The demographics of significant firearm injury in Canadian trauma centres and the associated predictors of inhospital mortality

• Published in: Canadian Journal of Surgery Vol. 51; no. 3; pp. 197 - 203
• Main Authors: Finley, Christian J., MPH, MD, Hemenway, David, PhD, Clifton, Joanne, MSc, Brown, D. Ross, MD, MA, Simons, Richard K., MD, Hameed, S. Morad, MPH, MD
• Format: Journal Article
• Language: French; English
• Published: Canada CMA Impact Inc 01.06.2008; CMA Impact, Inc; Canadian Medical Association
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; British Columbia; Canada; Child; Complications and side effects; Demographics; Female; Firearm accidents & safety; Health care industry; Hospital Mortality; Humans; Injury Severity Score; MacLean–Mueller Prize; Male; Management; Middle Aged; Mortality; Multivariate Analysis; Odds Ratio; Registries; Risk factors; Self-Injurious Behavior - epidemiology; Surgery; Trauma Centers; Wounds and injuries; Wounds, Gunshot - epidemiology; Wounds, Gunshot - mortality; British Columbia; Canada; British Isles, Scotland, Glasgow
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1016/S0008-428X(08)50049-X

Objective Our primary objective was to evaluate demographic and causal factors of inhospital mortality for significant firearm-related injuries (i.e., those with an Injury Severity Score [ISS] > 12) in Canadian trauma centres. Methods We analyzed data submitted to the Canadian Institute for Health Information (CIHI) in the National Trauma Registry for all firearm-injured patients for fiscal years 1999–2003. Univariate and bivariate adjusting for ISS and multivariate logistic regression were performed. Results Men accounted for 94% of the 784 injured. In all patients, the percentages of self-inflicted, intentional, unintentional and unknown injuries were 27.8%, 60.3%, 6.1% and 5.7%, respectively. The inhospital fatality rate was 39.8%, with 83% of fatalities occurring on the first day. Two-thirds of patients were discharged home. Univariate and adjusted analysis found that ISS, first systolic blood pressure (BP), first systolic BP under 100, first Glasgow Coma Scale (GCS) score, age over 45 years, self-inflicted injury, intentional injury and injury at home significantly worsened the odds ratio of death in hospital and that police shooting was relatively beneficial. BP under 100, age over 45 years and a low GCS score had an adjusted odds ratio of death of 4.12, 1.99 and 0.64 per point increase, respectively. The multivariate model showed that ISS, BP under 100, first GCS score, sex and self-inflicted injury were significant in predicting inhospital death. Conclusion A predominance of young men are injured intentionally with handguns in Canada, whereas older patients suffer self-inflicted injuries with long guns. The significant number of firearm deaths, largely in the first day, highlights the importance of preventative strategies and the need for rapid transport of patients to trauma centres for urgent care.