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Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries

Educational Objective To state the long-term physical, mental, emotional, and social outcomes among individuals with gunshot wounds (GSWs).
1 Credit CME
Key Points

Question  What are the long-term physical, mental, emotional, and social outcomes among individuals with gunshot wounds?

Findings  In this cohort study of patient-reported outcome measures, 183 young adult patients (median age, 27 years) who survived gunshot wounds (median time from injury, 5.9 years) reported worse physical and mental health compared with the general population, 48.6% had positive screen findings for probable posttraumatic stress disorder, and unemployment and substance use increased by 14.3% and 13.2%, respectively, after injury.

Meaning  These findings suggest that the outcomes of firearm injury reach far beyond mortality statistics; survivors of gunshot wounds may benefit from early identification and the initiation of long-term, multidisciplinary longitudinal care to improve recovery.


Importance  The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied.

Objective  To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries.

Design, Setting, and Participants  This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019.

Exposures  A GSW sustained from January 1, 2008, through December 31, 2017.

Main Outcomes and Measures  Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Results  Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P < .001), Global Mental Health (48 [11]; P = .03), and Physical Function (45 [12]; P < .001) PROMIS metrics. Eighty-nine participants (48.6%) had a positive screen for probable PTSD. Patients who required intensive care unit admission (n = 64) had worse mean (SD) Physical Function scores (42 [13] vs 46 [11]; P = .045) than those not requiring the intensive care unit. Survivors no more than 5 years after injury had greater PTSD risk (38 of 63 [60.3%] vs 51 of 119 [42.9%]; P = .03) but better mean (SD) Global Physical Health scores (47 [11] vs 43 [11]; P = .04) than those more than 5 years after injury.

Conclusions and Relevance  This study’s results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of GSWs may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount.

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Article Information

Accepted for Publication: August 2, 2019.

Corresponding Author: Michael A. Vella, MD, Division of Acute Care Surgery and Trauma, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Office 2.6222, Rochester, NY 14642 (mavella2@gmail.com).

Published Online: November 20, 2019. doi:10.1001/jamasurg.2019.4533

Author Contributions: Drs Vella and Seamon had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Vella, Warshauer, Sims, Schwab, Reilly, Lane-Fall, Seamon.

Acquisition, analysis, or interpretation of data: Vella, Warshauer, Tortorello, Fernandez-Moure, Giacolone, Chen, Cabulong, Chreiman.

Drafting of the manuscript: Vella, Giacolone, Seamon.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Vella, Warshauer, Giacolone, Sims.

Administrative, technical, or material support: Warshauer, Giacolone, Chreiman, Schwab, Reilly, Lane-Fall, Seamon.

Supervision: Schwab, Reilly, Lane-Fall, Seamon.

Conflict of Interest Disclosures: Dr Fernandez-Moure reported receiving grants from DSM Biomedical outside the submitted work. Dr Seamon reported receiving personal fees as the associate editor of The Trauma Manual: Trauma and Acute Care Surgery, 5th edition, from Wolters Kluwer (1.5% of book sale royalties); personal fees as the editor of Management of Chest Trauma: A Practical Guide, from Springer Nature (a fee plus 10% book royalties); and grants for the Longitudinal Assessment of Post-Traumatic Syndromes (AURORA) study from the National Institutes of Health (1% salary support plus $500 per patient enrollment) outside the submitted work. No other disclosures were reported.

Meeting Presentation: This article was a podium presentation at the 32nd Annual Meeting of the Eastern Association for the Surgery of Trauma; January 18, 2019; Austin, Texas.

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