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Divergent and Unified: A Path Forward for Firearm Injury Prevention. J Am Coll Surg 2021; 233:576-577. [PMID: 34563330 DOI: 10.1016/j.jamcollsurg.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
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Vascular Reconstruction for Traumatic Injuries. Adv Surg 2021; 55:251-271. [PMID: 34389095 DOI: 10.1016/j.yasu.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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53
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Flaskerud JH. Mental Illness and/or Guns? Issues Ment Health Nurs 2021; 42:880-883. [PMID: 31770046 DOI: 10.1080/01612840.2019.1659462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Loder RT, Young A, Atoa B. Firearm injuries associated with law enforcement activity. J Forensic Leg Med 2021; 83:102249. [PMID: 34461598 DOI: 10.1016/j.jflm.2021.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Law enforcement activity can involve firearms, and either a civilian or the law enforcement officer can be injured. It was the purpose of this study to characterize the injuries and demographics associated with law enforcement firearm activity across the entire US using a national data base. METHODS Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study data 1993-2015 was used. Law enforcement involvement and other demographic variables were ascertained. Statistical analyses were performed accounting for the weighted, stratified nature of the data. P < 0.05 was considered to be statistically significant. RESULTS There were an estimated 2,667,896 ED visits for injuries due to firearms; 1.7% (45,497) were associated with law enforcement. Those involved with law enforcement were older (33.2 vs 29.8 years), a handgun was more commonly involved (80.3 vs 71.5%), male (90.7 vs 86.8%), White (52.9 vs 37.2%), had more upper trunk injuries (25.2 vs 16.2%), fewer lower extremity (15.1% vs 25.9%) injuries, and more fatalities (10.0 vs. 6.2%). An argument, crime, fight and drug involvement were all greater in the law enforcement group. Within the law enforcement group, when the injured patient was the civilian and not the officer, the patient was more commonly Black, male, sustained more trunk injuries, fewer extremity injuries, and more frequently admitted to the hospital. The civilian group had fewer upper extremity (11.7% vs 29.7%), lower extremity (12.2% vs 23.7%) and lower trunk injuries (14.6% vs 8.0%), more upper trunk injuries (31.3% vs 7.8%, and similar proportion of head/neck injuries (31.5% vs 30.7%) compared to the officer group. More females were injured in the officer group (16.9% vs 7.5%). The fatality rate was 12.6% for the civilian group and 3.0% for the officer group. There were no differences by race in disposition from the ED (released, admitted, death) for those who sustained injuries by the officer. CONCLUSIONS Firearm injuries due to law enforcement activity occurred in 1.7% of all ED visits for injuries due to firearms. The law enforcement officer was the injured patient in 23% of the events. This study spanning nearly a quarter of a century of data for injuries due to firearm activity resulting in ED visits is baseline data for future studies, especially in the present setting of calls for police reform within the US. This will be important when analyzing the effect of new programs in law enforcement training and/or police reform.
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Affiliation(s)
- Randall T Loder
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Allison Young
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bradley Atoa
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Gentrification in America - The Potential Deadly Consequences. Ann Surg 2021; 274:218-219. [PMID: 33990476 DOI: 10.1097/sla.0000000000004937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bonne SL. American College of Surgeons Member Firearm Storage Practices: The Lives We Save May Be Our Own. J Am Coll Surg 2021; 233:336. [PMID: 34446217 DOI: 10.1016/j.jamcollsurg.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
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57
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Kuhls DA, Campbell BT, Thomas A, Michaels H, Bulger EM, Stewart RM. Survey of American College of Surgeons Members on Firearm Injury Prevention. J Am Coll Surg 2021; 233:369-382. [PMID: 34303833 DOI: 10.1016/j.jamcollsurg.2021.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/12/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Firearm-related injuries and deaths continue to be a substantial public health burden in the US. The purpose of this study was to describe the results of a survey of US members of the American College of Surgeons (ACS) on their practices, attitudes, and beliefs about firearms and firearm policies. The survey was designed to gain a representative understanding of the views of all US ACS members to help inform ACS positions related to firearm injury prevention. STUDY DESIGN A professional survey firm was engaged to facilitate the design of the survey and to support a web-based platform. Data collection through an anonymous survey began in July 2018, with the survey closing in September 2018. Survey data were weighted and analyses included descriptive and bivariate statistics. RESULTS There were 54,761 ACS members invited to participate in the survey. Of those, 11,147 respondents completed the survey, for an overall response rate of 20.4%. Respondents were questioned on firearm experience, purpose of firearm ownership, opinions on firearm ownership, and importance of ACS support for specific firearm legislation. Survey results varied by practice and training location, practice type, military experience, gender, age, presence of children in the home, level of training, and race and ethnicity. Most survey respondents were ACS fellows (n = 7,579 [68%]), male (n = 8,671 [77.8%]), and White (n = 8,639 [77.5%]). Forty-two percent of respondents keep guns in their home. Seventy-five percent of respondents believe that it is very or extremely important for the ACS to support policy initiatives to lower the incidence of firearm injury. CONCLUSIONS There is broad support among ACS members for many initiatives related to firearm injury prevention. The degree of support for these measures varies based on both the specific initiative and demographic characteristics. The results align with the ACS strategy of healthcare professionals working together to better understand and address the root causes of violence, and simultaneously working together to make firearm ownership as safe as reasonably possible.
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Affiliation(s)
- Deborah A Kuhls
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Nevada Las Vegas, Las Vegas, NV.
| | - Brendan T Campbell
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Connecticut, Hartford, CT
| | - Arielle Thomas
- American College of Surgeons Committee on Trauma, Chicago, IL
| | - Holly Michaels
- American College of Surgeons Committee on Trauma, Chicago, IL
| | - Eileen M Bulger
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Washington, Seattle, WA
| | - Ronald M Stewart
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Texas San Antonio, San Antonio, TX
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Dicker RA, Thomas A, Bulger EM, Stewart RM, Bonne S, Dechert TA, Smith R, Love-Craighead A, Dreier F, Kotagal M, Kozyckyj T, Michaels H. Strategies for Trauma Centers to Address the Root Causes of Violence: Recommendations from the Improving Social Determinants to Attenuate Violence (ISAVE) Workgroup of the American College of Surgeons Committee on Trauma. J Am Coll Surg 2021; 233:471-478.e1. [PMID: 34339811 DOI: 10.1016/j.jamcollsurg.2021.06.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rochelle A Dicker
- Division of Trauma and Critical Care, University of California at Los Angeles Geffen School of Medicine, Los Angeles, CA.
