Patients with gunshot wounds to the torso differ in risk of mortality depending on treating hospital.

Areg Grigorian, Jeffry Nahmias, Theresa Chin, Angela Allen, Eric Kuncir, Matthew Dolich, Victor Joe, Michael Lekawa

Open access · bronzeAbstract read

In one paragraph

Article in Updates in surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

5.4field-weighted citation impact, top 4% of its field

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 23 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Areg GrigorianDivision of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, USA, 92868-3298. agrigori@uci.edu.ORCID http://orcid.org/0000-0002-0998-796X

Jeffry NahmiasDivision of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, USA, 92868-3298.

Theresa ChinDivision of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, USA, 92868-3298.

Angela AllenDivision of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, USA, 92868-3298.

Eric KuncirDivision of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, USA, 92868-3298.

Matthew DolichDivision of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, USA, 92868-3298.

Victor JoeDivision of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, USA, 92868-3298.

Michael LekawaDivision of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, USA, 92868-3298.

University of California, Irvine Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Previous studies have had conflicting results when comparing risk of mortality in patients with gunshot wounds (GSWs) treated at Level-I and II trauma centers. However, the populations studied were restricted geographically. We hypothesized that patients presenting after a GSW to the torso at Level-I centers would have a shorter time to surgical intervention (exploratory laparotomy or thoracotomy) and a lower risk of mortality, compared to Level-IIs in a national database. The Trauma Quality Improvement Program (2010-2016) was queried for patients presenting to Level-I or II trauma center after a GSW to the torso. A multivariable logistic regression analysis was performed. From 17,965 patients with GSWs, 13,812 (76.8%) were treated at Level-Is and 4153 (23.2%) at Level-IIs. There was no difference in the injury severity score (ISS) (p = 0.55). The Level-I cohort had a higher rate of laparotomy (38.9% vs. 36.5%, p < 0.001) with a shorter median time to laparotomy (49 vs. 55 min, p < 0.001) but no difference in rate (p = 0.14) and time to thoracotomy (p = 0.62). After adjusting for covariates, only patients undergoing thoracotomy (OR = 0.66, CI = 0.47-0.95, p = 0.02) or those undergoing non-operative management (NOM) (OR = 0.85, CI = 0.74-0.98, p = 0.03) at a Level-I center had lower risk for death, compared to Level-II. Patients with torso GSWs managed with thoracotomy or NOM at a Level-I center have a lower risk of mortality, compared to a Level-II. Future prospective studies examining variations in practice, resources available and surgeon experience to account for these differences are warranted.

Indexed as

AdultFemaleHumansInjury Severity ScoreLaparotomyLogistic ModelsMaleRetrospective StudiesRisk FactorsThoracic InjuriesThoracotomyTime FactorsTrauma CentersUnited StatesWounds, GunshotYoung AdultGunshotLevel-ITraumaTrauma center

Identifiers

PMID31011998

DOI10.1007/s13304-019-00657-w

OpenAlexW2940588198

What OpenQuestion holds

Textmetadata

Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.