在美国创伤中心接受治疗的火器伤。
Firearm injuries treated at trauma centers in the United States.
作者信息
Rivara Frederick P, Hink Ashley B, Kuhls Deborah A, Banks Samantha, Agoubi Lauren L, Kirkendoll Shelbie, Winchester Alex, Hoeft Christopher, Patel Bhavin, Nathens Avery
机构信息
From the Harborview Medical Center (F.P.R.); Department of Pediatrics (F.P.R.), Department of Epidemiology (F.P.R.), Firearm Injury and Policy Research Program (F.P.R.), University of Washington, Seattle, Washington; Department of Surgery (A.B.H.), Medical University of South Carolina, Charleston, South Carolina; Department of Surgery (D.A.K.), Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada; Firearm Injury and Policy Research Program (S.B.), Harborview Injury Prevention and Research Center (L.L.A.), Department of Surgery (L.L.A.), University of Washington, Seattle, Washington; Department of Surgery (S.K.), Northwestern Feinberg School of Medicine; American College of Surgeons (A.W., C.H., B.P.), Chicago, Illinois; and Sunnybrook Health Sciences Center (A.N.), University of Toronto, Toronto, Ontario, Canada.
出版信息
J Trauma Acute Care Surg. 2024 Jun 1;96(6):955-964. doi: 10.1097/TA.0000000000004172. Epub 2023 Oct 24.
BACKGROUND
While firearm injuries and deaths continue to be a major public health problem, the number of nonfatal firearm injuries and the characteristics of patients are not well-known. The American College of Surgeons Committee on Trauma leveraged an existing data system to collect additional data on fatal and nonfatal firearm injuries presenting to trauma centers. This report provides an overview of this initiative and highlights the challenges associated with capturing actionable data on firearm-injured patients.
METHODS
A total of 128 trauma centers that are part of the American College of Surgeons Trauma Quality Improvement Program collected data on individuals of any age arriving alive between March 1, 2021, and February 28, 2022, with a firearm injury. In addition to the standard data collected for Trauma Quality Improvement Program, abstractors also extracted additional data specific to this study. We linked data from the Distressed Community Index to patient records using zip code of residence.
RESULTS
A total of 17,395 patients were included, with mean (SD) age of 30.2 (13.5) years, 82.5% were male, and the majority were Black and non-Hispanic. The mean proportion of variables with missing data varied among trauma centers, with a mean of 20.7% missing data. Injuries occurred most commonly in homes (31.2%) or on the street (26.6%); 70.4% of injuries were due to assaults. Nearly one third of patients were discharged from the emergency department, 25.9% were admitted directly to the operating room, and 10.9% were admitted to the intensive care unit; 5.9% died in the emergency department, and 10.3% died overall during their course of care. Nearly two thirds of patients lived in the two highest distressed categories of communities; only 7.5% lived in the least distressed quintile.
CONCLUSION
Using trauma center data can be a valuable tool to improve our knowledge of firearm injuries if clinical practices and documentation of patient risks and circumstances are standardized.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.
背景
虽然枪支伤害和死亡仍然是一个重大的公共卫生问题，但非致命枪支伤害的数量以及患者的特征尚不为人所知。美国外科医师学会创伤委员会利用现有的数据系统收集了更多关于创伤中心收治的致命和非致命枪支伤害的数据。本报告概述了这一举措，并强调了在获取有关枪支受伤患者的可操作数据方面所面临的挑战。
方法
美国外科医师学会创伤质量改进计划中的128家创伤中心收集了2021年3月1日至2022年2月28日期间任何年龄因枪支伤害而存活入院的患者的数据。除了为创伤质量改进计划收集的标准数据外，数据录入员还提取了本研究特有的其他数据。我们使用患者居住的邮政编码将困境社区指数中的数据与患者记录相链接。
结果
共纳入17395例患者，平均（标准差）年龄为30.2（13.5）岁，82.5%为男性，大多数为黑人且非西班牙裔。各创伤中心缺失数据变量的平均比例各不相同，平均缺失数据比例为20.7%。伤害最常发生在家中（31.2%）或街道上（26.6%）；70.4%的伤害是由袭击所致。近三分之一的患者从急诊科出院，25.9%直接进入手术室，10.9%入住重症监护病房；5.9%在急诊科死亡，10.3%在整个治疗过程中死亡。近三分之二的患者居住在困境程度最高的两类社区；只有7.5%居住在困境程度最低的五分之一社区。
结论
如果临床实践以及患者风险和情况的记录标准化，利用创伤中心数据可能是提高我们对枪支伤害认识的一个有价值的工具。
证据水平
预后和流行病学；三级。
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