| | - Arielle Thomas
- American College of Surgeons Committee on Trauma, Chicago, IL
| | - Eileen M Bulger
- American College of Surgeons Committee on Trauma, Chicago, IL; Division of Trauma, Burn, and Critical Care, University of Washington Harborview Medical Center, Seattle, WA
| | - Ronald M Stewart
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Texas San Antonio, San Antonio, TX
| | - Stephanie Bonne
- Division of Trauma and Surgical Critical Care, Rutgers New Jersey Medical School, Newark, NJ
| | - Tracey A Dechert
- Division of Acute Care and Trauma Surgery, Boston University School of Medicine, Boston, MA
| | - Randi Smith
- Division of Trauma and Surgical Critical Care, Emory University School of Medicine, Atlanta, GA
| | | | - Fatimah Dreier
- The Health Alliance for Violence Intervention, Jersey City, NJ
| | - Meera Kotagal
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Tamara Kozyckyj
- American College of Surgeons Committee on Trauma, Chicago, IL
| | - Holly Michaels
- American College of Surgeons Committee on Trauma, Chicago, IL
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Siry BJ, Knoepke CE, Ernestus SM, Matlock DD, Betz ME. Lethal Means Counseling for Suicidal Adults in the Emergency Department: A Qualitative Study. West J Emerg Med 2021; 22:471-477. [PMID: 34125016 PMCID: PMC8203001 DOI: 10.5811/westjem.2021.8.49485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/08/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Lethal means counseling (to reduce access to firearms or other suicide methods) is a recommended critical yet challenging component of care of suicidal patients. Questions remain about communication strategies for those in acute crisis. Methods This qualitative study was an analysis of semi-structured interviews with English-speaking, community-dwelling adults with a history of lived-experience of suicidal ideation or attempts in themselves or a family member. We used a mixed inductive and deductive approach to identify descriptive themes related to communication and decision-making. Results Among 27 participants, 14 (52%) had personal and 23 (85%) had family experience with suicide ideation or attempts. Emergent themes fell into two domains: (1) communication in a state of high emotionality; and (2) specific challenges in communication: initiating, maintaining engagement, considering context. Conclusion Engaging suicidal individuals in lethal means counseling may be more effective when messaging and approaches consider their emotional state and communication challenges.
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Affiliation(s)
- Bonnie J Siry
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Christopher E Knoepke
- University of Colorado School of Medicine, Division of Cardiology, Aurora, Colorado.,University of Colorado School of Medicine, Adult & Child Consortium for Outcomes Research & Delivery Science, Aurora, Colorado.,University of Southern California, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | | | - Daniel D Matlock
- University of Colorado School of Medicine, Adult & Child Consortium for Outcomes Research & Delivery Science, Aurora, Colorado.,University of Colorado School of Medicine, Department of Geriatric Medicine, Aurora, Colorado.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado
| | - Marian E Betz
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado
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Zatzick D, Jurkovich G, Heagerty P, Russo J, Darnell D, Parker L, Roberts MK, Moodliar R, Engstrom A, Wang J, Bulger E, Whiteside L, Nehra D, Palinkas LA, Moloney K, Maier R. Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial. JAMA Surg 2021; 156:430-474. [PMID: 33688908 PMCID: PMC7948109 DOI: 10.1001/jamasurg.2021.0131] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022]
Abstract
Importance To date, few multisite investigations have evaluated early interventions for injured patients with posttraumatic stress disorder (PTSD) symptoms. Objective To simultaneously assess the effectiveness and implementation of a brief stepped collaborative care intervention targeting PTSD and comorbidity. Design, Setting, and Participants A stepped-wedge cluster randomized clinical trial was conducted at 25 US level I trauma centers. Participants included hospitalized survivors of physical injury who underwent a 2-step evaluation for PTSD symptoms. Patients reporting high levels of distress on the PTSD Checklist (PCL-C) were randomized (N = 635) per the stepped-wedge protocol to enhanced usual care control (n = 370) or intervention (n = 265) conditions. The study was conducted from January 4, 2016, through November 2018. Data analysis was performed from November 4, 2019, to December 8, 2020. Interventions The Trauma Survivors Outcomes and Support collaborative care intervention included proactive injury case management that assisted patients transitioning from hospital inpatient to outpatient and community settings. The intervention also integrated evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD symptoms and comorbidity. Main Outcomes and Measures The primary study outcome was PTSD symptoms assessed with the PCL-C at baseline in the surgical ward and at 3, 6, and 12 months postinjury. Secondary outcomes included depressive symptoms, alcohol use, and physical function. Subgroup analyses examined the effect of baseline risk factors for enduring PTSD and quality of protocol implementation on study outcomes. Primary statistical analyses were conducted using the intent-to-treat sample. Results A total of 327 men (51.5%) were included in analysis; mean (SD) age was 39.0 (14.2) years. The investigation attained follow-up of 75% to 80% of the participants at 3 to 12 months. The intervention lasted a mean (SD) of 122 (132) minutes. Mixed model regression analyses revealed statistically significant changes in PCL-C scores for intervention patients compared with control patients at 6 months (difference, -2.57; 95% CI, -5.12 to -0.03; effect size, 0.18; P < .05) but not 12 months (difference, -1.27; 95% CI, -4.26 to 1.73; effect size, 0.08; P = .35). Subgroup analyses revealed larger PTSD treatment effects for patients with 3 or more baseline risk factors for enduring PTSD and for patients, including firearm injury survivors, treated at trauma centers with good or excellent protocol implementation. Intervention effects for secondary outcomes did not attain statistical significance. Conclusions and Relevance A brief stepped collaborative care intervention was associated with significant 6-month but not 12-month PTSD symptom reductions. Greater baseline PTSD risk and good or excellent trauma center protocol implementation were associated with larger PTSD treatment effects. Orchestrated efforts targeting policy and funding should systematically incorporate the study findings into national trauma center requirements and verification criteria. Trial Registration ClinicalTrials.gov Identifier: NCT02655354.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Gregory Jurkovich
- Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Michelle K. Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Psychology, University of California, Los Angeles
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lawrence A. Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Ronald Maier
- Department of Surgery, University of Washington School of Medicine, Seattle
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Turning value into action: Healthcare workers using digital media advocacy to drive change. PLoS One 2021; 16:e0250875. [PMID: 33914809 PMCID: PMC8084157 DOI: 10.1371/journal.pone.0250875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background The standard method of sharing information in academia is the scientific journal. Yet health advocacy requires alternative methods to reach key stakeholders to drive change. The purpose of this study was to analyze the impact of social media and public narrative for advocacy in matters of firearm-related injury and death. Study design The movement This Is Our Lane was evaluated through the #ThisIsOurLane and #ThisIsMyLane hashtags. Sources were assessed from November 2018 through March 2019. Analyses specifically examined message volume, time course, global engagement, and content across Twitter, scientific literature, and mass media. Twitter data were analyzed via Symplur Signals. Scientific literature reviews were performed using PubMed, EMBASE, Web of Science, and Google Scholar. Mass media was compiled using Access World News/Newsbank, Newspaper Source, and Google. Results A total of 507,813 tweets were shared using #ThisIsOurLane, #ThisIsMyLane, or both (co-occurrence 21–39%). Fifteen scientific items and n = 358 mass media publications were published during the study period; the latter included articles, blogs, television interviews, petitions, press releases, and audio interviews/podcasts. Peak messaging appeared first on Twitter on November 10th, followed by mass media on November 12th and 20th, and scientific publications during December. Conclusions Social media enables clinicians to quickly disseminate information about a complex public health issue like firearms to the mainstream media, scientific community, and general public alike. Humanized data resonates with people and has the ability to transcend the barriers of language, culture, and geography. Showing society the reality of caring for firearm-related injuries through healthcare worker stories via digital media appears to be effective in shaping the public agenda and influencing real-world events.
