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Response to Letter to the Editor RE: Use of ShotSpotter detection technology decreased prehospital time for patients sustaining gunshot wound.

The fourth issue regard additional information. We think that the data presented are not complete, because the authors did not disclose the total number of ShotSpotter activations during the study period (they enrolled 190 patients). Were any of them multiple activations, for example, two or more gunshot wound victims bought at the same time from the scene? How many ShotSpotter activations were false positives, for example, by extraneous loud sound like music or firecrackers? How many were nontrauma activations on arrival at the hospital, for example, minor gunshot wounds? If data are not available on these issues, this should be added to the limitation of their study. While the authors did adjust for distance, ISS, TRISS, and shock, they did not adjust for other confounding variables, such as body area Abbreviated Injury Scale (a gunshot wound [GSW] to the head may have a different prognosis than to the body area, despite similar Abbreviated Injury Scale scores) and comorbid conditions. Even when granting that the adjustment in mortality covered all relevant confounders, then the decreased transport times and EMS response times did not translate into improved outcomes for the patients (i.e., adjusted death was the same in both groups). Perhaps, the level of improvement in response and transport times is not clinically significant enough to change outcomes. Previously published data show that decreased transport times either by the police, EMS, or private vehicle do not always translate into improved outcomes for the patient. The abstract conclusion that “... this technology may be beneficial in enhancing the care of victims of penetrating trauma” might not include the benefit of lowering the mortality rate. The authors are to be congratulated on addressing a topic that has a paucity of data in the current literature and their description of this novel sonic early-response technology that once perfected can be used to reduce transport times to hospitals and translate to improved outcomes for gunshot wound victims. Future studies should investigate the accuracy and validity of this technology as well as its application to different geographic locations. Future studies could evaluate larger sample sizes or multiple centers to see if this fascinating technology can indeed save lives.