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EDs Aren’t Saving Higher Percentage of Gunshot Victims After All

Data showing significantly improved survival rates for gunshot victims might have been too good to be true, new research suggests.

The study published in the American Journal of Public Health said the supposed advances, credited to better emergency treatment, were called into question by problems with the way data was collected or coded.

“Our analysis shows that neither the estimate of nonfatal shootings nor the fatality rate changed much in the decade after 2003,” said lead author Philip Cook, PhD, ITT/Terry Sanford Professor at the Sanford School of Public Policy of Duke University.

Data from a 10-year period ending in 2013 was obtained from the National Electronic Injury Surveillance System (NEISS)-All Injury Program, which involved about 90 facilities providing emergency care. The study also used an actual count of gun homicides from the Centers for Disease Control.

During the NEISS research period, substitutions occurred in the hospitals included in the study. Researchers determined that some newly included hospitals “implausibly reported” a large increase in the number of gunshot cases. Simultaneously, a substantial increase in correct classification of gun assaults also occurred, the authors pointed out.


“As a result, it created an illusion that there were many more nonfatal gunshot cases than before,” Cook explained.

The article cites previous research showing a dramatic 49% increase in nonfatal assaults between 2003 to 2012 with little change in the gun homicide count. Those past studies suggested that the fatality rate dropped from 25% to 18% during the time period.

Authors of the new study came up with entirely different results. When the data issues were taken into consideration, no increase in nonfatal gun assaults was detected. In fact, the fatality rate was unchanged at 22%, while the adjusted estimate of nonfatal cases was 41,874 in 2003 and 41,996 in 2012. The difference in homicides also was small – ranging from 11,920 in 2003 to 11,622 in 2012.

The report notes that, given the increase in the U.S. population, the population-adjusted rate at which Americans suffered gunshot wounds actually declined 7.9% from 18.54 per 100,000 Americans to 17.07 per 100,000 Americans over the study period, Cook pointed out, although the trend has reversed more recently.

“The idea that there was a sharp reduction in the death rate failed a basic test of plausibility,” suggested co-author Garen Wintemute, a practicing emergency physician, professor of emergency medicine and director of the Violence Prevention Program at University of California Davis. “Absolutely, there have been major improvements in emergency medical care and delivery, but they have taken place over decades. In the short run, they simply could not account for the large change.”

“In addition, reports from individual hospitals have shown fatality rates increasing, not decreasing,” he said. “The on-the-ground experience conflicted with what the administrative data showed.”