A joinpoint analysis examining trends in firearm injuries at six us trauma centers from 2016 to 2022

Kristin Salottolo; R Joseph Sliter; Gary Marshall; Carlos H Palacio Lascano; Glenda Quan; David Hamilton; Robert Madayag; Gina Berg; David Bar-Or

doi:10.1186/s40621-024-00505-5

A joinpoint analysis examining trends in firearm injuries at six us trauma centers from 2016 to 2022

Inj Epidemiol. 2024 May 13;11(1):18. doi: 10.1186/s40621-024-00505-5.

Authors

Kristin Salottolo^{1

2

3}, R Joseph Sliter⁴, Gary Marshall⁵, Carlos H Palacio Lascano⁶, Glenda Quan⁷, David Hamilton⁸, Robert Madayag^{9

10}, Gina Berg⁴, David Bar-Or^{11

12

13}

Affiliations

¹ Trauma Research Department, Swedish Medical Center, Englewood, CO, USA.
² Trauma Research Department, Medical City Plano, Plano, TX, USA.
³ Trauma Research Department, Wesley Medical Center, Wichita, KS, USA.
⁴ Trauma Services Department, Wesley Medical Center, Wichita, KS, USA.
⁵ Trauma Services Department, Medical City Plano, Plano, TX, USA.
⁶ Trauma Services Department, South Texas Health System, McAllen, TX, USA.
⁷ Trauma Services Department, Swedish Medical Center, Englewood, CO, USA.
⁸ Trauma Services Department, Penrose Hospital, Colorado Springs, CO, USA.
⁹ Trauma Services Department, St. Anthony Hospital, Lakewood, CO, USA.
¹⁰ Trauma Services Department, Lutheran Hospital, Denver, CO, USA.
¹¹ Trauma Research Department, Swedish Medical Center, Englewood, CO, USA. Davidbme49@gmail.com.
¹² Trauma Research Department, Medical City Plano, Plano, TX, USA. Davidbme49@gmail.com.
¹³ Trauma Research Department, Wesley Medical Center, Wichita, KS, USA. Davidbme49@gmail.com.

Abstract

Background: There is an epidemic of firearm injuries in the United States since the mid-2000s. Thus, we sought to examine whether hospitalization from firearm injuries have increased over time, and to examine temporal changes in patient demographics, firearm injury intent, and injury severity.

Methods: This was a multicenter, retrospective, observational cohort study of patients hospitalized with a traumatic injury to six US level I trauma centers between 1/1/2016 and 6/30/2022. ICD-10-CM cause codes were used to identify and describe firearm injuries. Temporal trends were compared for demographics (age, sex, race, insured status), intent (assault, unintentional, self-harm, legal intervention, and undetermined), and severity (death, ICU admission, severe injury (injury severity score ≥ 16), receipt of blood transfusion, mechanical ventilation, and hospital and ICU LOS (days). Temporal trends were examined over 13 six-month intervals (H1, January-June; H2, July-December) using joinpoint regression and reported as semi-annual percent change (SPC); significance was p < 0.05.

Results: Firearm injuries accounted for 2.6% (1908 of 72,474) of trauma hospitalizations. The rate of firearm injuries initially declined from 2016-H1 to 2018-H2 (SPC = - 4.0%, p = 0.002), followed by increased rates from 2018-H2 to 2020-H1 (SPC = 9.0%, p = 0.005), before stabilizing from 2020-H1 to 2022-H1 (0.5%, p = 0.73). NH black patients had the greatest hospitalization rate from firearm injuries (14.0%) and were the only group to demonstrate a temporal increase (SPC = 6.3%, p < 0.001). The proportion of uninsured patients increased (SPC = 2.3%, p = 0.02) but there were no temporal changes by age or sex. ICU admission rates declined (SPC = - 2.2%, p < 0.001), but ICU LOS increased (SPC = 2.8%, p = 0.04). There were no significant changes over time in rates of death (SPC = 0.3%), severe injury (SPC = 1.6%), blood transfusion (SPC = 0.6%), and mechanical ventilation (SPC = 0.6%). When examined by intent, self-harm injuries declined over time (SPC = - 4.1%, p < 0.001), assaults declined through 2019-H2 (SPC = - 5.6%, p = 0.01) before increasing through 2022-H1 (SPC = 6.5%, p = 0.01), while undetermined injuries increased through 2019-H1 (SPC = 24.1%, p = 0.01) then stabilized (SPC = - 4.5%, p = 0.39); there were no temporal changes in unintentional injuries or legal intervention.

Conclusions: Hospitalizations from firearm injuries are increasing following a period of declines, driven by increases among NH Black patients. Trauma systems need to consider these changing trends to best address the needs of the injured population.

Keywords: Firearm; Hospitalization; Racial disparities; Temporal trends; Traumatic injury.