枪击伤在合法干预期间与平民造成的比较分析。
Gunshot wounds sustained during legal intervention versus those inflicted by civilians: A comparative analysis.
机构信息
From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California.
出版信息
J Trauma Acute Care Surg. 2022 Feb 1;92(2):436-441. doi: 10.1097/TA.0000000000003366.
BACKGROUND
Existing data demonstrate that injuries sustained during legal intervention (LI) differ from those incurred during civilian interpersonal violence (CIV), but gunshot wounds (GSWs) have not yet been specifically examined. This study was undertaken to provide an in-depth analysis of patients shot during LI versus CIV.
METHODS
Patients injured by GSW and captured by the National Trauma Data Bank (2007-2017) were included. Exclusions were transfer from outside hospital or self-inflicted, accidental, or undetermined injury intent GSWs. Study groups were defined by injury circumstances: GSWs sustained during LI versus CIV. Univariable analysis compared demographics, clinical/injury data, and outcomes.
RESULTS
In total, 248,726 patients met inclusion/exclusion criteria: 98% (n = 243,150) CIV versus 2% (n = 5,576) LI. Race varied significantly between study groups (p < 0.001). White patients were the most commonly injured race after LI (n = 2,176, 39%). Black patients were the most commonly injured race after CIV (n = 139,067, 57%). Psychiatric disease (9% vs. 2%, p < 0.001) was more common among LI GSWs. The LI patients were more frequently tachycardic (18% vs. 13%, p < 0.001), hypotensive (26% vs. 14%, p < 0.001), and comatose (34% vs. 15%, p < 0.001). The LI patients had higher Injury Severity Scores (13 vs. 9, p < 0.001), required emergent surgical intervention (39% vs. 28%, p < 0.001) and intensive care unit admission (47% vs. 32%, p < 0.001) more often, and had longer hospital stay (4 vs. 3 days, p < 0.001). Mortality was higher after LI (27% vs. 14%, p < 0.001).
CONCLUSION
Significant racial and injury severity differences exist between patients shot during LI and CIV. White patients were the most commonly injured race after LI, while Black patients were the most commonly injured race during CIV. In addition, Black patients were overrepresented in both groups when compared with their proportion in the US population. LI patients were more significantly injured, as quantified by clinical, injury, and outcomes variables including increased mortality. Further study of patients shot during LI is needed to better understand this increased burden of injury.
LEVEL OF EVIDENCE
Prognostic and epidemiological, level IV.
背景
现有数据表明，在法律干预（LI）中受伤与在平民人际暴力（CIV）中受伤不同，但枪伤（GSW）尚未专门研究。本研究旨在深入分析在 LI 和 CIV 中受伤的患者。
方法
纳入了国家创伤数据库（2007-2017 年）中因 GSW 受伤并被捕获的患者。排除标准为从其他医院转来的或自残、意外或未确定的 GSW 受伤患者。研究组根据受伤情况定义：LI 与 CIV 中的 GSW 受伤。单变量分析比较了人口统计学、临床/损伤数据和结果。
结果
共有 248726 名患者符合纳入/排除标准：98%（n=243150）为 CIV 与 2%（n=5576）为 LI。种族在两组之间差异显著（p<0.001）。LI 后受伤最常见的种族是白人（n=2176，39%）。CIV 后受伤最常见的种族是黑人（n=139067，57%）。LI 中的枪伤患者中，精神病患者更常见（9%比 2%，p<0.001）。LI 患者更常出现心动过速（18%比 13%，p<0.001）、低血压（26%比 14%，p<0.001）和昏迷（34%比 15%，p<0.001）。LI 患者的损伤严重程度评分更高（13 比 9，p<0.001），更常需要紧急手术干预（39%比 28%，p<0.001）和入住重症监护病房（47%比 32%，p<0.001），住院时间更长（4 天比 3 天，p<0.001）。LI 后死亡率更高（27%比 14%，p<0.001）。
结论
LI 和 CIV 中枪伤患者存在显著的种族和损伤严重程度差异。LI 后，白人患者是受伤最常见的种族，而黑人患者是 CIV 中受伤最常见的种族。此外，与美国人口比例相比，两组黑人患者的比例均过高。LI 患者的受伤程度更严重，表现在临床、损伤和结局变量上，包括死亡率增加。需要进一步研究 LI 中受伤的患者，以更好地了解这种受伤负担的增加。
证据水平
预后和流行病学，IV 级。
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