Background: Acts of violence can be considered random when viewed singularly, but are appreciable as patterns and clusters of an epidemic. Violence begets violence: it has been shown that people exposed to violence are more likely to harm themselves, their families, and members of the community. Our previous manuscript on this subject demonstrated distinct clusters of violent trauma, where each subtype appeared to have its own domain. Methods: The location, date, time of day, and mechanism of injury of all non-accidental trauma patients from 1 January 2008 to 31 December 2013 were collected and analyzed. Kernel density analysis was used to identify areas of increased activity and these were compared by year. The areas identified were mapped by their latitude and longitude. The data for the year 2013 were used to determine the potential for the predictive value of the prior 5 years. Results: Definite trends can be observed in the temporal distribution of trauma, with a higher incidence of violent trauma occurring between 6 pm and 6 am during the 6-year period. Seasonal variation of higher amounts of violent trauma is also observed from April through August. Predictive modeling did not yield significant results for the following year or for the following month using Crimestat software. Conclusion: Discernable trends of trauma are able to be demonstrated based upon the identifiable clusters of assault but these clusters do not remain constant from year to year. Predictive modeling can assist with the identification of elevated incidents of activity, however has poor predictive value for the entirety of the year. The use of the Crimestat Time Series Forecasting Module is best served with the early indication of large changes in assault patterns. Further study and improved collaboration with the local police precincts and surrounding trauma centers is required to treat the epidemic of violence.
Introduction: The 'found down' patient presents a unique circumstance for the clinician in that the patients are often unable to provide history of the events preceding their presentation to the emergency department. Studies on this population are limited. Methods: The trauma and emergency department registries from January 2013 through December 2014 at an urban level one trauma center were queried for patients described as 'found down' and related descriptions. Basic demographic data included patient disposition, Glasgow coma score and injury severity score (ISS), patient requiring intubation, imaging performed, and injuries sustained. Patients were stratified into those managed by the trauma service versus the emergency department. Results: A total of 298 patients met criteria to be included in this study, nine of whom died; the average age was 50 years old and 9% of this population was found to have an intracranial hematoma. The subset of patients who had a rapid return to Glasgow coma score 15 had a 6% incidence of having an intracranial hematoma. Four cervical fractures were identified. There was only one intra-abdominal injury. Conclusion: Computerized tomography scans of the brain and cervical spine should be performed for all patients who are found down. Intra-abdominal injuries are exceedingly rare and selective use of computerized tomography should be made. Superficial injury does not indicate more significant injury in this population; however, lack of superficial injury does not preclude more significant injuries.
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