This article is more than 5 years old. Information may no longer be current.

Accidental firearm injuries may indicate violence history

Patients reporting to the hospital with unintentional firearm-related injuries are more likely to have a history of violence, and may benefit from inclusion in a hospital-based violence prevention program, according to data published in Annals of Internal Medicine.

“An estimated 41,024 persons aged 15 years or older were hospitalized because of nonfatal firearm injuries in 2014 in the United States,” Ali Rowhani-Rahbar, MD, MPH, PhD, from the University of Washington School of Public Health in Seattle, and colleagues wrote. “Hospital-based violence intervention programs typically focus on patients whose firearm injury occurred through interpersonal violence (assault). Knowledge of violence perpetration by victims of unintentional (accidental) firearm injury is limited.”

Rowhani-Rahbar and colleagues conducted a case-control study and a retrospective cohort study of patients aged 15 years or older who were hospitalized between 2006 and 2007 to investigate the pattern of violence before (from 2001 through hospitalization) and after (from hospitalization through 2011) firearm injury based on whether the injury was intentional or unintentional. Patterns of violence found were compared among three groups: firearm injury, other injury and noninjury.

Results showed that a violence-related arrest before hospitalization was more likely among patients with unintentional firearm injuries (n = 180) compared with other unintentional injuries (n = 62,795; OR = 2.01 [95% CI, 1.31-3.09]) and no injuries (n = 172,830; OR = 3.43 [95% CI, 2.22-5.32]). No significant difference was seen in prior violence-related arrest between patients with intentional firearm injuries (n = 339) and other intentional injuries (n = 2,342; OR =1.1 [95% CI, 0.84-1.46]). The collective frequency of violence-related arrest for patients with unintentional firearm injuries, intentional firearm injuries and no injuries was 10%, 15% and 1%, respectively, over the follow-up period.

“Nonfatal firearm injuries of any intent — not just those that are assault-related — can have lasting negative physical and psychological effects,” Rowhani-Rahbar and colleagues concluded. “This investigation provides empirical evidence to support the inclusion of some patients with accidental firearm injury in hospital-based violence intervention programs.”

In an accompanying editorial, Stephen Hargarten, MD, MPH, from the Medical College of Wisconsin, wrote that these patients may benefit from biopsychosocial interventions that reduce future violence risk and address biophysical wounds.

"When people are injured by bullets, a team of caregivers provide vital resuscitation and operative interventions that save lives and reduce morbidity and disability," Hargarten wrote. "Trauma centers across America excel at treating acute injuries, especially those from bullets. However, treating only the biophysical effects of bullets on the human body is not enough. We need to probe about patients' behavioral and social history. Only by understanding the biopsychosocial factors that contribute to firearm violence can we develop informed prevention strategies."

He called for more research that “advances our understanding of the public health problem of firearm violence and incrementally informs our efforts for reducing its burden on communities across the United States.” – by Alaina Tedesco and Chelsea Frajerman Pardes

Disclosure: Rowhani-Rahbar reported no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.