{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T11:56:47Z","timestamp":1769342207591,"version":"3.49.0"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Remembering, the 15 Research Endowment in the Department of Surgery","award":["77317"],"award-info":[{"award-number":["77317"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Traumatic injuries are a major public health issue, being the leading cause of death in the U.S. Advancements in medical care, injury prevention, and regional trauma systems have improved survival rates, but there is limited information on outcomes for survivors. Blunt, sharp, and firearm injuries are the primary mechanisms in trauma forensics. This study examines patient outcomes for blunt, sharp, and firearm injuries over 20 years. Materials and Methods: De-identified data were collected from the TriNetX Research network in June 2024. Patients aged 18\u201390 were categorized by injury type (blunt, sharp, firearm) from 2004 to 2023. Trends were analyzed by stratifying the data into 20 consecutive one-year intervals. Mortality, blood transfusions, traumatic shock, hypovolemic shock, and acute post-hemorrhagic anemia were recorded annually. Statistical analysis was performed using One Way Repeated ANOVA and post hoc Tukey testing, with significance defined as p &lt; 0.05. Results: The study included 1,205,350 blunt, 710,875 sharp, and 144,562 firearm injuries. Firearm injuries predominantly affected males (83%) and African Americans (51%), while blunt and sharp injuries showed more demographic variability. Looking at the 20-year trends, the average age of firearm and sharp injury patients decreased by 21% (48 \u00b1 13 to 38 \u00b1 15, p \u2264 0.0001) and 14% (49 \u00b1 16 to 42 \u00b1 18, p \u2264 0.0001), respectively, while blunt injury patient age did not change significantly. Mortality rates significantly decreased from 12% for firearm, 7% for sharp, and 6% for blunt injuries in 2004 to less than 1% in 2023 for all three injury mechanisms. Blood transfusions increased 450% (2% to 11%) for firearm injuries and increased 100% for sharp and blunt injuries (1% to 2%). Traumatic shock and hypovolemic shock incidences also increased by 100% for firearm injuries (3% to 6% and 1% to 2%, respectively), while sharp and blunt injuries did not change significantly. Acute post-hemorrhagic anemia increased from 3% to 19% for firearm injuries (533% relative increase), while sharp and blunt injuries remained around 3% for the past 20 years. Conclusions: The study reveals that with improved survival rates over the last 20 years, there has been a significant increase in shock-related morbidities and blood transfusion rates, particularly for firearm injuries. These findings can inform trauma care to enhance resuscitation efforts, optimize resource allocation, and improve mortality and outcomes for these injury mechanisms.<\/jats:p>","DOI":"10.3390\/medicina62020235","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T13:55:34Z","timestamp":1769176534000},"page":"235","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Twenty-Year Retrospective Cohort Study of Mortality and Morbidities in Adult Trauma Patients with Blunt, Sharp, and Firearm Injuries"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3420-6010","authenticated-orcid":false,"given":"Sophia Rosella","family":"Lee","sequence":"first","affiliation":[{"name":"John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron Wang","family":"Lee","sequence":"additional","affiliation":[{"name":"John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Erickson","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2972-3440","authenticated-orcid":false,"given":"Steven E.","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9371-9078","authenticated-orcid":false,"given":"Juquan","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2025, June 15). Leading Causes of Death. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/lcd\/?o=LCD&y1=2022&y2=2022&ct=10&cc=ALL&g=00&s=0&r=0&ry=0&e=0&ar=lcd1age&at=groups&ag=lcd1age&a1=0&a2=199."},{"key":"ref_2","unstructured":"Centers for Disease Control and Prevention (2025, June 15). Deaths and Injuries Due to All Injury Among All Ages, 2017 to 2021, United States. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/infographics\/."},{"key":"ref_3","unstructured":"Centers for Disease Control and Prevention (2025, June 15). NVDRS Violent Deaths Report. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/nvdrs\/?rt=3&rt2=0&y=2020&g=00&i=2&i=4&m=20810&s=0&r=0&e=0&rl=0&pc=0&pr=0&h=0&ml=0&a=ALL&a1=0&a2=199&g1=0&g2=199&r1=NVDRS-MECH&r2=NONE&r3=NONE&r4=NONE."},{"key":"ref_4","unstructured":"Centers for Disease Control and Prevention (2025, June 15). Violence-Related Deaths and Injuries Due to Cut\/Pierce Among All Ages, 2017 to 2021, United States. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/infographics\/."},{"key":"ref_5","unstructured":"Centers for Disease Control and Prevention (2025, June 15). Violence-Related Deaths and Injuries Due to Struck by\/Against among All Ages, 2017 to 2021, United States. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/infographics\/."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/j.injury.2016.04.002","article-title":"Traumatic injury in the United States: In-patient epidemiology 2000\u20132011","volume":"47","author":"DiMaggio","year":"2016","journal-title":"Injury"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Cho, N.Y., Mabeza, R.M., Bakhtiyar, S.S., Richardson, S., Ali, K., Tran, Z., and Benharash, P. (2023). National trends and resource associated with recurrent penetrating injury. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0280702"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1136\/ip-2022-044817","article-title":"Mechanisms of traumatic injury by demographic characteristics: An 8-year review of temporal trends from the National Trauma Data Bank","volume":"29","author":"Tomas","year":"2023","journal-title":"Inj. Prev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1377\/hlthaff.2017.0625","article-title":"Emergency department visits for firearm-related injuries in the United States, 2006\u201314","volume":"36","author":"Gani","year":"2017","journal-title":"Health Aff."