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

(2024) 11:18 Salottolo et al. Injury Epidemiology https://doi.org/10.1186/s40621-024-00505-5 Injury Epidemiology Open Access RESEARCH A joinpoint analysis examining trends in firearm injuries at six us trauma centers from 2016 to 2022 Kristin Salottolo1,2,3, R. Joseph Sliter4, Gary Marshall5, Carlos H. Palacio Lascano6, Glenda Quan7, David Hamilton8, Robert Madayag9,10, Gina Berg4 and David Bar‑Or1,2,3*    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 2020H1 (SPC = 9.0%, p = 0.005), before stabilizing from 2020-H1 to 2022-H1 (0.5%, p = 0.73). NH black patients had the great‑ est 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 tem‑ poral 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 increas‑ ing 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, Racial disparities, Hospitalization, Traumatic injury, Temporal trends *Correspondence: David Bar‑Or Full list of author information is available at the end of the article © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom‑ mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Salottolo et al. Injury Epidemiology (2024) 11:18 Background There is an epidemic of firearm injuries in the United States (US) that impacts all ages, sexes, and races, but disproportionally affects males and racial/ethnic minorities (Fontanarosa and Bibbins-Domingo 2022; Mueller et al. 2023). More than 100,000 persons in the US suffer a firearm injury each year (Centers for Disease Control and Prevention 2023a). The US leads developed nations in firearm mortality, with nearly 49,000 firearm related deaths in 2021, up 30% from 38,000 deaths in 2016 (Centers for Disease Control and Prevention 2023b). Studies have reported a temporal increase in firearm related homicides and suicides over time (Wintemute 2015), and a spike during 2020, coinciding with the COVID-19 pandemic (Donnelly et al. 2023; McGraw et al. 2022). The largest temporal increases in firearm related homicides and suicides occurred among non-Hispanic (NH) black and other minority groups (Kegler et al. 2022). Much is known about firearm mortality due to several available US national repositories including the Centers for Disease Control and Prevention (CDC) WISQARS and National Violent Death Reporting System, and the CDC WONDER National Vital Statistics System (Centers for Disease Control and Prevention 2023a, b). However, nearly 80% of victims of firearm violence survive their injury and there is no adequate national repository to track nonfatal firearm injuries (National Opinion Research Center (NORC) at the University of Chicago 2020) Studies examining temporal changes in firearm related injuries across all ages report disparate findings, with some studies suggesting increases (Livingston et al. 2014) and others demonstrating no change (Cook et al. 2017; Davoudi and Woodworth 2023) or declines in hospitalization (Gross et al. 2017) due to firearm injuries. At a national level, firearm related emergency department (ED) visits have remained steady, but the patterns of ED visits due to firearms are changing with declines in assaults and increases in unintentional firearm injuries (Kalesan et al. 2021). However, most publications reporting on firearm injuries and hospitalizations present trends through 2016 (Cook et al. 2017; Gross et al. 2017; Kalesan et al. 2021, 2018; Gani et al. 2017; Smart et al. 2021). It is likely these data are not representative of present trends in firearm violence because there has been a nearly 30% increase in firearm mortality from 2016 to 2021 (Centers for Disease Control and Prevention 2023a), an increase in gun ownership from 39 to 45% from 2016 to 2021 (The Gallup Organization Guns 2024; Percentage of househol (...truncated)