Jan 31, 2018 - Overall, handguns accounted for 78% of firearm homicides, shotguns 3% and rifles. 2%; 16% had no firearm type stated and 1% were unknown ...
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Scientific Poster Presentations: 2017 Clinical Congress
J Am Coll Surg
Separating Truth from Alternative Facts: Guns, Murder, and Patterns of Violence over Twenty Years at a Level I Urban Trauma Center Nathan R Manley, MD, MPH, Timothy C Fabian, MD, FACS, John Sharpe, MD, Louis J Magnotti, MD, Martin A Croce, MD, FACS University of Tennessee Health Science Center, Memphis, TN
METHODS: TRICARE data from 2006 to 2014 were queried for individuals 18 years admitted with a primary diagnosis of trauma. An avoidable ED visit was defined as an ED visit that did not end in an admission. Multivariable logistic models, adjusted for confounders, were used to determine the independent association between outpatient visits and avoidable ED visits and the relative effect of follow-up visits with surgical providers as compared to primary care physicians (PCP).
INTRODUCTION: Gun violence remains a significant public health problem that is understudied and underfunded. Trauma registries are limited in describing details of firearm crimes. We therefore examined how law enforcement data might complement trauma registry data.
RESULTS: Of the 106,289 patients included in our cohort, 86% had at least 1 follow-up visit within 30 days of discharge. Of those who had at least 1 follow-up, 20% visited a PCP after discharge and 24% visited a surgical service. Overall, 6,586 (6.4%) patients had an avoidable ED visit. In adjusted analyses, follow-up was associated with reduced odds of having an avoidable ED visit overall (odds ratio [OR]¼0.21, CI [0.19,0.22]). Follow-up with a surgical service was associated with a 24% reduction in the likelihood of an avoidable ED visit as compared to a PCP visit (OR¼0.76, CI [0.69, 0.84].
METHODS: Primary data files for 1996 to 2015 were obtained from the Federal Bureau of Investigation (FBI). Data analyzed included homicide type, situation, circumstance, firearm type, and demographics of victims and offenders. RESULTS: A total of 1,994 incidents of firearm homicide were analyzed (69% of 2,879 total homicides). Most victims were male (88%), black (84%) and had a mean age of 31; offenders were predominantly male (79%), black (74%) with an average age of 28. 60% of all homicides involved a single victim and single offender, followed by single victim and multiple offenders (20%); 4% of firearm homicides had multiple victims. Felony homicides decreased from 23% in 1996 to 5% in 2015 (p¼0.0001), with robbery being the most commonly associated felony type (68%). Overall, handguns accounted for 78% of firearm homicides, shotguns 3% and rifles 2%; 16% had no firearm type stated and 1% were unknown. Shotgun homicides decreased from 8% in 1996 to 1% in 2015 (p¼0.0125). CONCLUSIONS: FBI homicide data can supplement trauma registry data and better characterize gun violence patterns, although gun type categories are not caliber specific. Handguns remain the gun of choice in homicide, likely because of their easy availability and semiautomatic capability. Stronger partnerships are needed between local law enforcement agencies and trauma centers to better characterize firearm type and resulting injury patterns. Surgical Outpatient Care Reduces Avoidable Emergency Department Visits among Trauma Patients Meesha Sharma, MD, MPH, Stephanie L Nitzschke, MD, FACS, Muhammad A Chaudhary, MD, Daniel J Sturgeon, Eric Goralnick, MD, Ali Salim, MD, FACS, Tracey Koehlmoos, PhD, Adil H Haider, MBBS, FACS, Andrew J Schoenfeld, MD Brigham and Women’s Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD INTRODUCTION: Avoidable emergency department (ED) visits after trauma discharge are a source of significant healthcare cost to the patient and healthcare system. We sought to determine whether follow-up care with surgical services could reduce avoidable ED visits within 30 days of discharge.
CONCLUSIONS: Out-patient care after trauma is associated with avoidable ED visits up to 30 days post-discharge. Follow-up care with surgical providers was found to be most effective at reducing the likelihood of avoidable post-discharge ED visits. Decline of Open Abdominal Aortic Aneurysm Repair among Vascular Surgery Training Programs in the United States Danielle C Sutzko, MD, Elizabeth Andraska, Anna Boniakowski, MD, Dawn M Coleman, MD, Nicholas H Osborne, MD University of Michigan, Ann Arbor, MI INTRODUCTION: Currently, the majority of abdominal aortic aneurysm repairs are performed via an endovascular approach. We sought to understand the current volume of open aortic volume at all vascular training programs in the US. METHODS: All open infrarenal (juxtarenal and infrarenal) aortic aneurysm (oAAA) repairs were identified from the Medicare database between 2010 and 2014. Training programs were then identified using the ACGME website and all associated hospitals with each program were identified using the Medicare ID. Surgical volumes across years were calculated for each program. Since Medicare represents about 55% of the payer mix for infrarenal aneurysm repair, all volumes were adjusted to reflect total volumes for each program. RESULTS: A total of 35,042 (23%) oAAA repairs and 119,408 (77%) EVARs were identified in the Medicare database between 2010 and 2014. Of these, 21% were performed among the 113 training programs, including 8,433 (27%) oAAA repairs and 23,243 (73%) EVARs. The estimated program volume of open repair declined during the study from a median of 35.6 repairs in 2010 to 22.2 repairs in 2014, as compared to a stable volume of EVAR (82.2 vs 75.5). There was a significant decline in oAAA repair volume among all programs and stable volumes for EVAR.
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