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Study Design

This was a retrospective review of eight years of previously compiled data from the trauma registry of a large, urban level-1 trauma center. The study period was January 1, 1992 through December 31, 1999. The study was approved by the hospital’s Institutional Review Board (IRB).

Study Setting and Population

The data compiled were from the District of Columbia General Hospital (DC General), which was the busiest level-1 trauma center in Washington, DC during the study period, seeing an average of 2,075 major trauma cases annually.
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The hospital was located one mile southeast of the U.S. Capitol and its catchment area was primarily the southeast quadrant of the city, an historical¬≠ly inner city, low-income, high-crime area. Occasional major trauma cases were drawn from adjacent Maryland and other parts of the District of Columbia. There were six level-1 trauma centers in Washington, DC during the study period, including one at Children’s Hospital. Pediatric trauma cases were initially treated and evaluated at the closest level-1 trauma center. Children who were initially treated at a general (all ages) level-1 trauma center were then transferred to the pediatric trauma center on an as-needed basis.

All 519,218 patients presenting to the emergency department (ED) at DC General Hospital during the study period were potential participants in this study (see Case Selection below).

Data Source

Data reviewed were from the American College of Surgeons Committee on Trauma (ACSCOT) standardized trauma registry. An eight-year period, from January 1, 1992 through December 31, 1999, was reviewed. ED census data were drawn from the trauma registry and the hospital census database.

Definition and Case Selection

Cases were designated as “major trauma” by meeting pre-established criteria (see Table 1). The mechanism of injury of each major trauma case was recorded after ED discharge. The categories used to track mechanism of injury were: gunshot wounds (GSW), stab wounds (SW), motor vehicle collisions (MVC), assaults (intentional injury, nonpenetrating), falls, pedestrian injuries, and “other.”
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Table 1. Criteria for Designation as Major Trauma
Acute trauma patient with one or more of the following:
1. Penetrating wounds to the head, neck, chest, abdomen, pelvis, or groin ;
2. Age 5 or less;
3. Fractures of two or more long bones;
4. Any partially or completely severed limb
5. Trauma Score less than 13 (Champion, 1989); or
6. Neurological presentation, including prolonged loss of consciousness, GCS less than 14, or focal neurological sign.

Data Analysis

We reviewed data from all trauma victims who suffered a penetrating injury, were the victim of either a gunshot wound or stabbing, met criteria to qualify as a major trauma victim, and were 18 years of age or under on arrival at the hospital. Analysis of Variance (ANOVA) and the Kruskal-Wallis tests were performed in order to determine the age at which the incidence of major gunshot wounds and stab wounds first exhibit a statistically significant increase.
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Tags: adolescents, epidemiology, firearms, injury surveillance, penetrating, penetrating injury, wounds

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