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Unrelenting violence: An analysis of 6,322 gunshot wound patients at a Level I trauma center

Livingston, David H. MD; Lavery, Robert F. MA; Lopreiato, Maeve C. MPH; Lavery, David F. JD; Passannante, Marian R. PhD

Journal of Trauma and Acute Care Surgery: January 2014 - Volume 76 - Issue 1 - p 2–11
doi: 10.1097/TA.0b013e3182ab19e7
AAST 2013 Plenary Papers
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BACKGROUND Perceptions of violence are too often driven by individual sensational events, yet “routine” gunshot wound (GSW) injuries are largely underreported. Previous studies have mostly focused on fatal GSW. To illuminate this public health problem, we studied the health care burden of interpersonal GSW at a Level I trauma center.

METHODS Retrospective analysis of GSW injuries (excluding self and law enforcement) treated from January 2000 to December 2011. Data collected included body regions injured, number of wounds per patient, and mortality. Costs were calculated using Medicare cost-charge modifiers. Geographic information system mapping of the incident location and home addresses were determined to identify hot spot locations and the characterization of those neighborhoods.

RESULTS A total of 6,322 patients were treated. There were significant increases in patients with three or more wounds (13–22%, p < 0.0001) and three or more body regions injured (6–16%, p < 0.0001). Mortality increased from 9% to 14% (p < 0.0001). Nineteen percent of the patients were never seen by the trauma service. Geographic information system mapping revealed significant clustering of GSWs. Five cities accounted for 85% of the GSWs, with rates per 100,000 ranging from 19 to 108 compared with a national rate of 20. Only 19% of the census tracts had no GSWs during the period, and 39% of the census tracts had at least one GSW per year for 12 years. Fifteen percent of the census tracts accounted for 50% of the GSWs. Seventy percent of the patients were shot in their home city, 25% within 168 m, and 55% within 1,600 m of their home. Total inpatient cost was $115 million, with cost per patient increasing more than three times over the course of the study; 75% were unreimbursed.

CONCLUSION GSW violence remains a significant public health problem, with escalating mortality and health costs. Relying on trauma registry data seriously underestimates GSW numbers. In contrast to episodic mass casualties, routine GSW violence is geographically restricted and not random. To combat this problem, policy makers must understand that the determinants of firearm violence reside at the community level.

LEVEL OF EVIDENCE Epidemiologic study, level II.

Supplemental digital content is available in the article.

From the New Jersey Trauma Center and Departments of Surgery Division of Trauma and Critical Care (D.H.L., R.F.L., M.C.L., D.F.L.) and Preventive Medicine and Community Health (M.R.P.), Rutgers-New Jersey Medical School, Newark, New Jersey.

Submitted: September 15, 2013, Revised: October 7, 2013, Accepted: October 9, 2013.

This study was presented at the 72nd annual meeting of the American Association for the Surgery of Trauma, September 18–21, 2013, in San Francisco, California.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: David H. Livingston, MD, University Hospital, M234 150 Bergen Street Newark, New Jersey 07103; email:

© 2014 Lippincott Williams & Wilkins, Inc.