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Abstract
Objective Injuries associated with firearms are a significant health burden. However, there is no comprehensive study of firearm spinal injuries over a large population. It was the purpose of this study to analyze the demographics of spinal firearm injuries across the entire United States for all ages using a national database. Methods A retrospective review of prospectively collected data using the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2015 (ICPSR 37276) was performed. The demographic variables of patients with spinal injuries due to firearms were analyzed with statistical analyses accounting for the weighted, stratified nature of the data, using SUDAAN 11.0.01™ software (RTI International, Research Triangle Park, North Carolina, 2013). A p-value of < 0.05 was considered statistically significant. Results For the years 1993 through 2015, there were an estimated 2,667,896 emergency department (ED) visits for injuries due to firearms; 10,296 of these injuries (0.4%) involved the spine. The vast majority (98.2%) were due to powder firearm gunshot wounds. Those with a spine injury were more likely to have been injured in an assault (83.7% vs. 60.2%), involved a handgun (83.5% vs. 60.2%), were male (90.8% vs. 86.4%), were admitted to the hospital (86.8% vs. 30.9%), and were seen in urban hospitals (86.7 vs. 64.6%). The average age was 28 years with very few on those < 14 years of age. Illicit drug involvement was over four times as frequent in those with a spine injury (34.7% vs. 8.0%). The cervical spine was involved in 30%, thoracic in 32%, lumbar in 32%, and sacrum in 6%. A fracture occurred in 91.8% and neurologic injury in 33%. Injuries to the thoracic spine had the highest percentage of neurologic involvement (50.4%). There was an annual percentage decrease for patients with and without spine involvement in the 1990s, followed by increases through 2015. The average percentage increase for patients with a spine injury was 10.3% per year from 1997 onwards (p < 10-6), significantly greater than the 1.5% for those without spinal involvement (p = 0.0001) from 1999 onwards. Conclusions This nation-wide study of spinal injuries associated with firearms covering all ages can be used as baseline data for future firearm studies. A reduction in the incidence of such injuries can be guided by our findings but may be difficult due to sociopolitical barriers (e.g. socioeconomic status of the injured patients, differences in political opinion regarding gun control in the US, and geospatial patterns of firearm injury).
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Affiliation(s)
- Randall T Loder
- Orthopaedic Surgery, Riley Hospital for Children, Indianapolis, USA
| | - Abhipri Mishra
- Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bradley Atoa
- Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Allison Young
- Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA
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Farcy DA, Doria N, Moreno-Walton L, Gordon H, Sánchez J, Cubeddu LX, Ranney ML. Emergency Physician Survey on Firearm Injury Prevention: Where Can We Improve? West J Emerg Med 2021; 22:257-265. [PMID: 33856309 PMCID: PMC7972360 DOI: 10.5811/westjem.2020.11.49283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Firearm injury and death is increasingly prevalent in the United States. Emergency physicians (EP) may have a unique role in firearm injury prevention. The aim of this study was to describe EPs' beliefs, attitudes, practices, and barriers to identifying risk of and counseling on firearm injury prevention with patients. A secondary aim was assessment of perceived personal vulnerability to firearm injury while working in the emergency department (ED). METHODS We conducted a cross-sectional survey of a national convenience sample of EPs, using questions adapted from the American College of Surgeons' Committee on Trauma 2017 survey of surgeons. Descriptive statistics and chi-square tests were calculated as appropriate. RESULTS A total of 1901 surveys were completed by EPs from across the United States. Among respondents, 42.9% had a firearm at home, and 56.0% had received firearm safety training. Although 51.4% of physicians in our sample were comfortable discussing firearm access with their high-risk patients, more than 70% agreed or strongly agreed that they wanted training on procedures to follow when they identify that a patient is at high risk of firearm injury. Respondents reported a variety of current practices regarding screening, counseling, and resource use for patients at high risk of firearm injury; the highest awareness and self-reported screening and counseling on firearm safety was with patients with suicidal ideation. Although 92.3% of EPs reported concerns about personal safety associated with firearms in the ED, 48.1% reported that there was either no protocol for dealing with a firearm in the ED, or if there was a protocol, they were not aware of it. Differences in demographics, knowledge, attitudes, and behavior were observed between respondents with a firearm in the home, and those without a firearm in the home. CONCLUSIONS Among respondents to this national survey of a convenience sample of EPs, approximately 40% had a firearm at home. The majority reported wanting increased education and training to identify and counsel ED patients at high risk for firearm injury. Improved guidance on personal safety regarding firearms in the ED is also needed.
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Affiliation(s)
- David A Farcy
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida.,Florida International University Herbert Wertheim College of Medicine, Department of Emergency Medicine & Critical Care, Miami Florida
| | - Nicole Doria
- Dalhousie University, School of Health and Human Performance, Halifax, Canada
| | - Lisa Moreno-Walton
- Louisiana State University Health Sciences Center, Department of Emergency Medicine, New Orleans, Louisiana
| | - Hannah Gordon
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida
| | - Jesus Sánchez
- NOVA Southeastern University, Department of Socio Behavioral Sciences, COP, Davie, Florida
| | - Luigi X Cubeddu
- NOVA Southeastern University, Department of Pharmaceutical Sciences, COP, Davie, Florida
| | - Megan L Ranney
- Brown University, Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island
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Whiteside LK, Vrablik MC, Russo J, Bulger EM, Nehra D, Moloney K, Zatzick DF. Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors. Trauma Surg Acute Care Open 2021; 6:e000550. [PMID: 33553651 PMCID: PMC7845668 DOI: 10.1136/tsaco-2020-000550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/07/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022] Open
Abstract
Background Accurate acute care medical utilization history is an important outcome for clinicians and investigators concerned with improving trauma center care. The objective of this study was to examine the accuracy of self-report emergency department (ED) utilization compared with utilization obtained from the Emergency Department Information Exchange (EDIE) in admitted trauma surgery patients with comorbid mental health and substance use problems. Methods This is a retrospective cohort study of 169 injured patients admitted to the University of Washington’s Harborview Level I Trauma Center. Patients had high levels of post-traumatic stress disorder and depressive symptoms, suicidal ideation and alcohol comorbidity. The investigation used EDIE, a novel health technology tool that collects information at the time a patient checks into any ED in Washington and other US states. Patterns of EDIE-documented visits were described, and the accuracy of injured patients’ self-report visits was compared with EDIE-recorded visits during the course of the 12 months prior to the index trauma center admission. Results Overall, 45% of the sample (n=76) inaccurately recalled their ED visits during the past year, with 36 participants (21%) reporting less ED visits than EDIE indicated and 40 (24%) reporting more ED visits than EDIE indicated. Patients with histories of alcohol use problems and major psychiatric illness were more likely to either under-report or over-report ED health service use. Discussion Nearly half of all patients were unable to accurately recall ED visits in the previous 12 months compared with EDIE, with almost one-quarter of patients demonstrating high levels of disagreement. The improved accuracy and ease of use when compared with self-report make EDIE an important tool for both clinical and pragmatic trial longitudinal outcome assessments. Orchestrated investigative and policy efforts could further examine the benefits of introducing EDIE and other information exchanges into routine acute care clinical workflows. Level of evidence II/III. Trial registration number ClinicalTrials.gov NCT02274688.
