Gentrification, gun violence, and disparities in access to care for shooting victims.

Background: Gentrification is associated with redistribution of shootings but impacts on access to care are unknown. We evaluate the association of gentrification with shooting rates, transport times, and survival in Boston.

Methods: Gentrification was defined using income, housing, and educational attainment from the 2010-2020 census.

Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial.

Introduction: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.

Methods: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020.

Association of prolonged emergency department length of stay and venous thrombo-embolism prophylaxis and outcomes in trauma: A nation-wide secondary analysis.

Introduction: The impact of prolonged emergency department length of stay (EDLOS) on appropriately timed pharmacological venous thromboembolism prophylaxis (VTEp) and VTE outcomes is unknown in trauma.

Methods: Retrospective cohort study of adult patients admitted to civilian trauma centers participating in the American College of Surgeons' TQIP (2019-2021). Patients with severe solid organ, head, or spine injury, early hemorrhage control intervention, pre-existing home anticoagulation or bleeding disorder, inter-facility transfer or early discharge, and injury severity score ≤9 were excluded.

Characterizing a Common Phenomenon: Why do Trauma Patients Re-present to the Emergency Department?

Introduction: Trauma patients return to the emergency department (ED) at alarmingly high rates, despite not all patients requiring hospital resources. Reasons for ED re-presentation and associated risk factors have not been fully investigated.

Methods: Retrospective cohort study of adult trauma admissions at an urban safety net level 1 trauma center (1/12018-12/312021).

Exploring rural-urban differences in the receipt of nonelective cancer-specific gastrointestinal surgery using a multilevel mixed-effects approach.

Background: Rural communities constitute a populace marked by various social challenges influencing health outcomes. As such, nonelective surgeries for cancer may have a disproportionate impact on rural populations. We explored patient and county-level factors contributing to differences in the receipt of nonelective cancer-specific surgery between rural and urban residents.

Association of pediatric firearm injury with neighborhood social deprivation in Philadelphia.

Background: Firearm-related injury is the leading cause of death among children and adolescents. There is a need to clarify the association of neighborhood environment with gun violence affecting children. We evaluated the relative contribution of specific social determinants to observed rates of firearm-related injury in children of different ages.

Nearly 20 Years Since the Federal Ban: Can State-Level Assault Weapon Prohibitions Fill the Void? Comparative Analysis of Case Fatality and Assault Weapon Recovery in States With and Without an Assault Weapon Ban.

Introduction: Few states established assault weapon bans (AWBs) after the federal AWB expired. The effectiveness of state AWBs as well as neighboring state legislation, in reducing the local prevalence of assault weapons (AWs) or in reducing overall shooting lethality is unknown.

Methods: We queried the Gun Violence Archive (2014-2021) to identify US firearm injuries and fatalities.

The Carceral State, Social Disorganization, and Firearm Homicides in Chicago.

Importance: Black and other racially minoritized groups are overrepresented among those who experience firearm homicide. There has been a stark increase in incarcerated populations in the US since the 1980s, largely due to differential drug sentencing, of which racially minoritized individuals are also overrepresented; social disorganization theory postulates that community and family instability resulting from incarceration can further worsen crime.

Objective: To understand the association of race-specific incarceration with race-specific firearm violence rates in Chicago, Illinois, through the lens of social vulnerability and family instability.

Trends in youth risk behaviours and firearm injury in the USA over 20 years.

Background: Firearm injuries are the leading cause of death in children and adolescents in the USA. We hypothesised that high rates of risky behaviour in high school students are associated with firearm injury and death in this population.

Methods: We obtained data from the Youth Behaviour Risk Survey of the Centers for Disease Control and Prevention (CDC) and combined it with data from the CDC Web-based Injury Statistics Query and Reporting System, CDC Wide-ranging Online Data for Epidemiologic Research and American Community Survey, 2001-2020.

Timing of venous thromboembolism prophylaxis initiation and complications in polytrauma patients with high-risk bleeding orthopedic interventions: A nationwide analysis.

Introduction: There are no clear recommendations for the perioperative timing and initiation of venous thromboembolism pharmacologic prophylaxis (VTEp) among polytrauma patients undergoing high-risk bleeding orthopedic operative intervention, leading to variations in VTEp administration. Our study examined the association between the timing of VTEp and VTE complications in polytrauma patients undergoing high-risk operative orthopedic interventions nationwide.

Methods: We performed a retrospective cohort study of trauma patients 18 years or older who underwent high-risk bleeding operative orthopedic interventions for pelvic, hip, and femur fractures within 24 hours of admission at American College of Surgeons-verified trauma centers using the 2019-2020 American College of Surgeons Trauma Quality Improvement Program databank.

Bullet holes: A novel model to identify the most impactful gaps in the firearm homicide prevention laws of each state.

Background: Firearm homicides (FH) are a major cause of mortality in the United States. Firearm law implementation is variable across states, and legislative gaps may represent opportunities for FH prevention. For each state, we sought to identify which firearm law category would have been most effective if implemented and how effective it would have been.

Management of penetrating cardiac injury and tricuspid regurgitation with extracorporeal-membrane oxygenation (ECMO): a case report.

