More Shooting Victims Are Dying Before They Reach the Hospital. Researchers Think an Increasing ‘Intensity’ of Gun Violence May Be to Blame.

Gunshot victims are four times more likely to die before reaching a hospital than they were a decade ago, according to a new nationwide analysis from Johns Hopkins. The findings suggest that gunshot injuries may be growing more lethal.

The study’s lead author, Dr. Joseph Sakran, said he was partly inspired by a Baltimore Sun investigation called “Shoot to Kill.” That series, by journalist Justin George, revealed that the odds of survival for gunshot victims “worsened in at least 10 of the nation’s largest cities,” and that people who got shot were more likely to die compared to gunshot victims just 10 or 15 years earlier.

Sakran, who is the director of emergency general surgery at The Johns Hopkins Hospital, sought to examine the issue from a national and more scientific perspective. Gun violence isn’t just a professional concern for Sakran, it’s a deeply personal one: he was shot in the throat at a high school football game in 1994, when he was just 17 years old.

“We wanted to look at pre-hospital mortality — death that happens before patients are taken care of in the hospital — and in-hospital mortality, death after patients arrive to the hospital,” Sakran said.

To do that, he partnered with other researchers from Johns Hopkins, the University of Toronto, and the University of Arizona to analyze statistics from the National Trauma Data Bank, the largest information repository of its kind. They focused on patients ages 15 or older who had experienced gunshot or stab wounds between 2007 and 2014. Among the 36,297 people declared dead-on-arrival at the hospital, the vast majority — 88 percent — had been shot. The remaining 12 percent died of stab wounds.

The team found that over the eight-year span, the rate of deaths from gunshots and stabbings stayed about the same. But when they looked more closely at where patients died, they discovered a striking trend: The rate of pre-hospital death rose significantly, while the rate of in-hospital death decreased. Specifically, the odds of a gunshot victim dying before reaching a trauma center increased fourfold, while the odds of a stabbing victim dying increased by eight.

The authors noted that the results were “very concerning.”

“We know that, over time, trauma care has improved,” Sakran said, referring to standardized methods in hemorrhage control, blood transfusions, and other medical protocols. But his team’s findings show that a significant number of patients are not surviving long enough to be treated in the emergency room. “Their injuries are so severe that by the time they come to us, it’s very difficult to save their life.”

The authors are not sure how to explain the uptick in pre-hospital mortality, but they offer a few ideas. One is that the “intensity” of gunshot injuries has increased: for instance, people are being shot by more rounds, or at closer proximity. They also posit that some victims may live too far from a trauma center, citing a review from 2005 that found more than 30 percent of Americans did not have access to a Level I trauma center within 45 minutes.

The study appeared earlier this month in the Journal of Trauma and Acute Care Surgery. Next, Sakran hopes to examine statewide coroners’ reports for gunshot survivors to see how patterns of injury have changed over time, in terms of size, severity, and location of bullet wounds.

“This is the beginning of us trying to explore what’s happening from a violence perspective in this country,” he said.