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Affiliation(s)
- Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Marie C Vrablik
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathleen Moloney
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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65
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Bleyer A, Siegel SE, Thomas CR. Increasing Rate of Unintentional Firearm Deaths in Youngest Americans: Firearm Prevalence and Covid-19 Pandemic Implication. J Natl Med Assoc 2021; 113:265-277. [PMID: 33446333 DOI: 10.1016/j.jnma.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The United States has had, by far, the world's greatest civilian ownership of firearms. An even greater ownership occurred during the Covd-19 pandemic, mostly of handguns and including many new owners. The U.S. has also had the least progress of the 41 highest sociodemographic countries ranked by the Institute for Health Metrics and Evaluation in reducing the unintentional firearm mortality rate in young children. This study characterized the unintentional firearm mortality trends in American 1-4 year-olds by sex and race/ethnicity and evaluated the trends in the context of firearm prevalence in the U.S. METHODS Mortality data for 1999-2018 were obtained from the U.S. Centers for Disease Control and Prevention and the Institute for Health Metrics and Evaluation, firearm injury and mortality data for 2016-2020 from Everytown for Gun Safety #NotAnAccident database, firearm background check data for 1999-2020 from the National Instant Criminal Background Check System, and civilian firearm prevalence for 2017 from the Small Arms Survey. RESULTS In American 1-4 year-olds, the rate of unintentional firearm deaths during 1999-2018 increased exponentially at an average annual percent rate of 4.9 (p < 0.001) and was greatest in non-Hispanic black children. Unintentional firearm deaths had the most rapid increase of all evaluable causes of death in the age group. The unintentional firearm death rate increase was correlated with the concurrent rate of firearm background checks and handgun permits issued (each p < 0.001) and in non-Hispanic white children with handgun prevalence in their families (p = 0.03). Globally, the unintentional firearm death rate was also correlated with firearm prevalence (p = 0.02). CONCLUSIONS An increase in fatal firearm accidents in the United States death rate among 1-4 year-olds is directly associated with the steadily increasing prevalence of firearms. The acceleration of firearm deaths and injuries among young Americans, especially among non-Hispanic black children, requires urgent solutions to address firearm prevalence and access. The problem is expected to become even more urgent as a result of the record high firearm sales that occurred in the United States during the 2020 coronavirus pandemic.
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Affiliation(s)
- Archie Bleyer
- Knight Cancer Institute and Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA; McGovern Medical School, University of Texas, Houston, TX, USA.
| | | | - Charles R Thomas
- Department of Radiation Medicine and Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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Guns, scalpels, and sutures: The cost of gunshot wounds in children and adolescents. J Trauma Acute Care Surg 2021; 89:558-564. [PMID: 32833412 DOI: 10.1097/ta.0000000000002766] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Firearm injuries are the second leading cause of death among US children. While injury prevention has been shown to be effective for blunt mechanisms of injury, the rising incidence of accidental gunshot wounds, school shootings, and interpersonal gun violence suggests otherwise for firearm-related injuries. The purpose of the study is to describe the incidence, injury severity, and institutional costs of pediatric gun-related injuries in Colorado. METHODS Pediatric patients (≤18 years), who sustained firearm injuries between 2008 and 2018, were identified from the trauma registries of three pediatric trauma centers in Colorado. Patients were stratified based on age: those younger than 14 years were defined as children and those 15 years to 18 years as adolescents. RESULTS Our cohort (n = 308) was predominantly male (87%), with a median age of 14 years. The overall mortality rate was 11% (34/308), with significantly fewer children (5%) dying from their injuries when compared with adolescents (14%; p = 0.04). Sixty-five (21%) patients required blood product transfusions, with 23 (7.4%) patients receiving a massive transfusion. Overall, 52% (161/308) required a major operation, with 15% undergoing an exploratory laparotomy. One third (4/13) of the patients who had a thoracotomy in the emergency department survived to hospital discharge. Overall, 14.0% of patients had psychiatric follow-up at both 30 days and 1 year. The readmission rate for complications was 11.6% at 30 days and 14% at 1 year. The total cost of care for all pediatric firearm-related injuries was approximately US $26 million. CONCLUSION The survivors of pediatric firearm injuries experience high operative and readmission rates, sustain long-term morbidities, and suffer from mental health sequelae. Combining these factors with the economic impact of these injuries highlights the immense burden of disease. This burden may be palliated by a multipronged approach, which includes the development and dissemination of injury prevention strategies and better follow-up care for these patients. LEVEL OF EVIDENCE Epidemiological, Level III.
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Epidemiology of orthopaedic fractures due to firearms. J Clin Orthop Trauma 2021; 12:45-49. [PMID: 33716427 PMCID: PMC7920201 DOI: 10.1016/j.jcot.2020.10.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 11/22/2022] Open
Abstract
The majority of firearm injuries involve the extremities and have concomitant orthopaedic injuries. National data on the epidemiology of wounds caused by firearms may better inform physicians and identify areas of public health intervention. We conducted an analysis of a national database to describe the epidemiology of orthopaedic firearm injuries in the United States. The Nationwide Inpatient Sample 2001-2013 database was queried for adult patients with fractures excluding those of the skull using injury billing codes. Characterization of injury was determined using External Cause of Injury billing codes. Sociodemographic and geographic variables were reported. Chi square and multinomial logistic regression analyses were performed to identify predictors of type of firearm implicated in injury. 334,212 firearm injuries were reported in the database and about half had concomitant orthopaedic fractures. Most patients were between the ages 19 and 29, were African American, and were male. The most frequent circumstance of injury was assault/homicide, the most common firearm used was a handgun, and the most common fracture site was the femur. Patients without insurance and patients of lower income were most commonly afflicted. Knowing this distribution of the burden of this class of injury provides the opportunity to identify and intervene on behalf of at-risk populations, potentially reducing injuries by promoting firearm safety to these groups and advocating sensible practices to reduce inequitable outcomes caused by these injuries.
