title: The effect of trauma care on the temporal distribution of homicide mortality in Jefferson County, Alabama.
abstract: The distribution of time from acute traumatic injury to death has three peaks: immediate (less than or equal to one hour), early (6 to 24 hours), and late (days to weeks). It has been suggested that coordinated trauma care dampens the late peak; however, this research may be more reflective of unintentional than intentional deaths. This study examines whether a coordinated trauma system (TS) alters the temporal distribution for assault-related deaths. Data were obtained from homicides examined by the Jefferson County Coroner's/Medical Examiner's Office from 1987 to 2008. Homicides were categorized-based on year of death-as occurring in the presence of no TS, during TS implementation, in the early years of the TS, or in a mature TS. The temporal distribution of homicide mortality was compared among TS categories using a χ(2) test. A Cox Markov multistate model was used to estimate proportional changes in the temporal distribution of death adjusted for assault mechanism. With a TS, after adjusting for assault mechanism, a lower proportion of homicide victims survived through the first hour (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.54 to 1.03) and from one to six hours (HR, 0.68; 95% CI, 0.49 to 0.96). Additionally, the presence of a TS was associated with a proportional decrease in deaths after 24 hours (P = 0.0005). These results suggest that a trauma system is effective in preventing late homicide deaths; however, other means of preventing death (such as violence prevention programs) are needed to decrease the burden of immediate homicide-related deaths.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Russell L
authors.initials: RL
authors.lastname: Griffin
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Davis
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.forename: Paul A
authors.initials: PA
authors.lastname: Maclennan
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
mesh_terms: D000328:Adult; D000407:Alabama / Q000453:epidemiology; D002423:Cause of Death; D016208:Databases, Factual; D042241:Early Diagnosis; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*