The Wall Street Journal over the weekend used Baltimore and the world-renowned Maryland Shock Trauma Center as the setting for a story saying hospital statistics show gun violence nationwide was “soaring,” and that a continuing national decline in homicides in spite of this trend was improved trauma care.
The article doesn't go into city-specific data. But at least in Baltimore, those findings go against most every measure of crime available, and indeed Shock Trauma’s own statistics.
Citing medical data and other surveys in the U.S., the article said that gun violence is climbing and points to a rising number of serious injuries from assaults with guns and knives. For example, the estimated number of people wounded seriously enough by gunshots to require a hospital stay, rather than treatment and release, rose 47 percent from 20,844 in 2001 to 30,759 in 2011, according to data from the Centers for Disease Control and Prevention.
“More people in the U.S. are getting shot, but doctors have gotten better at patching them up,” the newspaper reported.
Shootings are not counted by police on a national level, largely because they are not required to by the FBI's Uniform Crime Reporting program, and are instead counted among overall aggravated assaults. But because of its historically staggering gun violence problem, Baltimore police began breaking out shootings as an internal data subset.
In 2000, police say there were 725 non-fatal shooting victims, a number that fell to 381 in 2011. That's a decline of 47 percent, or a 94 percent difference compared to what the CDC estimates show is taking place at trauma centers across the country.
Dr. Thomas Scalea, the physician-in-chief at Shock Trauma, allowed the Journal access to the unit, where 24 people were admitted before the sun rose, including five people shot or stabbed. “Violence down?” Scalea told a reporter. “I don't think so.”
This is not the first time Scalea has been on record questioning whether violence is down. “The violence is getting worse, in my opinion; it's not getting substantially better,” Scalea said during an appearance on the television show “Square Off.” “The guns on the street are more deadly, and it's every day for us.”
In a short e-mail to a Sun reporter, Scalea said “our numbers … are unchanged." He was not immediately available for additional comment.
But Shock Trauma’s own data don’t appear to support that statement.
In fiscal year 2009, which is how the trauma center collects data, there were 414 people from the region treated there for gunshot wounds that were the result of assaults, according to internal demographics reports. That declined to 347 in 2009-2010, and 306 in 2011-2012. That’s a drop of 26 percent.
In comparison, during the 2008 to 2011 calendar years, police statistics show total shootings declined 29 percent — within the margin of error of Shock Trauma’s data.
The Wall Street Journal also said that the national percentage of people who died after being shot has declined two percentage points since 2007 to 2010, to 13.96 percent. Scalea told the Journal that the mortality rate for gunshot wounds at Shock Trauma is about 4 percent, including the patients who are dead on arrival.
In Baltimore, where trauma victims are likely to be taken to Shock Trauma or Johns Hopkins Hospital, police statistics show that of the total number of people shot in 2000, 203 died — about 21 percent. In 2011, 149 homicide victims had been shot, representing 28 percent of all shooting victims. It is important to note that not all shooting victims are taken to the hospital, but the data nevertheless shows an increase.
The article's conclusions that gun violence is up, not down, would especially resonate in Baltimore where residents are deeply distrustful of the sentiment that gun violence is on the decline, often looking to other reasons to explain a decline in homicides, including improvements in trauma care. It was a great frustration of former Police Commissioner Frederick H. Bealefeld III, who would jokingly say that critics would attribute crime declines to lunar tables and the tides before crediting police.
Dr. Adil H. Haider, co-director of the Howard University-Johns Hopkins University Surgical Outcomes Research Center that performed research for the Journal, said he did not have state-by-state data to analyze trends in Maryland or Baltimore trauma care in comparison to the national data.
But as a surgeon at Johns Hopkins Hospital's trauma unit, Haider agreed that trauma center activity is “certainly down” over the past six years in Baltimore.
“The story is based on a national data set. I wonder if it's possible that Baltimore may be experiencing a different phenomenon, where gunshots are down but lethal gunshots continue to be right up there,” he said.
What explains Scalea’s observations about rising crime? It could be that overall, trauma trends at Shock Trauma appear to show a slight increase in violence-related treatment. Overall referrals for critical injury and illness are up 24 percent, from about 6,900 to 8,600 referrals. While shooting assaults are down, stabbings are up – from 318 in fiscal 2009 to 377 in fiscal 2012.
A possible theory that explains why the percentage of people who are shot that die is rising could be a increase in the number of execution-style shootings in Baltimore. The Sun reported in 2010 that though shootings were down, the percentage of people shot in the head had increased significantly, giving rise to a larger proportion of victims with more serious injuries and who are harder to save through medical intervention.
Statistics showed that while 35 percent of homicide victims in 2004 had suffered gunshots to the head, that number had increased to 37 percent in 2007, to 53 percent in 2008, and to 59 percent in 2009.
However, the trend didn't continue or hold. In 2010, the number of homicide victims shot in the head fell to 50 percent, and to 47 percent in 2011.
But removing Baltimore from the equation, the notion that shootings are “soaring” across the country is difficult to understand. Police statistics show aggravated assaults per capita were down nationwide 16 percent from 2007 to 2011, according to the FBI's UCR, and down 24 percent from 2001 to 2011.
“Did assaults with guns really soar while aggravated assaults overall were dropping?” wrote Kent Scheidegger, the legal director of the Sacramento-based Criminal Justice Legal Foundation. “I'll join [critics] in the leery section.”
The Bureau of Justice Statistics, which uses a survey of victims to try to account for disparities in police reporting, also shows that aggravated assaults are down 21 percent from 2002 to 2011, with serious violent crime involving weapons down 26 percent during that time frame and serious violent crime involving injury down 10 percent.
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