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Hoofnagle MH, Mubang RN, Joseph DK, Joseph BA, Christmas AB, Zakrison TL. Eastern Association for the Surgery of Trauma Statement on Structural Racism, and the Deaths of George Floyd, Ahmaud Arbery, and Breonna Taylor. Ann Surg 2020; 272:911-914. [PMID: 32976286 PMCID: PMC7668345 DOI: 10.1097/sla.0000000000004430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Mark H Hoofnagle
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University in St. Louis, MO
| | - Ronnie N Mubang
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - D'Andrea K Joseph
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, NY
| | - Bellal A Joseph
- Department of Surgery, Division of Trauma, Acute Care, Burns, and Emergency Surgery, University of Arizona Health Sciences, Tucson, AZ
| | | | - Tanya L Zakrison
- Department of Surgery, Division of Trauma and Critical Care, University of Chicago, Chicago, IL
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Kaufman EJ, Passman JE, Jacoby SF, Holena DN, Seamon MJ, MacMillan J, Beard JH. Making the news: Victim characteristics associated with media reporting on firearm injury. Prev Med 2020; 141:106275. [PMID: 33027614 PMCID: PMC7533055 DOI: 10.1016/j.ypmed.2020.106275] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/25/2022]
Abstract
Firearm injury is a public health crisis in the United States. Selective media coverage may contribute to incomplete public understanding of firearm injury. To better understand how firearm injury is communicated to the public, we analyzed media coverage of intentional, interpersonal shootings in 3 U.S. cities. We hypothesized that multiple shootings and fatal shootings would be more likely to make the news, as would shootings affecting children, women, and white individuals. We compared police department data on shootings to media reports drawn from the Gun Violence Archive (GVA) for 2017 in Philadelphia, PA, Rochester, NY, and Cincinnati, OH. GVA reports were matched to police data by shooting date, location, victim age, and gender. Matched victims were compared to unmatched using chi2 tests for categorical variables and Kruskal Wallis tests for continuous variables. Philadelphia police reported 1216 firearm assault victims; Cincinnati police reported 407; and Rochester police reported 178. News reports covered 562 (46.2%), 222 (54.6%), and 116 (65.2%) victims, respectively. Fatal shootings were more often reported as were shootings involving multiple victims or women. Half of shooting victims did not make the news. Selective reporting likely limits awareness of the public health impact of firearm injury. Researchers and policy makers should work with journalists and editors to improve the quantity and content of reporting on firearm injury.
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Affiliation(s)
- Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, United States of America.
| | - Jesse E Passman
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, United States of America.
| | - Sara F Jacoby
- University of Pennsylvania School of Nursing, United States of America.
| | - Daniel N Holena
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, United States of America.
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, United States of America.
| | - Jim MacMillan
- Initiative for Better Gun Violence Reporting, United States of America.
| | - Jessica H Beard
- Division of Trauma and Surgical Critical Care, Temple University School of Medicine, United States of America.
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Bonne S. Educational Innovation for Gun Violence in the US. J Am Coll Surg 2020; 231:637-638. [PMID: 33243394 DOI: 10.1016/j.jamcollsurg.2020.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
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Abstract
OBJECTIVES To review the public health approach to preventing and treating firearm violence. DATA SOURCES Peer-reviewed, published scholarship and federal data systems. STUDY SELECTION English-language, indexed research articles on the epidemiology, risk, prevention, and consequences of firearm violence. DATA EXTRACTION This narrative review includes findings related to the epidemiology and impact of firearm violence, focusing on short- and long-term outcomes. Evidence supporting interventions at the individual, agent, and environmental level to reduce firearm-related harm was examined. DATA SYNTHESIS Firearm violence is a major public health challenge in the Unites States. The consequences of firearm violence reach beyond the nearly 40,000 firearm-related deaths and 90,000 firearm-related injuries each year. Firearm violence, including self-harm, assault, and unintentional injury, affects the health of individuals, families, communities, and health systems. Data sources remain inadequate, however, to fully capture these impacts. Treating firearm violence as a disease and taking a public health approach to prevention and treatment is key to reducing the harms of firearm violence. Using a public health framework not only recognizes the physical and mental consequences of firearm violence but also focuses our attention on underlying causes and on innovative, multi-level interventions to reduce the harms of firearm violence. CONCLUSIONS The public health approach positions clinicians to change the conversation from political diatribe of pro-gun and anti-gun to systematically reducing injury and death. To achieve comparable success, we must design, test, and implement effective interventions at the environmental, policy, technological, and individual levels to prevent firearm violence. We must collect robust data on firearm violence and its consequences. And we must reckon with the conditions of inequality and disadvantage that feed violence through all means.
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Diurba S, Johnson RL, Siry BJ, Knoepke CE, Suresh K, Simpson SA, Azrael D, Ranney ML, Wintemute GJ, Betz ME. Lethal Means Assessment and Counseling in the Emergency Department: Differences by Provider Type and Personal Home Firearms. Suicide Life Threat Behav 2020; 50:1054-1064. [PMID: 32598076 PMCID: PMC7722150 DOI: 10.1111/sltb.12649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/09/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined emergency department (ED) and behavioral health (BH) provider attitudes and behaviors related to lethal means screening and counseling of patients with suicide risk, specifically examining differences by provider type and whether providers had firearms in their own home. METHODS Emergency department providers (physicians and mid-level practitioners) and behavioral health (BH) providers at four Colorado EDs completed an anonymous, web-based survey. RESULTS Fewer ED providers (35%) than BH providers (81%) felt confident in their ability to counsel patients about lethal means (p < .001). In multivariable analysis, the only clinical or provider factor associated with often or almost always asking patients about firearm access was provider type, with BH providers more likely than ED providers to ask in all scenarios (OR: 5.58, 95% CI 1.68-18.6). Behaviors and attitudes about lethal means counseling did not vary by whether the provider had firearms at home. Almost all providers said that additional training and protocols about how to help patients make firearm storage decisions would be helpful. CONCLUSIONS Gaps in ED-delivered lethal means counseling persist, highlighting directions for future provider education and protocol development.
