Nationwide Trends in Mortality Following Penetrating Trauma: Are We Up for the Challenge?
Despite a focus on improved pre-hospital care, penetrating injuries contribute substantially to trauma mortality in the United States (U.S.). We therefore analyzed contemporary trends in pre-hospital mortality from penetrating trauma in the past decade.Methods
We identified patients in the The National Trauma Data Bank from 2007-2010 ("early period") and 2011-2014 ("late period") with gunshot (GSW) and stab wounds (SW), who were treated at hospitals that recorded dead-on-arrival statistics. Multivariable logistic regressions assessed differences in body locations of trauma, pre-hospital mortality, and in-hospital mortality between the early and late periods. Models accounted for hospital clusters and adjusted for age, pulse, hypotension, NISS, GCS, and number of injured body parts.Results
From 2007-2014, 437,398 patients experienced penetrating traumas, with equal distributions of GSW and SW. There were unadjusted differences in pre-hospital mortality (GSW: early 2.0% vs late 4.9%; SW: early 0.2% vs late 1.1%) and in-hospital mortality (GSW: early 13.8% vs late 9.5%; SW: early 1.8% vs late 1.0%) by both mechanisms. After adjustment, patients in the late period relative to those in the early period had significantly higher odds of pre-hospital death (GSWs: aOR 4.54 [95%-CI 3.31-6.22]; SWs: aOR 8.98 [5.50-14.67]) and lower odds of in-hospital death (GSWs: aOR 0.85 [0.80-0.90]; SWs: aOR 0.81 [0.71-0.92]). Sensitivity analyses assessing GSWs and SWs by locations of body injury found similar results. Additionally, patients in the late period were more likely to experience penetrating injuries to the face, spine, and lower extremities.Conclusions
In the U.S., the prevalence of penetrating traumas remains a nationwide burden. The odds of pre-hospital mortality has increased over 4-fold for gunshot wounds and almost 9-fold for stab wounds. Examining violence intensity, along with improvements in hospital care and data collection, may explain these findings.Level of Evidence
Level IVType of Study
Prognostic and Epidemiological