Community characteristics and demographic information as determinants for a hospital-based injury prevention outreach program

Hypothesis: To focus the efforts of a hospital-based injury prevention outreach program, information on patient demographics, community characteristics, and catchment area must be known. Design and Setting: Evaluation of prospectively collected data maintained in the Trauma Registry of a level I university-based trauma center. Patients and Main Outcome Measures: Demographics, mechanism of injury, mortality, and home ZIP codes of patients admitted to the Adult Trauma Service, The Johns Hopkins Medical Institution, Baltimore, Md, were compared for 2 separate calendar years, at 2 years before (1995) and at 2 years after (2000) the implementation of a dedicated trauma program that includes an injury prevention outreach program. Results: The list of common patient ZIP codes varied minimally from 1995 to 2000. The 18 most common ZIP codes represent (1) 80% of patients, (2) total area of 99 square miles (257.4 km(2)) (5.7-mile [9.1-km] radius), and (3) a region with a mean household income that is 67% of the statewide median. An increasingly disproportionate percentage of patients with gunshot wounds (GSWs) were the youngest patients (ages 15-24 years) treated by the Adult Trauma Service. While overall survival of trauma patients improved in 2000, no improvement was seen among patients with GSWs. Over half of the nonsurviving patients (37/65 [57%]) seen in 2000 and more than two thirds of patients with lethal GSWs (25/37 [67.6%]) were declared dead in the emergency department, suggesting nonpreventability from a clinical care standpoint. Conclusions: The catchment area represented by the bulk of patients admitted to a level I urban trauma center is compact and economically disadvantaged. While overall trauma mortality has decreased, GSWs are more lethal and prevalent in teenagers and young men. This identifies violence prevention as an area of emphasis.