Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (K.L.M., R.A., D.B.L.).
Institute for Public Health, Washington University in St. Louis School of Medicine, St. Louis, Missouri (B.P.C., R.E.F.).
Ann Intern Med. 2023 Sep;176(9):1163-1171. doi: 10.7326/M23-0069. Epub 2023 Aug 29.
Firearm injuries are a public health crisis in the United States.
To examine the incidence and factors associated with recurrent firearm injuries and death among patients presenting with an acute (index), nonfatal firearm injury.
Multicenter, observational, cohort study.
Four adult and pediatric level I trauma hospitals in St. Louis, Missouri, 2010 to 2019.
Consecutive adult and pediatric patients ( = 9553) presenting to a participating hospital with a nonfatal acute firearm injury.
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.
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.
Limited data on comorbidities and patient-level social determinants of health. Inability to account for recurrent injuries presenting to nonstudy hospitals.
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.
Emergency Medicine Foundation-AFFIRM and Missouri Foundation for Health.
在美国，枪支伤害是公共卫生危机。
研究在因急性（指数）非致命性枪支受伤而就诊的患者中，与复发性枪支伤害和死亡相关的发生率和因素。
多中心、观察性、队列研究。
密苏里州圣路易斯的四家成人和儿科一级创伤医院，2010 年至 2019 年。
连续的成人和儿科患者（=9553 名）因非致命性急性枪支受伤到参与医院就诊。
从圣路易斯地区基于医院的暴力干预计划数据存储库中收集有关枪支伤害患者人口统计学、医院和诊断信息、健康保险状况和死亡的数据。疾病控制和预防中心（CDC）社会脆弱性指数用于描述患者居住地的人口普查区的社会脆弱性。分析包括描述性统计和时间事件分析，以估计经历复发性枪支伤害的概率。
我们确定了 10293 名急性枪支受伤患者，其中 9553 名患者在受伤后存活下来并构成了分析样本。在中位数为 3.5 年（IQR，1.5 至 6.4 年）的随访中，1155 名患者经历了复发性枪支伤害，包括 5 例枪支自杀和 149 例致命枪支伤害。经历复发性枪支伤害的人年龄较小（25.3±9.5 岁），主要为男性（93%）、黑人（96%）和无保险（50%），居住在高社会脆弱性地区（65%）。枪支再受伤的估计风险在 1 年时为 7%，在 8 年时为 17%。
关于合并症和患者社会决定因素的有限数据。无法解释在非研究医院就诊的复发性伤害。
枪支伤害幸存者中经常发生复发性伤害和死亡，特别是来自社会脆弱地区的患者。我们的研究结果强调需要采取干预措施来预防复发。
急诊医学基金会-AFFIRM 和密苏里州健康基金会。
