The firearm mortality rate in West Virginia (WV) increased over the past four years and is currently 50% higher than the national rate. These alarming statistics, combined with the urban-to-rural shift in firearm injuries, prompted this 10-year epidemiologic overview. To the best of the authors’ knowledge, the current study stands alone as the only report of its kind on firearm injuries in the rural setting of southern WV. Firearm injuries were common in White males within the age range of 20–49 years. Assault, which is typically identified as an urban problem, was found to be the most common injury in the study population. In our data series, injury severity score was the strongest predictor of mortality, followed by self-inflicted cause of injury and trauma to the neck/head region.
Introduction West Virginia (WV) had the ninth highest rate of firearm mortality of all states in the United States according to the CDC in 2018. Gun violence in WV has been a steady problem over the last decade. The rural population is more vulnerable to unintentional firearm injuries and suicides. Previously published literature from urban settings has demonstrated a link between firearm injuries and modifiable situational variables such as crime, unemployment, low income, and low education. There are very few studies that have utilized geospatial analytic techniques as a tool for injury mapping, surveillance, and primary prevention in rural and frontier zones of the United States. Methods We performed a 10-year retrospective single-institution review of firearm injuries at a rural WV level 1 trauma center between January 2010 and December 2019. The AIS World Geocoding Service was then used to identify specific areas of emerging firearm-related injuries within the service area. Results Specific hot spots of emerging firearm injury were identified in both intentional and unintentional populations. These were located in geographically distinct areas of the WV unincorporated rural and frontier population. These rural WV hotspots were associated with the modifiable variables of crime, unemployment, lower income, and lower education level. Conclusions Emerging hot spots of firearm injury in rural and frontier locations were associated with modifiable social determinants. These areas represent an opportunity for targeted injury prevention efforts addressing these disparities. Further prospective study of these findings is warranted.
Background: To monitor the time elapsed since patient arrival in the emergency department, Trauma Services at the study institution installed a large digital stopwatch timer placed at the head of each trauma bay on June 5, 2017. This quality improvement endeavor became an essential component of performance evaluation. Objective: The purpose of the study is to measure the impact of trauma bay time clocks on emergency department length of stay. Methods: This is a retrospective before-and-after study of trauma activation patients between June 2015 and May 2019. Two 24-month intervals were compared before and after installation of time clocks. Results: In full activation patients, outcomes of emergency department length of stay ≤50 min (39.2% vs. 61.7%, p < .001) and time to transfer to intensive care unit ≤56 min (45.3% vs. 55.1%, p = .002) were significantly favorable in the postimplementation phase. Time to first computed tomography scan and time to first operating room from arrival to the emergency department were comparable between both phases. For limited activation patients, positive changes were noted in emergency department length of stay ≤87 min (41.4% vs. 60.6%, p < .001), time to first computed tomography scan ≤32 min (47.7% vs. 53.0%, p = .015), and time to transfer to intensive care unit ≤74 min (50.2% vs. 57.2%, p = .008). Time to first operating room remained comparable between two periods. Conclusions: The study institution improved their provision of immediate care by using time clocks in trauma bays. This is a simple and cost-effective intervention and may benefit similar institutions.
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