Characteristics of Firearm Injury by Injury Intent: The Need for Tailored Interventions

Shelbie D Kirkendoll; Ashley B Hink; Deborah A Kuhls; Frederick P Rivara; Joseph V Sakran; Lauren L Agoubi; Alex S Winchester; Jacy Richards; Christopher Hoeft; Bhavin Patel; Holly Michaels; Avery B Nathens

doi:10.1097/TA.0000000000004344

Characteristics of Firearm Injury by Injury Intent: The Need for Tailored Interventions

J Trauma Acute Care Surg. 2024 Apr 24. doi: 10.1097/TA.0000000000004344. Online ahead of print.

Affiliations

¹ Department of Surgery, Medical University of South Carolina, Charleston, SC.
² Department of Surgery. Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV.
³ Departments of Pediatrics and Epidemiology and the Firearm Injury and Policy Research Program, University of Washington, Seattle, WA.
⁴ Department of Surgery, Johns Hopkins Medicine, Baltimore, MD.
⁵ Harborview Injury Prevention and Research Center and the Department of Surgery, University of Washington, Seattle, WA.
⁶ American College of Surgeons, Chicago, IL.

PMID: 38654417
DOI: 10.1097/TA.0000000000004344

Abstract

Introduction: While the U.S. has high quality data on firearm-related deaths, less information is available on those who arrive at trauma centers alive, especially those discharged from the emergency department. This study sought to describe characteristics of patients arriving to trauma centers alive following a firearm injury, postulating that significant differences in firearm injury intent might provide insights into injury prevention strategies.

Methods: This was a multi-center prospective cohort study of patients treated for firearm-related injuries at 128 U.S. trauma centers from 3/2021-2/2022. Data collected included patient-level sociodemographic, injury and clinical characteristics, community characteristics, and context of injury. The outcome of interest was the association between these factors and the intent of firearm injury. Measures of urbanicity, community distress, and strength of state firearm laws were utilized to characterize patient communities.

Results: 15,232 patients presented with firearm-related injuries across 128 centers in 41 states. Overall, 9.5% of patients died, and deaths were more common among law enforcement and self-inflicted (SI) firearm injuries (80.9% and 50.5%, respectively). These patients were also more likely to have a history of mental illness. SI firearm injuries were more common in older White men from rural and less distressed communities, whereas firearm assaults were more common in younger, Black men from urban and more distressed communities. Unintentional injuries were more common among younger patients and in states with lower firearm safety grades whereas law enforcement-related injuries occurred most often in unemployed patients with a history of mental illness.

Conclusions: Injury, clinical, sociodemographic, and community characteristics among patients injured by a firearm significantly differed between intents. With the goal of reducing firearm-related deaths, strategies and interventions need to be tailored to include community improvement and services that address specific patient risk factors for firearm injury intent.

Level of evidence: Level III, Prognostic/Epidemiological.