Introduction: Gunshot wounds to the head (GSWH) are associated with significant morbidity and mortality. The epidemiology of GSWH in urban civilian populations in the U.S. has not been well-documented.
Methods: We retrospectively analyzed all GSWH patients presenting to Ryder Trauma Center and the Miami-Dade Medical Examiner (ME) from 2013-2015, with longitudinal trauma center analysis starting in 2008. We analyzed patient-specific variables, demographics, and temporal/spatial trends.
Results: 402 patients (297 ME, 105 Ryder) with GSWH from 2013-2015 yielded an annual prevalence of 7.4 cases/100,000 population. Patients were predominantly male (86.3%) Caucasian (50.7%), suicide victims (47.8%), with mean age of 42 years. While the overall case fatality rate was 89%, Ryder mortality was 58%, and 42% for those surviving to obtain CT. Ryder patients were commonly assault victims (69%), with more suicides at the ME (60%; p<0.0001). African-Americans (64%) more commonly presented to Ryder and Caucasians (58%) to the ME (p<0.0001). Patients were significantly younger at Ryder vs. ME (mean 31 vs. 46 years, p<0.0001). Among the Ryder cohort, the number of GSWH occurring in a given zip code (p=.0306, r2=.4621) and victims’ zip code of residence (p=.0014, r2=.7395) were significantly correlated with percent of population living below the poverty line. Miami-Dade violent crime experienced an overall decrease from 2008-2013 with an increase in 2014; temporal Ryder analysis of GSWH incidence mirrored this trend.
Conclusions: This is the first study linking GSWH and SES, and the first to provide the complete patient spectrum by combining ME and hospital data. Our longitudinal analyses of GSWH closely mirrored the MDC incidence of firearm murders. Ryder is more likely to receive cases of young African American males involved in assaults, significantly correlated with low SES regions, while attempted suicide with GSWH more frequently presents to the ME. Identifying the GSWH “hot spots” may allow for targeted gun violence interventions.
Patient Care: Our research fills a gap in existing literature as the first study to link GSWH and SES, as well as combine hospital and medical examiner data to expose a more complete epidemiological purview of gun violence. We aim to provide the foundation for primary prevention programs, such as the Violence Interrupter Model, to be applied in Miami-Dade County. We also aim to demonstrate the window of opportunity for neurosurgical intervention, as well as predictors of outcome to enhance survival and quality of life.
Learning Objectives: 1. Urban trauma centers may be more likely to receive cases of younger African American males from low SES regions involved in assaults, while corresponding Medical Examiner cases are more likely to be older Caucasian male victims of suicide.
2. While the violent crime rate in Miami has decreased, the corresponding use of firearms and resulting GSWH has recently increased.
3. Despite the high initial mortality of GSWH, there remains a window of opportunity for neurosurgical intervention and patient survival.