There is a National Trauma Data Base and the Centers for Disease Control, both of which maintain data on the outcome of victims of all types of trauma, penetrating and blunt, including, of course, gunshot wounds. This data is available to researchers for meta-analysis. This data base extends back many decades, but not hundreds of years. Of course, mortality rates were much higher back in the days before general anesthesia, modern surgical care, antibiotics, aseptic technique, and effective emergency medical treatment and transport. And yes, this data is limited to the US.I do not see any reason to give credence to the idea that survival rates from firearm injuries are skewed by hospitals keeping two sets of books on firearm injuries based on whether or not the patient arrives dead or dies onsite.
But I'm open to the possibility that I'm wrong. Is there actually any credible evidence that hospitals actually do keep their statistics in that fashion?If you throw a pole with two flat ends into the air, there are only two options for how it will end up. It can end up lying on its side, or it could land balanced on one of the two ends. It lies flat or stands up--only two options. But one of those options is TREMENDOUSLY more likely than the other. The idea that the odds of an outcome are 50/50 because there are only two options is not at all based on fact.
Some medical centers with large trauma centers will also publish results of their collective experience over a number of years, and in some larger urban areas these studies might include several hundred cases.
Case fatality rates are given for various types of trauma. Of course, the case fatality rates include those patients who arrive DOA. Gunshot wound victims who have no signs of life at the scene or in transport are not just dropped off in dumpsters on the way to the hospital. Nor do they go directly to morgues or funeral homes. They wind up being declared in the Emergency Department. Even then, they are assigned a patient identification number and bracelet before going to the morgue, and Coroner. Someone who is found stone-cold dead of a gunshot wound out on the streets somewhere nearly always becomes a Coroner's case to establish the mechanism of death, etc, so they are included as well.
There are a number of gunshot wounds that do not appear in the registries because they wind up getting self-treated for various reasons. If these could be accounted for they would tend to skew the case fatality rate for gunshot wounds further downwards.
When looking at studies of the fatality rates for gunshot wounds, one has to take into account that some will include the outcome of all gunshot wounds. The great majority of these will be handgun wounds, but there will usually be a percentage of long gun wounds as well, which skews the case fatality rate higher. Some studies also include the outcome of intentionally self-inflicted gunshot wounds, i.e, suicides and suicide attempts. These self-inflicted gunshot wounds have a much higher fatality rate than those sustained as a result of assault or accident.
The vast majority of handgun gunshot wound victims who arrive at the hospital alive survive. I saw a moderate number of handgun wounds over the course of my career. I only saw one that arrived at the hospital with signs of life die. That was an individual who had a perforating brain injury from a self-inflicted .22 caliber handgun wound. He was later determined to be brain dead and probably was on arrival, but still had cardiopulmonary function on arrival.
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