A multi-decade joinpoint analysis of firearm injury severity

Abstract

BackgroundNon-fatal firearm injuries constitute approximately 70% of all firearm trauma injuries in the United States. Patterns of severity of these injuries are poorly understood. We analyzed the overall, age-, sex- and intent-specific temporal trends in the injury severity of firearm hospitalizations from 1993 to 2014.MethodsWe assessed temporal trends in the severity of patients hospitalized for firearm using Nationwide Inpatient Sample (NIS) data over a 22 year period. Firearm hospitalization was identified using assault (E965x), unintentional (E922x), intentional self-harm (E955x), legal (E970) and undetermined (E985x) International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) codes. Injury severity was measured using the computed New Injury Severity Score (NISS). We used survey weighted means, SD and annual percent change (APC), and joinpoint regression to analyze temporal trends.ResultsA weighted total of 648 662 inpatient admissions for firearm injury were analyzed. Firearm injury severity demonstrated a significant annual increase of 1.4% (95% CI=1.3 to 1.6), and was driven by annual increases among young adults (APC=1.4%, 95% CI=1.3 to 1.5), older adults (APC=1.5%, 95% CI=1.3 to 1.6), female (APC=1.5%, 95% CI=1.3 to 1.6) and male (APC=1.4%, 95% CI=1.3 to 1.6) hospitalizations. The annual increase among assault/legal injuries was 1.4% (95% CI=1.3 to 1.5), similar to unintentional (APC=1.4%, 95% CI=1.3 to 1.6), intentional self-harm (APC=1.5%, 95% CI=1.4 to 1.6) and undetermined (APC=1.4%, 95% CI=1.3 to 1.6).ConclusionsThe severity of hospitalized firearm injuries increased significantly from 1993 to 2014. This annual increase reflects a move towards hospitalization of more serious injuries, and outpatient management of less serious injuries across the board, suggesting a mounting burden on the US healthcare system.Level of evidenceLevel IV.

Prevalence and hospital charges from firearm injuries treated in US emergency departments from 2006 to 2016

“…The mean charges per patient who died was greater versus those discharged alive, with no significant difference in the magnitude of annual increase in temporal trends between those who died versus discharged alive, indicating that the charges increased over time for all types of treatment for firearm injury. Increasing burden of costs for treating firearm visits may be attributed to increasing injury severity among those subsequently hospitalized 16 and for lifesaving procedures among those who died in the ED. These are novel findings that build on the available evidence to help in a better understanding of the resources spent to treat the victims of a major public health crisis.…”

Trends in Firearm Injury and Motor Vehicle Crash Case Fatality by Age Group, 2003-2013

“…17,18 Data from the National Inpatient Sample, from 1993 to 2014 suggest annual increases in the New Injury Severity Score (NISS) for firearms. 19 The NSP does not include the NISS. Given that the NISS may be more accurate in predicting mortality and complications in penetrating injuries, the trend reported using the NISS is not surprising even where our analysis of the ISS showed no change.…”

Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US

“…3 In addition, for patients hospitalized as a result of a firearm injury, the injury severity has increased steadily over time. 4 Suicide by firearm carries an 85% fatality rate, which is significantly higher than all other mechanisms. [5][6][7] Firearm suicide disproportionately involves older, white males in rural environments, and firearm homicide disproportionally affects young men of color in urban environments.…”

“…Research is needed to better understand the root causes of violence, identify people at risk, and determine the most effective strategies for firearm injury prevention. 4. Federal and philanthropic research funding must be provided to match the burden of disease.…”