Background: The burden of firearm injury (FI) extends beyond hospitalization; however, literature focuses mostly on short-term physical outcomes. This study aimed to assess changes in patient-reported outcomes following firearm-related trauma. We hypothesized long-term patient-reported socioeconomic, mental health, and quality-of-life (QoL) outcomes are worse post-FI compared to pre-FI.
Methods: This was a retrospective study where a phone survey was conducted with FI survivors admitted between January 2017 and August 2022 at a level 1 trauma center. Survey questions assessed demographics, socioeconomics, and mental and physical health pre-FI vs ≥ 6 months post-FI; the McNemar test was used for comparisons. The PROMIS-29 + 2v2.1 NIH validated instrument was used to assess long-term QoL. Standardized NIH PROMIS T-scores were calculated using the HealthMeasures Scoring Service.
Results: Of 204 eligible FI survivors, 71 were successfully contacted and 38 surveyed. Respondents were male (86.8%), Black (76%), and aged 18-29 (55.3%), and 68.4% had high school level education. Post-FI, patients were more likely to be unemployed (55.2% vs 13.2%, P < .001) and report increased mental health needs (84.2% vs 21%, P < .001) compared to pre-FI. Most (73.7%) also reported lasting physical disability. Similarly, the PROMIS instrument demonstrated largely worse health-related QoL scores post-FI, particularly high anxiety/fear (T-score 60.2, SE 3.1, CI 54.6-66.3, Table 2), pain resulting in life interference (T-score 60.0, SE 2.3, CI 55.7-63.9), and worse physical function (T-score 42.5, SE 3.0, CI 38.2-46.9).
Conclusions: Firearm injury survivors had more unemployment and worse mental health post-FI compared to pre-FI. Firearm injury survivors also reported significantly worse health-related QoL metrics including pain, anxiety, and physical function 6 months following their trauma. These long-term patient-reported outcomes are a framework to build future outpatient resources.
Centers for Disease Control and Prevention. Fatal injury data. In: Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: National Center for Injury Prevention and Control. Available fromhttp://www.cdc.gov/injury/wisqars/index.html. Accessed on 1 December 2023.
2.
Injuries by Intent in the United States. 2016-2018 hospital discharge records from the healthcare cost and utilization project. West J Emerg Med. 2021;22(3):462-470.
3.
GreenspanAIKellermannAL. Physical and psychological outcomes 8 months after serious gunshot injury. J Trauma. 2002;53(4):709-716.
4.
VellaMAWarshauerATortorelloG, et al.Long-term functional, psychological, emotional, and social outcomes in survivors of firearm injuries. JAMA Surg. 2020;155(1):51-59.
5.
KisalaPABoultonAJCohenML, et al.Interviewer- versus self-administration of PROMIS® measures for adults with traumatic injury. Health Psychol. 2019;38(5):435-444.
6.
HungMStuartARHigginsTFSaltzmanCLKubiakEN. Computerized adaptive testing using the PROMIS Physical Function item bank reduces test burden with less ceiling effects compared with the short musculoskeletal function assessment in orthopaedic trauma patients. J Orthop Trauma. 2014;28(8):439-443.
7.
BroderickJEDeWittEMRothrockNCranePKForrestCB. Advances in patient-reported outcomes: the NIH PROMIS(®) measures. EGEMS (Wash DC). 2013;1(1):1015.
8.
KellerDKulpHMaherZSantoraTAGoldbergAJSeamonMJ. Life after near death: long-term outcomes of emergency department thoracotomy survivors. J Trauma Acute Care Surg. 2013; 74(5):1315-1320.
9.
LivingstonDHTrippTBiggsCLaveryRFLaveryRobert F. A fate worse than death? long-term outcome of trauma patients admitted to the surgical intensive care unit. J Trauma. 2009;67(2):341-348.
10.
HaysRDSpritzerKLSchaletBDCellaD. PROMIS®-29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018;27(7):1885-1891.
11.
GabbeBJSimpsonPMCameronPAPonsfordJLyonsRACollieAFitzgeraldMJudsonRTeagueWJBraafSNunnAAmeratungaSHarrisonJE. Long-term health status and trajectories of seriously injured patients: a population-based longitudinal study. Plos Medicine. 2017;14:e1002322.
12.
JosephBHannaKCallcutRAColemanJJSakranJVNeumayerLA. The hidden burden of mental health outcomes following firearm-related injures. Ann Surg. 2019;270(4):593-601.
13.
ZatzickDJurkovichGJRivaraFPWangJFanMYJoeschJMackenzieE. A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Ann Surg. 2008;248(3):429-437.
14.
American College of Surgeons. Resources for Optimal Care of the Injured Patient. Chicago, IL: American College of Surgeons; 2022:107.
15.
HaiderAHHerrera-EscobarJPAl RafaiSSHarlowAFApojMNehraDKasotakisGBraselKKaafaraniHMAVelmahosGSalimA. Factors associated with long-term outcomes after injury: results of the functional outcomes and recovery after trauma emergencies (FORTE) multicenter cohort study. Ann Surg. 2020;271(6):1165-1173.
16.
SobergHLBautz-HolterERoiseOFinsetA. Long-term multidimensional functional consequences of severe multiple injuries two years after trauma: a prospective longitudinal cohort study. J Trauma. 2007;62(2):461-470.
17.
BlackN. Patient reported outcome measures could help transform healthcare. BMJ. 2013;346:f167.
18.
PapeHCZelleBLohseRStalpMHildebrandFKrettekCPanzicaMDuhmeVSittaroNA. Evaluation and outcome of patients after polytrauma--can patients be recruited for long-term follow-up?Injury. 2006;37(12):1197-1203.