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Affiliation(s)
- Sofiya Diurba
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel L. Johnson
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bonnie J. Siry
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher E. Knoepke
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Krithika Suresh
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Scott A. Simpson
- Psychiatric Emergency Services, Denver Health, Denver, Colorado, USA and Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, University of California Davis, Sacramento, California, USA
| | - Marian E. Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Firearm Safety and Injury Prevention. Ann Emerg Med 2020; 76:e99-e100. [DOI: 10.1016/j.annemergmed.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Indexed: 11/16/2022]
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74
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Flaskerud JH. Reviewing the Decade, 2010 to 2019 and Challenges for the Next. Issues Ment Health Nurs 2020; 41:958-962. [PMID: 32401561 DOI: 10.1080/01612840.2020.1719249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bonne S, Tufariello A, Coles Z, Hohl B, Ostermann M, Boxer P, Sloan-Power E, Gusmano M, Glass NE, Kunac A, Livingston D. Identifying participants for inclusion in hospital-based violence intervention: An analysis of 18 years of urban firearm recidivism. J Trauma Acute Care Surg 2020; 89:68-73. [PMID: 32574483 DOI: 10.1097/ta.0000000000002680] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identifying individuals at highest risk maximizes efficacy of prevention programs in decreasing recidivist gunshot wound (GSW) injury. Characteristics of GSW recidivists may identify this population. Hospital-based violence intervention programs (HVIPs) are one effective strategy; however, programs are expensive, therefore, when possible, epidemiologic data should guide inclusion criteria. METHODS Seventeen years of all GSW patients presenting to an urban Level I trauma center were reviewed. Countywide murders were reviewed from the same timeframe. Recidivists were any patient presenting twice, either to the hospital or once to the hospital and subsequently dying by firearm. Demographics and characteristics of future recidivists were compared with nonfuture recidivists. RESULTS There were 9,699 unique intentional, GSW cases reviewed and 1,426 died, leaving 8,273 at risk of recidivism. Five hundred fourteen (6.2%) became recidivists. Most recidivists were African-American men and were younger at first GSW. Median time between incidents was 2.5 years, with a range of 0 days to 16 years. Nearly half were treated and released from the emergency department at their first episode of GSW. For recidivists who died, 128 died at the second incident, 29 at later incidents. Mortality from a second incident of firearm injury is 10% higher than first injuries, second hospitalizations are US $5,000 more expensive, and loss of life has a societal cost of US $167 billion in this community alone. CONCLUSION The most appropriate population for inclusion in HVIPs at our hospital are young black men. The HVIP services are needed in the emergency department to address those treated and released at first GSW. Recidivists have higher mortality, and hospitalizations are significantly more expensive at the second injury. The investment in prevention is justified and may lead to a decrease in recidivism. LEVEL OF EVIDENCE Therapeutic/Care Management level III.
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Affiliation(s)
- Stephanie Bonne
- From the Division of Trauma and Critical Care, Department of Surgery, Rutgers New Jersey Medical School (S.B., A.T., N.E.G., A.K., D.L.); Rutgers Graduate School of Biomedical Sciences (Z.C.), Newark; Department of Epidemiology (B.H.), Rutgers School of Public Health, Piscataway; Rutgers School of Criminal Justice (M.O.); Department of Psychology (P.B.), Department of Social Work (E.S-P.), Rutgers-Newark School of Arts and Sciences, Newark; Department of Health Behavior, Society and Policy (M.G.), Rutgers School of Public Health, Piscataway; and The New Jersey Center on Gun Violence Research at Rutgers (S.B., B.H., M.O., P.B., E.S-P., M.G.), Newark, New Jersey
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76
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Haut ER. Eastern Association for the Surgery of Trauma (EAST) practice management guidelines and the perpetual quest for excellence. J Trauma Acute Care Surg 2020; 89:1-10. [PMID: 32251261 DOI: 10.1097/ta.0000000000002709] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Elliott R Haut
- From the Division of Acute Care Surgery, Department of Surgery, Department of Anesthesiology and Critical Care Medicine, and Department of Emergency Medicine, Johns Hopkins University School of Medicine; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine; and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Abstract
BACKGROUND Gun injury accounts for substantial acute mortality worldwide and many others survive with lingering disabilities. We investigated whether additional health losses beyond mortality can also arise for patients who survive with long-term disability. METHODS We conducted a population-based individual patient analysis of adults injured by firearms who had received emergency medical care in Ontario, Canada, from Apr. 1, 2002, to Apr. 1, 2019. Longitudinal cohort analyses were evaluated through deterministic linkages of individual electronic patient files. The primary outcome was death or subsequent application for long-term disability in the years after hospital discharge. RESULTS In total, 8313 patients were injured from firearms, of which 3020 were injured from intentional incidents and 5293 were injured from unintentional incidents. A total of 2657 (88.0%) patients with intentional gun injury and 5089 (96.1%) patients with unintentional gun injury survived initial injuries. After a mean 7.75 years of follow-up, patients surviving intentional injuries had a disability rate twice as high as patients surviving unintentional injuries (19.7% v. 10.1%, p < 0.001), equivalent to a hazard ratio of 2.01 (95% confidence interval 1.80-2.25). The higher risk of long-term disability for survivors after intentional gun injury was not explained by demographic characteristics, extended to survivors treated and released from the emergency department, and was observed regardless of whether the incident was self-inflicted or from interpersonal assault. Half of the disability cases were identified after the first year. Additional predictors of long-term disability included a lower socioeconomic status, an urban home location, arrival by ambulance transport, a history of mental illness and a diagnosis of substance use disorder. INTERPRETATION Our study shows that gun death statistics underestimate the extent of health losses from long-term disability, particularly for those with intentional injuries. Additional and sustainable follow-up medical care might improve patient outcomes.
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Affiliation(s)
- Sheharyar Raza
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont
| | - Deva Thiruchelvam
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont
| | - Donald A Redelmeier
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont.
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Bulger EM. Harnessing your passion and connecting to purpose. J Trauma Acute Care Surg 2020; 89:13-17. [PMID: 32574482 DOI: 10.1097/ta.0000000000002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eileen M Bulger
- From the Department of Surgery, University of Washington (E.M.B.), Seattle, Washington
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Powell RE, Sacks CA. A National Research Strategy to Reduce Firearm-Related Injury and Death: Recommendations from the Health Policy Research Subcommittee of the Society of General Internal Medicine (SGIM). J Gen Intern Med 2020; 35:2182-2185. [PMID: 32410123 PMCID: PMC7351911 DOI: 10.1007/s11606-020-05850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
Injury due to firearms is a serious health issue in the USA, leading to nearly 40,000 deaths annually and many more non-fatal injuries. Despite the significant impact on morbidity and mortality, relatively little research funding is dedicated to understanding the impact of firearm-related injury and to developing strategies to mitigate harm. In part, research has been stymied by decades-old language in federal legislation that was interpreted as prohibiting federal funding for firearm injury-related research. This paper, prepared by members of the Society of General Internal Medicine (SGIM), calls for support for research that seeks to understand the nature of firearm-related injury and resources to develop effective approaches to prevent it. We outline recommendations to develop evidence to inform policymakers and the medical and public health communities. These recommendations include (1) development of a shared national research agenda to address firearm-related injury and death; (2) allocation of federal funds specifically for research related to firearm injury; (3) support for the career development of researchers studying firearm-related injury; and (4) facilitating access to comprehensive data sources needed for developing evidence.
