Gunshot Wounds Just as Deadly as Always, Despite Data Claims to the Contrary

0623_gunshot_victim_data_study_01 — Gunshot survivor Angel Santiago looks over at fellow victim Patience Carter, as she recounts her story at a news conference at Florida Hospital Orlando on the shooting at the Pulse nightclub in Orlando, Florida, on June 14, 2016. Jim Young/Reuters

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The survival rate of U.S. gunshot victims hasn't necessarily improved remarkably with advances in trauma care, despite findings from recent studies and media reports, according to new research from Duke University and the University of California, Davis. Scholars published new findings this week that challenge the claim that gunshot victims' survival rate has greatly improved.

In recent years, researchers of various studies have credited the increase in survival rate to advances in emergency treatment and medical care of critically injured patients. But on close analysis, the scholars in this new study—which was published Thursday in the American Journal of Public Health— found problems in the way data has been collected and analyzed.

The researchers looked at statistics from 2003 to 2012 from the National Electronic Injury Surveillance System (NEISS)-All Injury Program and NEISS Firearms Injury Surveillance Study. The data comes from a sample of about 90 hospitals with six or more beds that provide 24-hour emergency care. They then deduced it to produce an annual estimate of the number of gun assault injuries.

They found that a gun injury from an assault was just as likely to be fatal in 2012 as it was in 2003, and that more people were not, in fact, surviving gunshot wounds. They identified two main problems: During the 10-year period, some of the hospitals that withdrew from the NEISS survey were replaced by hospitals that "implausibly reported orders of magnitude more gunshot cases," the authors wrote. This led to researchers no longer examining the same data from year to year.

The authors of the new study also found that the hospitals appeared to record the cases more specifically over time, as they noticed an increase in gun assaults being correctly classified.

"As a result, it created an illusion that there were many more nonfatal gunshot cases than before," said Philip Cook, a professor at the Sanford School of Public Policy and lead author of the study.

Previous analyses had interpreted the NEISS data to mean nonfatal assaults had increased 49 percent from 2003 to 2012 while the gun homicide count stayed steady, the authors wrote. This suggested many fewer gunshot victims were dying and led to a presumed drop in the fatality rate from 25 percent to 18 percent.

"Our analysis shows that neither the estimate of nonfatal shootings nor the fatality rate changed much in the decade after 2003," Cook said.

After adjusting for the data reporting problems, the purported increase in nonfatal gun assaults disappeared. The adjusted estimate of nonfatal cases was 41,874 in 2003 and 41,996 in 2012, while homicides numbered 11,920 in 2003 and 11,622 in 2012. The fatality rate held steady at 22 percent.

Mass shootings throughout the United States in recent years have reignited the public health debate about measures to decrease gun violence. But there's not a single system that records the information at the hospitals. Still, shootings are now the third leading cause of death, according to a study published Monday in the journal Pediatrics.

Data from the U.S. Centers for Disease Control and Prevention demonstrate that although gun-related homicide rates were stable between 2002 and 2011, rates of violent gunshot injuries increased. A study published in the January 2014 issue of the Journal of General Internal Medicine found that the seemingly paradoxical trends may reflect the declining lethality of gunshot injuries brought about by surgical advances in the care of the patient with penetrating trauma. Researchers from that study concluded that focusing on gun-related homicide rates as a summary statistic of gun violence, rather than on the total violent gunshot injuries, can misrepresent the rising epidemic of gun violence in the U.S.

In 2014, a study published in the Journal of the American College of Surgeons set out to determine outcomes in patients with gunshot wounds to the brain, and found that those are the most lethal of all firearm injuries, with reported survival rates of 10 percent to 15 percent. With 132 patients with gunshot wounds to the brain, the researchers found that the survival rates increased incrementally every year, from 10 percent in 2008 to 46 percent in 2011, with the adoption of aggressive management, or resuscitation.

It remains to be seen what will happen on gun laws at the federal level under the GOP-controlled Congress and the new administration. President Donald Trump has made it known that he supports weakening gun restrictions, and already has taken steps to do so. A new Morning Consult/ Politico poll this week showed that Democrats and Republicans, who often land on the opposite sides of the gun debate, could almost equally agree that the chances are slim of Congress passing stricter firearms laws in the next year or more.