Ann Intern Med. 2015 Apr 7;162(7):492-500. doi: 10.7326/M14-2362.
Risk for violent victimization or crime perpetration after firearm-related hospitalization (FRH) must be determined to inform the need for future interventions.
To compare the risk for subsequent violent injury, death, or crime perpetration among patients with an FRH, those hospitalized for noninjury reasons, and the general population.
Retrospective cohort study.
All hospitals in Washington.
Patients with an FRH and a random sample of those with a non-injury-related hospitalization in 2006 to 2007 (index hospitalization).
Primary outcomes included subsequent FRH, firearm-related death, and the combined outcome of firearm- or violence-related arrest ascertained through 2011.
Among patients with an index FRH (n = 613), rates of subsequent FRH, firearm-related death, and firearm- or violence-related arrest were 329 (95% CI, 142 to 649), 100 (CI, 21 to 293), and 4221 (CI, 3352 to 5246) per 100 000 person-years, respectively. Compared with the general population, standardized incidence ratios among patients with an index FRH were 30.1 (CI, 14.9 to 61.0) for a subsequent FRH and 7.3 (CI, 2.4 to 22.9) for firearm-related death. In survival analyses that accounted for competing risks, patients with an index FRH were at greater risk for subsequent FRH (subhazard ratio [sHR], 21.2 [CI, 7.0 to 64.0]), firearm-related death (sHR, 4.3 [CI, 1.3 to 14.1]), and firearm- or violence-related arrest (sHR, 2.7 [CI, 2.0 to 3.5]) than those with a non-injury-related index hospitalization.
Lack of information on whether patients continued to reside in Washington during follow-up may have introduced outcome misclassification.
Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization or crime perpetration. Further research at the intersection of clinical care, the criminal justice system, and public health to evaluate the effectiveness of interventions delivered to survivors of firearm-related injury is warranted.
Seattle City Council and University of Washington Royalty Research Fund.
为了制定未来干预措施，必须确定与枪支相关的住院治疗（FRH）后暴力受害或犯罪的风险。
比较 FRH 患者、非伤害相关住院治疗患者和普通人群中随后发生暴力伤害、死亡或犯罪的风险。
回顾性队列研究。
华盛顿的所有医院。
2006 年至 2007 年 FRH 患者和随机抽取的非伤害相关住院患者（索引住院）。
主要结果包括通过 2011 年确定的随后 FRH、枪支相关死亡以及枪支或暴力相关逮捕的综合结果。
在 FRH 索引患者中（n = 613），随后 FRH、枪支相关死亡和枪支或暴力相关逮捕的发生率分别为 329（95%CI，142 至 649）、100（CI，21 至 293）和 4221（CI，3352 至 5246）每 100000 人年。与普通人群相比，FRH 索引患者的标准化发病率比分别为 30.1（CI，14.9 至 61.0）用于随后的 FRH 和 7.3（CI，2.4 至 22.9）用于枪支相关死亡。在考虑竞争风险的生存分析中，FRH 索引患者随后发生 FRH（亚危险比 [sHR]，21.2 [CI，7.0 至 64.0]）、枪支相关死亡（sHR，4.3 [CI，1.3 至 14.1]）和枪支或暴力相关逮捕（sHR，2.7 [CI，2.0 至 3.5]）的风险更高与非伤害相关索引住院的患者相比。
缺乏患者在随访期间是否继续居住在华盛顿的信息，这可能导致结果分类错误。
因枪支相关伤害住院治疗与随后暴力受害或犯罪的风险增加有关。需要进一步在临床护理、刑事司法系统和公共卫生的交叉点进行研究，以评估对枪支相关伤害幸存者实施干预措施的有效性。
西雅图市议会和华盛顿大学皇家研究基金。