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Affiliation(s)
- Rhea E Powell
- Division of Internal Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Chana A Sacks
- Division of General Internal Medicine and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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A systematic review of the causes and prevention strategies in reducing gun violence in the United States. Am J Emerg Med 2020; 38:2169-2178. [PMID: 33071102 DOI: 10.1016/j.ajem.2020.06.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Approximately 100 lives are lost each day as a result of gun violence in the United States (US) with civilian mass shootings increasing annually. The gun violence rate in the US is almost 20 times higher than other comparable developed countries and has the most gun ownership per capita of any nation in the world. Understanding the causes and risk factors are paramount in understanding gun violence and reducing its incidence. METHODS A literature search of all published articles relating to gun violence and mass shootings in the US was conducted using the Medline and PMC databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used in conducting this study. Rayyan statistical software was utilized for analysis. Statistical significant was defined as p < .05. RESULTS Of the initial 2304 eligible manuscripts identified, 22 fulfilled our selection criteria. A variety of common causal and contributory factors were identified including but not limited to mental illness, suicidal ideation, intimate partner violence, socioeconomic status, community distress, family life, childhood trauma, current or previous substance abuse, and firearm access. CONCLUSION Gun violence is pervasive and multi-factorial. Interventions aimed at reducing gun violence should be targeted towards the most common risk factors cited in the literature such as access, violent behavioral tendencies due to past exposure or substance abuse, and mental illness including suicidal ideation.
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Gibbons MJ, Fan MD, Rowhani-Rahbar A, Rivara FP. Legal Liability for Returning Firearms to Suicidal Persons Who Voluntarily Surrender Them in 50 US States. Am J Public Health 2020; 110:685-688. [PMID: 32191527 PMCID: PMC7144456 DOI: 10.2105/ajph.2019.305545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2019] [Indexed: 11/04/2022]
Abstract
Temporary transfers of firearms from suicidal persons is a strategy to reduce the incidence of suicide deaths. We discuss a barrier to the effective operation of voluntary temporary firearm transfer laws: the dearth of guidance on the liability for returning firearms to persons who voluntarily surrender them. We examine the laws of all 50 US states that regulate temporary surrenders of firearms and evaluate whether any provisions govern liability for returning temporarily surrendered firearms.Although 14 states create background check exceptions to permit temporary transfers of firearms from an owner to family, friends, retailers, or law enforcement, no states prescribe procedures for returning those firearms.ability for returning the firearms to people who voluntarily surrendered them.We recommend amending state laws to clarify the process and liability for returning temporarily surrendered firearms to the original owner. Such amendments would be intended to mitigate the potential chilling effect that lack of clarity and presumption of liability may impose on efficiently reducing firearm access to protect firearm owners at risk for suicide.
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Affiliation(s)
- Molly J Gibbons
- Molly J. Gibbons and Mary D. Fan are with the University of Washington School of Law, Seattle. Molly J. Gibbons, Mary D. Fan, Ali Rowhani-Rahbar, and Frederick P. Rivara are with the Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle. Ali Rowhani-Rahbar is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Frederick P. Rivara is also with the School of Public Health and the School of Medicine, University of Washington, Seattle
| | - Mary D Fan
- Molly J. Gibbons and Mary D. Fan are with the University of Washington School of Law, Seattle. Molly J. Gibbons, Mary D. Fan, Ali Rowhani-Rahbar, and Frederick P. Rivara are with the Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle. Ali Rowhani-Rahbar is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Frederick P. Rivara is also with the School of Public Health and the School of Medicine, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Molly J. Gibbons and Mary D. Fan are with the University of Washington School of Law, Seattle. Molly J. Gibbons, Mary D. Fan, Ali Rowhani-Rahbar, and Frederick P. Rivara are with the Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle. Ali Rowhani-Rahbar is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Frederick P. Rivara is also with the School of Public Health and the School of Medicine, University of Washington, Seattle
| | - Frederick P Rivara
- Molly J. Gibbons and Mary D. Fan are with the University of Washington School of Law, Seattle. Molly J. Gibbons, Mary D. Fan, Ali Rowhani-Rahbar, and Frederick P. Rivara are with the Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle. Ali Rowhani-Rahbar is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Frederick P. Rivara is also with the School of Public Health and the School of Medicine, University of Washington, Seattle
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Ranney ML, Zeoli AM, Beidas R. Evidence-Based Solutions to Pediatric Firearm Deaths-The Need for Out-of-the-Box Answers. JAMA Pediatr 2020; 174:411-412. [PMID: 32119061 PMCID: PMC8274372 DOI: 10.1001/jamapediatrics.2019.6239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI
| | - April M. Zeoli
- School of Criminal Justice, Michigan State University, East Lansing, MI
| | - Rinad Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA
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83
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Betz ME, Knoepke CE, Simpson S, Siry BJ, Clement A, Saunders T, Johnson R, Azrael D, Boudreaux ED, Omeragic F, Adams LM, Almond S, Juarez-Colunga E, Matlock DD. An Interactive Web-Based Lethal Means Safety Decision Aid for Suicidal Adults (Lock to Live): Pilot Randomized Controlled Trial. J Med Internet Res 2020; 22:e16253. [PMID: 32012056 PMCID: PMC7016618 DOI: 10.2196/16253] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/15/2019] [Accepted: 12/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Counseling to reduce access to lethal means such as firearms and medications is recommended for suicidal adults but does not routinely occur. We developed the Web-based Lock to Live (L2L) decision aid to help suicidal adults and their families choose options for safer home storage. OBJECTIVE This study aimed to test the feasibility and acceptability of L2L among suicidal adults in emergency departments (EDs). METHODS At 4 EDs, we enrolled participants (English-speaking, community-dwelling, suicidal adults) in a pilot randomized controlled trial. Participants were randomized in a 13:7 ratio to L2L or control (website with general suicide prevention information) groups and received a 1-week follow-up telephone call. RESULTS Baseline characteristics were similar between the intervention (n=33) and control (n=16) groups. At baseline, many participants reported having access to firearms (33/49, 67%), medications (46/49, 94%), or both (29/49, 59%). Participants viewed L2L for a median of 6 min (IQR 4-10 min). L2L also had very high acceptability; almost all participants reported that they would recommend it to someone in the same situation, that the options felt realistic, and that L2L was respectful of values about firearms. In an exploratory analysis of this pilot trial, more participants in the L2L group reported reduced firearm access at follow-up, although the differences were not statistically significant. CONCLUSIONS The L2L decision aid appears feasible and acceptable for use among adults with suicide risk and may be a useful adjunct to lethal means counseling and other suicide prevention interventions. Future large-scale studies are needed to determine the effect on home access to lethal means. TRIAL REGISTRATION ClinicalTrials.gov NCT03478501; https://clinicaltrials.gov/ct2/show/NCT03478501.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Eastern Colorado Geriatric Research Education and Clinical Center, Veterans Health Administration, Aurora, CO, United States
| | - Christopher E Knoepke
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
- Adult & Child Consortium for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO, United States
| | - Scott Simpson
- Psychiatric Emergency Services, Denver Health Medical Center, Denver, CO, United States
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Bonnie J Siry
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ashley Clement
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Tamara Saunders
- School of Public Affairs, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Rachel Johnson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, United States
| | - Edwin D Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Faris Omeragic
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Leah M Adams
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sydney Almond
