Increasing Injury Intensity among 6,500 Violent Deaths in the State of Maryland

BACKGROUND

Anecdotal evidence strongly suggests there has been a rise in violent crimes. This study sought to examine trends in injury characteristics of homicide victims in Maryland. We hypothesized that there would be an increase in the severity of wound characteristics.

STUDY DESIGN

The Office of the Chief Medical Examiner is a statewide agency designated by law to investigate all homicides, suicides, or unusual or suspicious circumstances. Using individual autopsy reports, we collected data among all homicides from 2005 to 2017, categorizing them into 3 time periods: 2005 to 2008 (early), 2009 to 2013 (mid), and 2014 to 2017 (late). Primary outcomes included the number of gunshots, stabs, and fractures from assaults. High-violence intensity outcomes included victims having 10 or more gunshots, 5 or more stabs, or 5 or more fractures from assaults.

RESULTS

Of 6,500 homicides (annual range 403 to 589), the majority were from firearms (75%), followed by stabbings (14%) and blunt assaults (10%). Most homicide victims died in the hospital (60%). The average number of gunshots per victim was 3.9 (range 1 to 54), stabs per victim was 9.4 (range 1 to 563), and fractures from assaults per victim was 3.7 (range 0 to 31). The proportion of firearm victims with at least 10 gunshots nearly doubled from 5.7% in the early period to 10% (p < 0.01) in the late period. Similarly, the proportion with 5 or more stabbings increased from 39% to 50% (p = 0.02) and assault homicides with 5 or more fractures increased from 24% to 38% (p < 0.01).

CONCLUSIONS

In Maryland, the intensity of violence increased across all major mechanisms of homicide. Further follow-up studies are needed to elucidate the root causes underlying this escalating trend.

Urology Consult Association with Renal Trauma Imaging and Intervention

OBJECTIVE

To describe rates of urology consultation following renal trauma and assess subsequent impact on imaging and intervention. Renal trauma may be initially managed by either trauma or urologic surgeons alone or collaboratively. Differences in management between the specialties are not well studied.

METHODS

We conducted an IRB-approved retrospective review of patients at a Level I trauma center sustaining renal trauma between 2014 and 2021. Demographic, injury, radiologic, and intervention variables were extracted. Frequencies and medians were compared using chi-squared and Fischer's exact tests or Mann-Whitney U tests, respectively. Analyses were performed using STATA with p<0.05 considered significant.

RESULTS

From 2014 to 2021, 118 patients with median age 29 (IQR 22-41) sustained renal trauma. Urology was consulted in 18 (15.3%) cases. Demographic and injury characteristics were similar between the two groups. AAST renal injury grade was transcribed in the initial radiologic reports for 49 (41.5%) of patients. Those in the urology consult group were more likely to receive delayed contrast imaging during their admission (50.0% vs. 17.0%, p<0.01). Among those with high-grade injuries, those with urology consult were less likely to undergo nephrectomy (36.4% vs. 78.8%, p=0.02).

CONCLUSIONS

We observed differences in imaging patterns between renal trauma patients who are managed primarily by trauma surgery versus urology. However, the impact of these differences in imaging remains to be elucidated. Among patients with high-grade renal trauma, urology consult was associated with decreased rate of nephrectomy, emphasizing the feasibility of renal salvage in a multidisciplinary trauma setting.

An uncommon unintentionally retained foreign object (URFO): The retained surgical specimen

Unintentionally Retained Foreign Objects (URFO) are an uncommon, but significant type of patient harm. Retained surgical specimens are new entities that accompanied the surge of minimally invasive surgery (MIS). Despite being rare sentinel events, they are associated with increased morbidity, healthcare cost, and liability. We present a case of a retained surgical specimen, identified after surgical closure but before patient extubation, thanks to routine utilization of end-of-procedure checklists.

[New techniques in endodontics. An overview]

Recently new instruments and methods have been developed in endodontics to clean, prepare and fill the root canal. In this article the new preparation-methods en techniques with the accompanying instruments will be discussed.