Building a Trauma System Through Detection: ShotSpotter Technology and Increased Capture of Injured Patients

Background Early identification and transport of penetrating trauma patients improve survival. Acoustic gunshot detection systems (ShotSpotter) may speed emergency response, but clear evidence for reduced mortality is lacking. This study examines whether ShotSpotter can reduce violent community death rates and affect resource utilization in a mid-sized city. Methods We retrospectively reviewed gunshot wound patients from March 2019 to August 2023, before and after ShotSpotter implementation (August 2021). We analyzed geographic factors, blood product use, and mortality. Bayesian modeling estimated mean gunshot death rate per 100K in each group, accounting for zip code-specific trends over time. Multivariate Poisson regression estimated mean blood packets per patient for both groups, before and after ShotSpotter deployment. Results There were 575 patients presenting with firearm-related injuries in Winston-Salem during the study period, with 202 in the ShotSpotter area (100 pre-ShotSpotter, 102 post-ShotSpotter) and 373 in non-ShotSpotter areas (179 pre-ShotSpotter, 194 post-ShotSpotter). Following ShotSpotter implementation, gunshot mortality rates in the ShotSpotter area increased significantly, but remained unchanged in non-ShotSpotter areas remained unchanged (RR 5.61, 95% CrI: 1.06, 73). Whole blood use did not differ between groups, but blood component use increased significantly in the ShotSpotter group ( P < 0.05). Discussion ShotSpotter deployment was associated with increased resource utilization. However, the study design does not allow determination of whether this reflects improved patient capture, changes in injury severity, or other unmeasured factors. Despite this, no improvement in community death rates or hospital mortality was observed, suggesting detection alone may be insufficient without coordinated emergency medical response.