- University of Colorado Denver, Denver, CO, United States
| | - Elizabeth Juarez-Colunga
- Adult & Child Consortium for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Daniel D Matlock
- Eastern Colorado Geriatric Research Education and Clinical Center, Veterans Health Administration, Aurora, CO, United States
- Adult & Child Consortium for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO, United States
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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84
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Building Consensus to Decrease Firearm Injuries and Death in the USA: Engaging Medical and Public Health Organizations to Find Common Ground. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00190-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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85
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Moodliar R, Russo J, Bedard-Gilligan M, Moloney K, Johnson P, Seo S, Vaziri N, Zatzick D. A Pragmatic Approach to Psychometric Comparisons between the DSM-IV and DSM-5 Posttraumatic Stress Disorder (PTSD) Checklists in Acutely Injured Trauma Patients. Psychiatry 2020; 83:390-401. [PMID: 32762319 PMCID: PMC7858198 DOI: 10.1080/00332747.2020.1762396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Prior investigations suggest the relative equivalence of the DSM-IV and DSM-5 versions of the Posttraumatic Stress Disorders (PTSD) Checklist, yet no investigations have assessed the psychometric properties of the scales in pragmatic trials of acutely injured trauma survivors. Method: DSM-IV and DSM-5 versions of the PTSD Checklist were included in follow-up interviews of physically injured patients enrolled longitudinally in a pragmatic clinical trial; pragmatic trials aim to efficiently implement research procedures to inform healthcare system policy changes. Psychometric comparisons of the DSM-IV, DSM-5, and a 20-item blended version of the scale included evaluations of internal consistency, correlational assessments, evaluation of item level agreements, and estimation of DSM-5 cutoffs that optimize electronic health record screening protocols. Results: 128 patients were included in the pragmatic psychometric study. Cronbach's alphas for the 3 versions of the PTSD Checklist ranged from 0.93 to 0.95. Correlations between the 3 scales ranged from 0.79 to 0.99. All 3 measures demonstrated excellent convergent and discriminant properties. Item level agreement ranged from 70-80%. For the DSM-5 and blended versions of the scale, a score of 30 and 24, respectively, best approximated the DSM-IV cutoff of ≥35 that had previously optimized PTSD detection in conjunction with EHR screening. Conclusions: Among injured trauma survivors, the psychometric performance of the DSM-IV PTSD Checklist with the addition of the 4 new DSM-5 PTSD Checklist items is nearly equivalent to the DSM-5 PTSD Checklist. The investigation also suggests that pragmatic psychometric methods can catalyze the rapid translation of research findings into real-world practice settings.
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Affiliation(s)
- Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA;,
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Michele Bedard-Gilligan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Peyton Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Sara Seo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Natalie Vaziri
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA;,Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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86
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Dicker RA, Punch LJ. Long-term Consequences in Trauma: At the Center of the Public Health Approach Is the Survivor's Voice. JAMA Surg 2020; 155:59-60. [PMID: 31746974 DOI: 10.1001/jamasurg.2019.4560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rochelle A Dicker
- Department of Surgery, UCLA (University of California, Los Angeles)-Geffen School of Medicine
| | - Laurie J Punch
- Department of Surgery, Washington University School of Medicine in St Louis
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Vella MA, Warshauer A, Tortorello G, Fernandez-Moure J, Giacolone J, Chen B, Cabulong A, Chreiman K, Sims C, Schwab CW, Reilly PM, Lane-Fall M, Seamon MJ. Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries. JAMA Surg 2020; 155:51-59. [PMID: 31746949 PMCID: PMC6902182 DOI: 10.1001/jamasurg.2019.4533] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/02/2019] [Indexed: 11/14/2022]
Abstract
Importance The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. Objective To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries. Design, Setting, and Participants This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019. Exposures A GSW sustained from January 1, 2008, through December 31, 2017. Main Outcomes and Measures Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Results Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P < .001), Global Mental Health (48 [11]; P = .03), and Physical Function (45 [12]; P < .001) PROMIS metrics. Eighty-nine participants (48.6%) had a positive screen for probable PTSD. Patients who required intensive care unit admission (n = 64) had worse mean (SD) Physical Function scores (42 [13] vs 46 [11]; P = .045) than those not requiring the intensive care unit. Survivors no more than 5 years after injury had greater PTSD risk (38 of 63 [60.3%] vs 51 of 119 [42.9%]; P = .03) but better mean (SD) Global Physical Health scores (47 [11] vs 43 [11]; P = .04) than those more than 5 years after injury. Conclusions and Relevance This study's results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of GSWs may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount.
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Affiliation(s)
- Michael A. Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- currently affiliated with Division of Acute Care Surgery and Trauma, University of Rochester Medical Center, Rochester, New York
| | - Alexander Warshauer
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Gabriella Tortorello
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Joseph Fernandez-Moure
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Joseph Giacolone
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- currently affiliated with Department of Surgery, Stanford University, Palo Alto, California
| | - Bofeng Chen
- medical student, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alexander Cabulong
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Kristen Chreiman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Carrie Sims
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - C. William Schwab
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Patrick M. Reilly
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Meghan Lane-Fall
- Department of Anesthesia and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Mark J. Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Chiu RG, Fuentes AM, Mehta AI. Gunshot wounds to the head: racial disparities in inpatient management and outcomes. Neurosurg Focus 2019; 47:E11. [DOI: 10.3171/2019.8.focus19484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 08/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVESeveral studies have indicated that racial disparities may exist in the management and outcomes of acute trauma care. One segment of trauma care that has not been as extensively investigated, however, is that of cranial trauma care. The goal of this study was to determine whether significant differences exist among racial and ethnic groups in various measures of inpatient management and outcomes after gunshot wounds to the head (GWH).METHODSIn this study, the authors used the Nationwide (National) Inpatient Sample (NIS) to investigate all-cause mortality, receipt of surgery, days from admission to initial intervention, discharge disposition, length of hospital stay, and total hospital charges of those with GWH from 2012 to 2016. A 1:1 propensity score–matched analysis was conducted to evaluate the effect of race on these endpoints, while controlling for baseline demographics and comorbidities.RESULTSA total of 333 patients met the inclusion and exclusion criteria: 148 (44.44%) white/Caucasian, 123 (36.94%) black/African American, 54 (16.22%) Hispanic/Latinx, and 8 (2.40%) Asian. African American patients were sent to immediate care and rehabilitation significantly less often than Caucasian patients (RR 0.17 [95% CI 0.04–0.71]). There were no significant differences in mortality, length of stay, rates of surgical intervention, or total hospital charges among any of the racial groups.CONCLUSIONSThe authors’ findings suggest that racial disparities in inpatient cranial trauma care and outcomes may not be as prevalent as previously thought. In fact, the disparities seen were only in disposition. More research is needed to further elucidate and address disparities within this population, particularly those that may exist prior to, and after, hospitalization.
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Major Medical Organizations Support Gun Safety Research: Their Political Contributions Say Otherwise. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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