Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts.
Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts.
J Surg Res. 2024 Jan;293:50-56. doi: 10.1016/j.jss.2023.08.006. Epub 2023 Sep 14.
No association regarding classification of social vulnerability and outcomes of patients with gunshot injury have been described. Our goal was to assess whether the socioeconomic vulnerability index (SVI), is associated with an increased risk of hospital readmission following gunshot wounds.
We conducted an exploratory retrospective cohort study on Massachusetts patients with trauma following gunshot wounds from January 1, 2012 to December 31, 2020 using the institutional trauma registry. We estimated the association between high social vulnerability (defined by the Centers for Disease Control and Prevention as ≥90th percentile) and incidence of all-cause readmission at 30, 60, and 90 d (overall and stratified over sex, race, and age groups). Estimates from unadjusted log-binomial regression were reported using relative risks (RRs) and 95% confidence intervals. Time-to-event (readmission) was assessed using Kaplan-Meier plots.
A total of 386 patients were included for analysis: 211 (55%) with SVI <0.90 and 175 (45%) with SVI ≥0.90. The mean (standard deviation) age was 29 (13) y, with majority being male (89%). There was no strong risk of readmission associated with SVI ≥0.90; the interval with the greatest risk was at 60 d (RR = 1.34; 95% confidence interval [0.73, 2.45]). Among stratified analyses, the strongest associations were observed when restricting to young adults (aged 18-35) with RRs of 2.49, 2.62, and 2.45 for 30, 60, and 90 d readmission, respectively.
Overall, high SVI was not associated with all-cause readmission; however, subanalyses suggest an association among young adults. Future research should explore SVI as a tool for identifying patients with trauma at risk for readmission.
尚未描述社会脆弱性分类与枪击伤患者结局之间的关联。我们的目标是评估社会经济脆弱性指数（SVI）是否与枪击伤患者的住院再入院风险增加相关。
我们对 2012 年 1 月 1 日至 2020 年 12 月 31 日马萨诸塞州因枪击伤接受创伤治疗的患者进行了一项探索性回顾性队列研究，使用机构创伤登记处。我们估计了高社会脆弱性（由疾病控制与预防中心定义为≥第 90 百分位数）与 30、60 和 90 天（总体和按性别、种族和年龄组分层）所有原因再入院发生率之间的关联。使用相对风险（RR）和 95%置信区间报告未调整的对数二项式回归估计值。使用 Kaplan-Meier 图评估时间到事件（再入院）。
共纳入 386 例患者进行分析：211 例（55%）SVI<0.90，175 例（45%）SVI≥0.90。平均（标准差）年龄为 29（13）岁，大多数为男性（89%）。SVI≥0.90 与再入院风险无明显关联；风险最大的间隔为 60 天（RR=1.34；95%置信区间[0.73，2.45]）。在分层分析中，当限制在年轻成年人（18-35 岁）时，观察到最强的关联，30、60 和 90 天再入院的 RR 分别为 2.49、2.62 和 2.45。
总体而言，高 SVI 与所有原因再入院无关；然而，亚分析表明年轻成年人之间存在关联。未来的研究应探索 SVI 作为识别有再入院风险的创伤患者的工具。
