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, 71 (3), 561-567

Patients With Gunshot Wounds to the Torso Differ in Risk of Mortality Depending on Treating Hospital

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Patients With Gunshot Wounds to the Torso Differ in Risk of Mortality Depending on Treating Hospital

Areg Grigorian et al. Updates Surg.

Abstract

Previous studies have had conflicting results when comparing risk of mortality in patients with gunshot wounds (GSWs) treated at Level-I and II trauma centers. However, the populations studied were restricted geographically. We hypothesized that patients presenting after a GSW to the torso at Level-I centers would have a shorter time to surgical intervention (exploratory laparotomy or thoracotomy) and a lower risk of mortality, compared to Level-IIs in a national database. The Trauma Quality Improvement Program (2010-2016) was queried for patients presenting to Level-I or II trauma center after a GSW to the torso. A multivariable logistic regression analysis was performed. From 17,965 patients with GSWs, 13,812 (76.8%) were treated at Level-Is and 4153 (23.2%) at Level-IIs. There was no difference in the injury severity score (ISS) (p = 0.55). The Level-I cohort had a higher rate of laparotomy (38.9% vs. 36.5%, p < 0.001) with a shorter median time to laparotomy (49 vs. 55 min, p < 0.001) but no difference in rate (p = 0.14) and time to thoracotomy (p = 0.62). After adjusting for covariates, only patients undergoing thoracotomy (OR = 0.66, CI = 0.47-0.95, p = 0.02) or those undergoing non-operative management (NOM) (OR = 0.85, CI = 0.74-0.98, p = 0.03) at a Level-I center had lower risk for death, compared to Level-II. Patients with torso GSWs managed with thoracotomy or NOM at a Level-I center have a lower risk of mortality, compared to a Level-II. Future prospective studies examining variations in practice, resources available and surgeon experience to account for these differences are warranted.

Keywords: Gunshot; Level-I; Trauma; Trauma center.

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References

    1. JAMA. 2000 Apr 19;283(15):1990-4 - PubMed
    1. J Trauma. 2000 Jul;49(1):63-9; discussion 69-70 - PubMed
    1. JAMA. 2001 Mar 7;285(9):1164-71 - PubMed
    1. J Trauma. 2001 Mar;50(3):465-72; discussion 473-4 - PubMed
    1. Ann Surg. 2001 Sep;234(3):395-402; discussion 402-3 - PubMed

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