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Firearm Injury Prevention

Avery Nathens, MD & Deborah Kuhls, MD

This project will use data from 71 trauma centers in the ACS Trauma Quality Improvement Program (TQIP). Investigators will plumb TQIP data in order to quantify and describe the risk factors for non-lethal firearm injuries in the U.S., the context in which injuries occur, the severity of injuries, how healthcare resources are used, and patient outcomes.

Firearm homicide is the second-leading cause of death for adolescents and young adults in the U.S. As such, its prevention is imperative, as is the prevention of non-lethal firearm assaults, because survivors are at higher risk of future violence; injury recidivism; and poor social, economic, and mental health outcomes.

“There are major gaps in the collection and availability of firearm-related data across the country,” said Avery Nathens, MD, Medical Director of Trauma Quality Programs at ACS, and the co-principal investigator on the project. “We need a dataset that provides a robust description of non-lethal firearm injuries, hospitalization characteristics, circumstances surrounding the event, personal risk factors, and community-level factors that predispose to these risks.”

Existing systems, including the CDC Web-based Injury Statistics Query and Reporting System (WISQARS) and the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ), have many limitations. Importantly, these databases do not collect or report on clinical information such as severity of injuries and their outcomes, nor do they contextualize injuries with data related to individual risk factors, co-morbid illnesses, substance abuse or mental illness, life stressors, prior violent injuries or suicide attempts, community social determinants of health (SDH), how or why firearms are accessed or obtained for suicide attempts, circumstances preceding injury, and victim-perpetrator relationships.

“We need to understand who is most impacted, why such injuries occur, what are modifiable risk factors, and how potential interventions might work,” added Deborah Kuhls, MD, a recognized clinical leader in the firearm injury prevention field and co-principal investigator. “Understanding such factors can better inform policies that could be employed to address both individual and community risk factors contributing to violence.”

This work has the potential to dramatically enhance our understating of non-lethal firearm injuries across the U.S. in both pediatric and adult populations, to identify differences between lethal and non-lethal firearm injuries, and to inform better estimates of the burden of firearm injuries in the U.S.

The American College of Surgeons Trauma Quality Improvement Program presents aggregated injury data from over 800 trauma programs. In all, the 71 centers being queried for the study treated 6,153 firearm injuries in 2018, 74% of which were assaults, providing an adequate dataset of firearm injuries for analysis. The ACS submitted the proposal as a member of the Coalition for National Trauma Research (CNTR).