Gunshot wounds sustained during legal intervention versus those inflicted by civilians: A comparative analysis

Abstract

BACKGROUND:Existing data demonstrate that injuries sustained during legal intervention (LI) differ from those incurred during civilian interpersonal violence (CIV), but gunshot wounds (GSWs) have not yet been specifically examined. This study was undertaken to provide an in-depth analysis of patients shot during LI versus CIV. METHODS:Patients injured by GSW and captured by the National Trauma Data Bank (2007-2017) were included. Exclusions were transfer from outside hospital or self-inflicted, accidental, or undetermined injury intent GSWs. Study groups were defined by injury circumstances: GSWs sustained during LI versus CIV. Univariable analysis compared demographics, clinical/injury data, and outcomes. RESULTS:In total, 248,726 patients met inclusion/exclusion criteria: 98% (n = 243,150) CIV versus 2% (n = 5,576) LI. Race varied significantly between study groups (p < 0.001). White patients were the most commonly injured race after LI (n = 2,176, 39%). Black patients were the most commonly injured race after CIV (n = 139,067, 57%). Psychiatric disease (9% vs. 2%, p < 0.001) was more common among LI GSWs. The LI patients were more frequently tachycardic (18% vs. 13%, p < 0.001), hypotensive (26% vs. 14%, p < 0.001), and comatose (34% vs. 15%, p < 0.001). The LI patients had higher Injury Severity Scores (13 vs. 9, p < 0.001), required emergent surgical intervention (39% vs. 28%, p < 0.001) and intensive care unit admission (47% vs. 32%, p < 0.001) more often, and had longer hospital stay (4 vs. 3 days, p < 0.001). Mortality was higher after LI (27% vs. 14%, p < 0.001). CONCLUSION:Significant racial and injury severity differences exist between patients shot during LI and CIV. White patients were the most commonly injured race after LI, while Black patients were the most commonly injured race during CIV. In addition, Black patients were overrepresented in both groups when compared with their proportion in the US population. LI patients were more significantly injured, as quantified by clinical, injury, and outcomes variables including increased mortality. Further study of patients shot during LI is needed to better understand this increased burden of injury.

Outcomes of Hospitalized Injured Suspects Sustaining Gunshot Wounds From Law Enforcement Action

“…As corroborated by Schellenberg et al, increased resource use may be driven by greater requirement for emergency operations and increased need for ICU admission. 3 Due to the higher odds of cardiac complications and respiratory failure, management of these complications may also be contributors to increased costs. Finally, although need for major operations was similar, ISs were found to have a greater requirement of head and truncal operations.…”

“…2 Additionally, Schellenberg and colleagues found that compared to civilian firearm injuries, those injured during LEI were more likely to have higher ISS, increased need for emergent surgical interventions, and greater mortality. 3 Collectively, these findings highlight the significant morbidity of patients injured after LEI.…”

“…As firearms are implicated in the majority of law enforcement-related deaths, several studies have aimed to better characterize LEI. 2,3 Examination of firearm injuries among suspects, bystanders, and law enforcement found injured suspects (ISs) to have significantly higher injury severity score (ISS) but similar in-hospital mortality and complication rates compared to law enforcement officers. 2 Additionally, Schellenberg and colleagues found that compared to civilian firearm injuries, those injured during LEI were more likely to have higher ISS, increased need for emergent surgical interventions, and greater mortality.…”

“…Importantly, Schellenberg et al compared outcomes of all patients involved in LEI, including IS, law enforcement officers, and bystanders, to all other patients with gunshot wounds. 3 Therefore, data are deficient regarding comparison of IS specifically. Current literature regarding in-hospital care and associated costs for IS is also lacking.…”