Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this observational cohort study, recurrent injury was frequent among firearm injury survivors, especially patients from socially vulnerable areas.

2. Fatal firearm injuries also occurred more frequently in prior firearm injury survivors.

Evidence Rating Level: 1 (Excellent)

Study Rundown:

Firearm injuries are the leading cause of death for United States youths aged 1 to 19 years old, with socially vulnerable groups such as Black children and young adults disproportionally affected. Additionally, structural racism and other social determinants of health have increased the risk of violent injury among these populations. Recently, the Centers for Disease Control and Prevention reported an estimated 981,135 nonfatal firearm injuries from 2010 to 2019, but there is a gap in knowledge as to creating a comprehensive United States database of fatal and nonfatal firearm injuries. Overall, this study found that by using the St. Louis Region-Wide Hospital-Based Violence Intervention Program (HVIP) Data Repository (STL-HVIP-DR), recurrent injury and death are frequent among patients who survived prior firearm injuries that are from socially vulnerable areas. This study was limited by having limited data on comorbidities and patient-level social determinants of health, as well as the inability to account for recurrent injuries that presented to hospitals, not in the study design. Nevertheless, these study’s findings are significant, as they demonstrate that socially vulnerable patients who survived firearm injuries are likely to experience recurrent firearm injuries.

In-Depth [observational cohort study]:

This multicenter, observational, cohort study studied four adult and pediatric level 1 trauma hospitals in St. Louis, Missouri, from 2010 to 2019. Patients who had a hospital encounter for an index firearm injury with a corresponding International Classification of Diseases code were included in the study. People who did not survive their index firearm injury and patients who did not have a date of birth listed in the STL-HVIP-DR were excluded from the study. The primary outcome measured was patient demographics and whether recurrent firearm injury, either fatal or nonfatal, occurred. Outcomes in the primary analysis were assessed via descriptive statistics and a Kaplan-Meier time-to-event survival analysis. Based on the primary analysis, there were 10,293 firearm injuries identified, with 9553 survivors. However, with a median follow-up of 3.5 years, 1155 patients experience a recurrent firearm injury including five firearm suicides and 149 fatal firearm injuries. The patients most likely to experience a recurrent firearm injury came from high social vulnerability regions (65%) and were more likely to be young (25.3 ± 9.5 years), predominantly male (93%), Black (96%), and uninsured (50%). In summary, this study demonstrates that recurrent firearm injury and death are frequent among survivors of firearm injury, especially in socially vulnerable and marginalized patients.

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