NEW YORK (Reuters Health) - A Baltimore hospital is reporting an "alarming surge" over the past five years in the percentage of gunshot and stabbing victims who die before reaching the emergency room, or within minutes of arrival.
"We feel this represents a true change in violence intensity," Dr. David T. Efron and colleagues from the Johns Hopkins Medical Institutions conclude in their study in the Archives of Surgery.
Even though the hospital was getting better at treating patients who arrived at the emergency department (ED) with survivable wounds, Efron and his team had noticed a "sharp increase" in the discussion of trauma deaths over the previous 15 months at hospital conferences.
To investigate, they looked at data from 11,025 trauma patients treated at the hospital's ED between January 2000 and March 2005, comparing injuries and deaths from 2000 to 2003 with those occurring between 2004 and 2005. In the early period 1.7% of patients died before or shortly after ED arrival, compared to 3.1% in the later period. But the percentage of trauma patients who died after admission did not change significantly.
Among blunt trauma patients, meaning those whose injuries did not penetrate the body, ED fatality rates rose from 0.4% to 1.1%, while fatality rates among patients with penetrating trauma -- that is, gunshot or stab wounds -- climbed from 5.1% to 9.3%. Again, deaths from either type of injury after hospital admission did not show an increase.
The researchers note that studies in other urban areas have identified a similar rise in the lethality of violent crime, while one research team found semiautomatic handguns were increasingly being used instead of revolvers.
The findings provide "a compelling argument for violence prevention strategies to reduce urban trauma mortality," Efron and colleagues argue. "The only way to save these patients is to reach out to them in the community before they are victims of violence," they conclude.
SOURCE: Archives of Surgery, August 2006.
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