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ypmed.2015.06.002","article-title":"Firearm injuries in the United States","volume":"79","author":"Fowler","year":"2015","journal-title":"Prev. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1093\/aje\/kww147","article-title":"The hidden epidemic of firearm injury: Increasing firearm injury rates during 2001\u20132013","volume":"185","author":"Kalesan","year":"2017","journal-title":"Am. J. Epidemiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jss.2020.03.009","article-title":"The impact of geographic distribution on trauma center outcomes: Do center outcomes vary by region","volume":"252","author":"Elkbuli","year":"2020","journal-title":"J. Surg. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.jamcollsurg.2016.08.569","article-title":"Geographic distribution of trauma burden, mortality, and services in the United States: Does availability correspond to patient need?","volume":"223","author":"Metcalfe","year":"2016","journal-title":"J. Am. Coll. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1097\/TA.0b013e3181bbfe2a","article-title":"Trauma mortality in mature trauma systems: Are we doing better? An analysis of trauma mortality patterns, 1997\u20132008","volume":"69","author":"Dutton","year":"2010","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2915","DOI":"10.1016\/j.injury.2022.06.011","article-title":"Change in outcomes for trauma patients over time: Two decades of a state trauma system","volume":"53","author":"Kaufman","year":"2022","journal-title":"Injury"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.joad.2015.03.001","article-title":"Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution","volume":"4","author":"Negoi","year":"2015","journal-title":"J. Acute Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1016\/j.injury.2011.05.030","article-title":"Does the use of a \u201ctrack and trigger\u201d warning system reduce mortality in trauma patients?","volume":"42","author":"Patel","year":"2011","journal-title":"Injury"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1016\/j.injury.2019.07.017","article-title":"Trauma care before and after optimisation in a level I trauma Centre: Life-saving changes","volume":"50","author":"Havermans","year":"2019","journal-title":"Injury"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"44","DOI":"10.4103\/2229-5151.79281","article-title":"Advances in prehospital trauma care","volume":"1","author":"Williamson","year":"2011","journal-title":"Int. J. Crit. Illn. Inj. Sci."},{"key":"ref_20","first-page":"349","article-title":"Blood transfusion in trauma patients: Unresolved questions","volume":"77","author":"Cushing","year":"2011","journal-title":"Minerva Anestesiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.jamcollsurg.2010.01.031","article-title":"Impact of plasma transfusion in trauma patients who do not require massive transfusion","volume":"210","author":"Inaba","year":"2010","journal-title":"J. Am. Coll. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1111\/trf.16552","article-title":"Blood transfusions in gunshot-wound-related emergency Department visits and hospitalizations in the United States","volume":"61","author":"Goel","year":"2021","journal-title":"Transfusion"},{"key":"ref_23","unstructured":"Centers for Disease Control and Prevention (2025, June 15). All Intents Struck by\/Against Nonfatal Emergency Department Visits and Rates per 100,000. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/reports\/?o=NFI&y1=2004&y2=2022&d=0&i=0&m=3070&g=00&me=&s=0&r=&e=&a=custom&g1=0&g2=199&a1=18&a2=85&r1=YEAR&r2=NONE&r3=NONE&r4=NONE&adv=true."},{"key":"ref_24","unstructured":"Centers for Disease Control and Prevention (2025, June 15). All Intents Struck by\/Against Deaths and Rates per 100,000. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/reports\/?o=MORT&y1=2004&y2=2022&t=0&i=0&m=21080&g=00&me=0&s=0&r=0&ry=0&e=0&yp=65&a=custom&g1=0&g2=199&a1=18&a2=85&r1=YEAR&r2=NONE&r3=NONE&r4=NONE."},{"key":"ref_25","unstructured":"Centers for Disease Control and Prevention (2025, June 15). All Intents Cut\/Pierce Nonfatal Emergency Department Visits and Rates per 100,000. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/reports\/?o=NFI&y1=2004&y2=2022&d=0&i=0&m=3080&g=00&me=&s=0&r=&e=&a=custom&g1=0&g2=199&a1=18&a2=85&r1=YEAR&r2=NONE&r3=NONE&r4=NONE&adv=true."},{"key":"ref_26","unstructured":"Centers for Disease Control and Prevention (2025, June 15). All Intents Cut\/Pierce Deaths and Rates per 100,000. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/reports\/?o=MORT&y1=2004&y2=2022&t=0&i=0&m=20820&g=00&me=0&s=0&r=0&ry=0&e=0&yp=65&a=custom&g1=0&g2=199&a1=18&a2=85&r1=YEAR&r2=NONE&r3=NONE&r4=NONE."},{"key":"ref_27","unstructured":"Centers for Disease Control and Prevention (2025, June 15). All Intents Firearm Nonfatal Emergency Department Visits and Rates per 100,000. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/reports\/?o=NFI&y1=2004&y2=2022&d=0&i=0&m=3180&g=00&me=&s=0&r=&e=&a=custom&g1=0&g2=199&a1=18&a2=85&r1=YEAR&r2=NONE&r3=NONEr4=NONE&adv=true."},{"key":"ref_28","unstructured":"Centers for Disease Control and Prevention (2025, June 15). All Intents Firearm Deaths and Rates per 100,000. Web-Based Injury Statistics Query and Reporting System, Available online: https:\/\/wisqars.cdc.gov\/reports\/?o=MORT&y1=2004&y2=2022&t=0&i=0&m=20890&g=00&me=0&s=0&r=0&ry=0&e=0&yp=65&a=custom&g1=0&g2=199&a1=18&a2=85&r1=YEAR&r2=NONE&r3=NONE&r4=NONE."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/235\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T14:25:39Z","timestamp":1769178339000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/235"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["medicina62020235"],"URL":"https:\/\/doi.org\/10.3390\/medicina62020235","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]}}}