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Abstract
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BACKGROUND: Existing data demonstrate that injuries sustained during legal intervention differ from those incurred during civilian interpersonal violence, but gunshot wounds (GSWs) have not yet been specifically examined. This study was undertaken to provide an in-depth analysis of patients shot during legal intervention (LI) vs. civilian interpersonal violence (CIV).
METHODS: Patients injured by GSW and captured by the NTDB (2007-2017) were included. Exclusions were transfer from outside hospital or self-inflicted, accidental, or undetermined injury intent GSWs. Study groups were defined by injury circumstances: GSWs sustained during LI vs. CIV. Univariable analysis compared demographics, clinical/injury data, and outcomes.
RESULTS: In total, 248,726 patients met inclusion/exclusion criteria: 98% (n = 243,150) CIV vs. 2% (n = 5,576) LI. Race varied significantly between study groups (p < 0.001). White patients were the most commonly injured race after LI (n = 2,176, 39%). Black patients were the most commonly injured race after CIV (n = 139,067, 57%). Psychiatric disease (9% vs. 2%, p < 0.001) was more common among LI GSWs. LI patients were more frequently tachycardic (18% vs. 13%, p < 0.001), hypotensive (26% vs. 14%, p < 0.001), and comatose (34% vs. 15%, p < 0.001). LI patients had higher ISS (13 vs. 9, p < 0.001), required emergent surgical intervention (39% vs. 28%, p < 0.001) and ICU admission (47% vs. 32%, p < 0.001) more often, and had longer hospital stay (4 vs. 3 days, p < 0.001). Mortality was higher after LI (27% vs. 14%, p < 0.001).
CONCLUSION: Significant racial and injury severity differences exist between patients shot during legal intervention and civilian interpersonal violence. White patients were the most commonly injured race after legal intervention while Black patients were the most commonly injured race during civilian interpersonal violence. Additionally, Black patients were overrepresented in both groups when compared to their proportion in the US population. Legal intervention patients were more significantly injured, as quantified by clinical, injury, and outcomes variables including increased mortality. Further study of patients shot during legal intervention is needed to better understand this increased burden of injury. LEVEL OF EVIDENCE: IV.
Language: en |