One-Fifth of Gunshot Wounds Not Transferred to Appropriate Trauma Care in Chicago: Study

The findings of a new study suggest that about one out of every five individuals who suffer a serious gunshot wound are not taken to a level one trauma center in the Chicago area, which is not the appropriate standard of care recommended in such emergencies.

Researchers indicate that many patients who needed care from a specialized trauma center after suffering a gunshot wound, were instead taken to community hospitals in Chicago not trained to treat trauma wounds. This places patients at risk of suffering serious side effects or even death, researchers from the University of Illinois School of Public Health warn.

The findings were published online January 18 in the journal JAMA Surgery, involving a retrospective analysis focused on firearm-related injuries among residents of Cook County, Illinois, from January 1, 2009, to December 31, 2013. Outpatient and inpatient hospital databases were used and participants who had firearm-related cause of injury codes were included.

Nearly 10,000 patients were included, 8,955 or 90 percent, were male. Seventy-five percent were African-American and half were between the ages of 15 and 24.

About 2,800 of the 9,986 patients, or 28 percent, were taken to level 1 trauma facilities during that timeframe. Patients were initially treated at facilities that were not designated or equipped to treat those types of injuries.

Level 1 trauma centers are facilities that are capable of providing the level of care needed for severe injuries. Doctors and nurses are specially trained to treat those types of injures and the facilities.

Researchers also determined that 4,934 of the patients had injuries severe enough that they should have been taken to a level 1 trauma center.

About 18 percent of those patients were initially triaged at a facility not designated to treat those types of injuries. Only 10 percent were properly transferred to a designated level 1 trauma center. Cook County, the greater Chicago area, has 19 designated trauma centers.

“Better regional coordination among hospitals and frequent trauma care system assessments are needed to improve prehospital triage of firearm-related injuries,” the researchers wrote.

Other studies show patients treated in special trauma centers have lower in-hospital mortality rates. Authors of this study noted that despite so many patients being treated at undesignated facilities, the death rate did not increase.

National anatomic triage criteria calls for specific transport rules for patients injured by gunshots. Patients with wounds closer to the elbows and knees should be treated in specialized trauma units, even if it means bypassing a nearby community hospital. However, researchers found that often wasn’t the case.

Patients were often taken to community hospitals instead, for a variety of reasons, including a lack of trauma centers near the site of the injury, errors occurring before reaching the hospital, patients being self-transported to incorrect facilities, and emergency first responders diverting patients to facilities not designated as a trauma center.

Each year 110,000 people are injured by firearms in the U.S. More than 30,000 die from their injures.