Clustered Arrivals of Firearm-Injured Patients in an Urban Trauma System: A Silent Epidemic
Clustered Arrivals of Firearm-Injured Patients in an Urban Trauma System: A Silent Epidemic
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DOI：
10.1016/j.jamcollsurg.2019.03.020
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发表时间：
2019-09-01
影响因子：
5.2
通讯作者：
Goldberg, Amy J.
中科院分区：
文献类型：
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作者：
Beard, Jessica H.;Resnick, Shelby;Goldberg, Amy J.
背景：最近，创伤中心在应对大规模枪击事件中所起的作用受到了关注。尽管备受瞩目的公共活动是媒体和政策制定者的主要焦点，但枪伤患者(FIP)每天都会成群结队地出现在城市创伤中心。我们从城市创伤系统的角度检查了FIP集群的负担。研究设计：在这项描述性流行病学研究中，我们使用了费城警察局2005年至2015年枪击登记的数据。变量包括患者人口统计数据、受伤日期和时间、住院治疗和死亡率。我们将集群FIP定义为在另一个FIP 15分钟内到达的FIP。我们使用滚动时间窗口计算每家医院的FIP聚类数，评估患者的人口学特征和死亡率，并使用线性回归模型评估FIP聚集率的趋势。结果：在纳入的14,217个FIP中，22.1%被聚集。在15分钟内出现4个或4个以上的事件54个，在60分钟内出现4个或4个以上的事件92个。FIP聚集性在夜班(晚上7：00至早上7：00)最常见(73.1%)，在I级创伤中心(93.6%)，地理聚集性显示在医院水平。与总体FIP人群相比，聚集的FIP更有可能是女性(p=0.039)，在夜间受伤(p=0.031)，但死亡的可能性较小(p=0.014)。在研究过程中，FIP聚集率和死亡率保持稳定。结论：在所研究的创伤系统中，FIP聚集性是常见的，在其他城市中心也可能以类似的比率发生。因此，在短时间内出现多名FIP对卫生保健资源造成的直接负担并不限于传统上定义的大规模枪击事件。(C)2019年由美国外科医师学会主办。由Elsevier Inc.出版。保留所有权利。)
BACKGROUND: Recent attention has been paid to the role trauma centers play in responding to mass shootings. Although high-profile public events are the primary focus of media and policy makers, firearm-injured patients (FIPs) present in clusters to urban trauma centers every day. We examined the burden of FIP clusters from an urban trauma system perspective.STUDY DESIGN: In this descriptive epidemiologic study, we used data from the Philadelphia Police Department registry of shootings from 2005 to 2015. Variables included patient demographics, injury date and time, receiving hospital, and mortality. We defined clustered FIPs as those arriving within 15 minutes of another FIP. We used rolling temporal windows to calculate the number of FIP clusters for each hospital, assessed patient demographic characteristics and mortality, and used linear regression models to evaluate trends in FIP cluster rates.RESULTS: Of the 14,217 FIPs included, 22.1% were clustered. There were 54 events when 4 or more FIPs presented within 15 minutes and 92 events when 4 or more FIPs presented within 60 minutes. Clusters of FIP occurred most frequently during night shifts (7:00 PM to 7:00 AM) (73.1%) at level I trauma centers (93.6%), with geographic clustering demonstrated at the hospital level. Compared with the overall FIP population, clustered FIPs were more likely to be female (p = 0.039), injured at night (p = 0.031), but less likely to die (p = 0.014). The rate of FIP clusters and mortality remained steady over the course of the study.CONCLUSIONS: In the trauma system studied, FIP clusters are common and are likely to occur at similar rates in other urban centers. Therefore, the immediate burden on health care resources caused by multiple FIPs presenting within a short period of time is not limited to traditionally defined mass shootings. ((C) 2019 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)