Background: Gunshot wounds (GSW) to the heart are lethal, and most patients die before they arrive to the hospital. Survival decreases with number of cardiac chambers involved. We report a case of a 17-year-old male who survived a GSW injury involving two cardiac chambers with acute severe tricuspid regurgitation (TR) who subsequently developed cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO) support.

Timing to First Whole Blood Transfusion and Survival Following Severe Hemorrhage in Trauma Patients.

Importance: Civilian trauma centers have revived interest in whole-blood (WB) resuscitation for patients with life-threatening bleeding. However, there remains insufficient evidence that the timing of WB transfusion when given as an adjunct to a massive transfusion protocol (MTP) is associated with a difference in patient survival outcome.

Objective: To evaluate whether earlier timing of first WB transfusion is associated with improved survival at 24 hours and 30 days for adult trauma patients presenting with severe hemorrhage.

Re-thinking the value of cross-sectional torso imaging for ground-level fall patients with altered mental status: Outcomes from a level 1 trauma center.

Introduction: Patients with altered mental status (AMS) are often excluded from studies evaluating the utility of computed tomography of the torso (CTT) after ground level falls (GLF). It is not known whether CTT identifies otherwise undetectable injuries in patients with AMS after GLF. We sought to describe the value of performing CTT in patients with AMS after GLF, and hypothesized that CTT would not identify new, clinically significant injuries in patients with a normal torso physical exam (PE) and normal chest and pelvic radiographs (CXR/PXR).

Death by the minute: Inequities in trauma care for victims of firearm violence.

Background: Gunshot wounds (GSWs) remain a significant source of mortality in the United States. Timely delivery of trauma care is known to be critical for survival. We sought to understand the relationship of predicted transport time and death after GSW.

Geospatial Analysis of Social Vulnerability, Race, and Firearm Violence in Chicago.

Introduction: Urban firearm violence (UFV) is associated with inequities rooted in structural racism and socioeconomic disparities. Social vulnerability index (SVI) is a composite measure that encompasses both. We sought to understand the relationship between SVI and the incidence of UFV in Chicago using geospatial analysis for the first time.

Gun Laws, Stay-at-Home Orders, and Poverty: Surges in Pandemic Firearm Violence in Large US Cities.

Introduction: The COVID-19 pandemic heralded a surge in firearm homicides (FH) in many, but not all, urban centers. We aimed to determine the relationship of firearm restrictive legislation, stay-at-home orders (SaHOs), and FH during the height of the COVID-19 pandemic in US cities.

Methods: Demographics and socioeconomic data were captured from the 2020 US Census for large (population ≥250,000) cities.

Secondary Traumatic Stress Disorder in the Surgical Profession.

Introduction: The psychological impact of treating individuals who have undergone severely traumatic experiences is known as secondary traumatic stress (STS). It has been well characterized by mental health therapists and social workers. Analysis of STS in surgeons and medical students is limited to merely a handful of studies, with only 1 paper describing STS in trauma surgeons and two describing STS in medical students.

A tale of two cities: Policing and firearm homicides in Boston and Philadelphia.

Background: Recent political movements have raised questions about the effectiveness of police funding, but the impact of law enforcement budgets on firearm violence is unknown. We hypothesized that department funding and measures of police activity would be associated with decreased shootings and firearm homicides (FHs) in two major cities with different police funding patterns.

Methods: We collected data from the following sources: district attorney's offices, police departments, Federal Bureau of Investigation Uniform Crime Reporting program, the Centers for Disease Control, the Annual Survey of Public Employment and Payroll, and the American Community Survey.

Outcomes among trauma patients with duodenal leak following primary versus complex repair of duodenal injuries: An Eastern Association for the Surgery of Trauma multicenter trial.

Background: Duodenal leak is a feared complication of repair, and innovative complex repairs with adjunctive measures (CRAM) were developed to decrease both leak occurrence and severity when leaks occur. Data on the association of CRAM and duodenal leak are sparse, and its impact on duodenal leak outcomes is nonexistent. We hypothesized that primary repair alone (PRA) would be associated with decreased duodenal leak rates; however, CRAM would be associated with improved recovery and outcomes when leaks do occur.

History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence.

Background: Violence-related reinjury impacts both patients and health care systems. Mental illness (MI) is prevalent among violently injured individuals. The relationship between preexisting MI and violent reinjury among women has not been fully characterized.

Funding the war in America: A look in the mirror.

Background: Health care political action committees (HPACs) historically contribute more to candidates opposing firearm restrictions (FRs), clashing with their affiliated medical societies. These societies have increasingly emphasized the prevention of firearm violence and it is not known if recent contributions by their HPACs have aligned with their stated goals. We hypothesized that such HPACs still contribute similar amounts toward legislators up for reelection opposing FR.

Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers.

Importance: Whole-blood (WB) resuscitation has gained renewed interest among civilian trauma centers. However, there remains insufficient evidence that WB as an adjunct to component therapy-based massive transfusion protocol (WB-MTP) is associated with a survival advantage over MTP alone in adult civilian trauma patients presenting with severe hemorrhage.

Objective: To assess whether WB-MTP compared with MTP alone is associated with improved survival at 24 hours and 30 days among adult trauma patients presenting with severe hemorrhage.