An Epidemiological Overview of 13 Years of Firearm Hospitalizations in Pennsylvania

• Published in: The Journal of surgical research
• Main Authors: Gross, Brian W., BS, Cook, Alan D., MD, Rinehart, Cole D., BS, Lynch, Caitlin A., BS, Bradburn, Eric H., DO, MS, FACS, Bupp, Katherine A., BS, Morrison, Chet A., MD, FACS, FCCM, Rogers, Frederick B., MD, MS, FACS
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Surgery; Firearm violence; gunshot wound; firearm hospitalization; mortality; gun violence; functional status at discharge
• ISSN: 0022-4804
• DOI: 10.1016/j.jss.2016.11.021

Abstract Background Gun violence is a controversial public health issue plagued by a lack of recent research. We sought to provide a 13-year overview of firearm hospitalizations in Pennsylvania, analyzing trends in mode, intent, and outcome. We hypothesized that no adjusted change in mortality or functional status at discharge (FSD) would be observed for gunshot wound (GSW) victims over the study period. Methods All admissions to the Pennsylvania Trauma Outcome Study database from 2003-2015 were queried. GSWs were identified by external cause-of-injury codes. Collected variables included patient demographics, firearm type, intent (assault, attempted suicide), FSD, and mortality. Multilevel mixed-effects logistic regression models and ordinal regression analyses using generalized linear mixed models assessed the impact of admission year (continuous) on adjusted mortality and FSD score, respectively. Significance was set at p <0.05. Results Of the 462,081 patients presenting to Pennsylvania trauma centers from 2003-2015, 19,342 (4.2%) were GSWs. Handguns were the most common weapon of injury (n=7,007; 86.7%) among cases with specified firearm type. The majority of GSWs were coded as assaults (n=15,415; 79.7%), with suicide attempts accounting 1,866 hospitalizations (9.2%). Suicide attempts were most prevalent among young and middle-aged white males, while assaults were more common in young black males. Rates of firearm hospitalizations decreased over time (test of trend p=0.001), however admission year was not associated with improved adjusted survival (AOR: 0.99, 95% CI: 0.97-1.01; p=0.353) or FSD (AOR: 0.99, 95% CI: 0.98-1.00; p=0.089) while controlling for demographic and injury severity covariates. Conclusion Temporal trends in outcomes suggest rates of firearm hospitalizations are declining in Pennsylvania, however outcomes remain unchanged. To combat this epidemic, a multidisciplinary, demographic-specific approach to prevention should be the focus of future scientific pursuits.