs) made possible by high-caliber automated weapons. Our study analyzes outcomes of trauma patients of firearms using the National Trauma Databank (NTDB).
We conducted a retrospective review of the NTDB from the years 2003-2015 for patients with penetrating injuries. We separated patients into groups based on stab wounds, single GSW, and multiple GSW. We performed multivariate logistic regression analyses in which we adjusted for demographics and injury severity.
Overall, 382 376 patients presenting with penetrating injuries were analyzed. Of those 167 671 had stab, 106 538 single GSW, and 57 819 multiple GSW injuries. Crude mortality was 1.97% for stab wounds, 13.26% for single GSW, and 18.84% for multiple GSW. Adjusted odds ratio (OR) compared with 2003 demonstrates a trend toward decreased mortality for stab wounds (OR range of 0.48-0.69, < .05 for years 2010-2015). A similar trend was demonstrated in single GSW injuries (OR 0.31-0.83, < .01 for years 2005-2015). Conversely, multiple GSW injuries did not follow this trend (OR 0.91-1.36 with > 0.05 for each year).
In contrast to significant improvement in survival in patients with a single GSW injury since 2003, multiple GSW injuries still pose a challenge to trauma care. This warrants further investigation into the efficacy of legislature, and the lack thereof, as well as future preventative measures to this type of injury.
在过去的几年中，创伤中心的护理和生存率有所提高。然而，每年与枪支有关的死亡人数仍保持在 33000 人左右。降低枪击死亡率的一个挑战是，由于高口径自动武器的存在，患者可能会出现多种枪伤（GSW）导致的复杂损伤模式。我们的研究使用国家创伤数据库（NTDB）分析了因枪支受伤的创伤患者的结局。
我们对 2003 年至 2015 年 NTDB 中穿透性损伤患者进行了回顾性研究。我们根据刺伤、单发 GSW 和多发 GSW 将患者分为不同组。我们进行了多变量逻辑回归分析，其中我们调整了人口统计学和损伤严重程度。
总体而言，分析了 382376 名患有穿透性损伤的患者。其中 167671 例为刺伤，106538 例为单发 GSW，57819 例为多发 GSW。刺伤的粗死亡率为 1.97%，单发 GSW 为 13.26%，多发 GSW 为 18.84%。与 2003 年相比，调整后的比值比（OR）表明，刺伤的死亡率呈下降趋势（2010 年至 2015 年的 OR 范围为 0.48-0.69，<.05）。单发 GSW 损伤也表现出类似的趋势（2005 年至 2015 年的 OR 为 0.31-0.83，<.01）。相反，多发 GSW 损伤并未遵循这一趋势（每年的 OR 为 0.91-1.36，>.05）。
与 2003 年以来单发 GSW 损伤患者生存率显著提高形成对比的是，多发 GSW 损伤仍然对创伤护理构成挑战。这需要进一步研究立法的效果，以及缺乏立法的原因，以及针对这种类型损伤的未来预防措施。
