Incidence of and Factors Associated With Recurrent Firearm Injury Among Patients Presenting to St. Louis Trauma Centers, 2010 to 2019 : A Cohort Study

Abstract

Background: Firearm injuries are a public health crisis in the United States.

Objective: To examine the incidence and factors associated with recurrent firearm injuries and death among patients presenting with an acute (index), nonfatal firearm injury.

Design: Multicenter, observational, cohort study.

Setting: Four adult and pediatric level I trauma hospitals in St. Louis, Missouri, 2010 to 2019.

Participants: Consecutive adult and pediatric patients (n = 9553) presenting to a participating hospital with a nonfatal acute firearm injury.

Measurements: Data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and death were collected from the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository. The Centers for Disease Control and Prevention (CDC) Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the probability of experiencing a recurrent firearm injury.

Results: We identified 10 293 acutely firearm-injured patients of whom 9553 survived the injury and comprised the analytic sample. Over a median follow-up of 3.5 years (IQR, 1.5 to 6.4 years), 1155 patients experienced a recurrent firearm injury including 5 firearm suicides and 149 fatal firearm injuries. Persons experiencing recurrent firearm injury were young (25.3 ± 9.5 years), predominantly male (93%), Black (96%), and uninsured (50%), and resided in high social vulnerability regions (65%). The estimated risk for firearm reinjury was 7% at 1 year and 17% at 8 years.

Limitations: Limited data on comorbidities and patient-level social determinants of health. Inability to account for recurrent injuries presenting to nonstudy hospitals.

Conclusion: Recurrent injury and death are frequent among survivors of firearm injury, particularly among patients from socially vulnerable areas. Our findings highlight the need for interventions to prevent recurrence.

Primary funding source: Emergency Medicine Foundation-AFFIRM and Missouri Foundation for Health.

Figure 1.

Assembly of cohort at-risk for recurrent firearm injury and occurrence of subsequent injuries. Definitions SRTL-HVIP-DR: St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository ICD: International Classification of Diseases

Figure 2.

Index firearm injury and Social Vulnerability Index in the St. Louis Metropolitan Area

Figure 3.

Kaplan-Meier estimates of recurrent firearm injury probability for each year after index injury.

Figure 4.

Kaplan-Meier estimates of recurrent firearm injury probability for each year after index injury stratified by age, gender, race, insurance status, and social vulnerability index.