Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries
IMPORTANCE: The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. OBJECTIVE: To determine the long-term functional, psychological, emotional, a...
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| Veröffentlicht in: | Archives of surgery (Chicago. 1960) 2020-01, Vol.155 (1), p.51-9 |
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| creator | Vella, Michael A Warshauer, Alexander Tortorello, Gabriella Fernandez-Moure, Joseph Giacolone, Joseph Chen, Bofeng Cabulong, Alexander Chreiman, Kristen Sims, Carrie Schwab, C. William Reilly, Patrick M Lane-Fall, Meghan Seamon, Mark J |
| description | IMPORTANCE: The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. OBJECTIVE: To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019. EXPOSURES: A GSW sustained from January 1, 2008, through December 31, 2017. MAIN OUTCOMES AND MEASURES: Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. RESULTS: Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P |
| doi_str_mv | 10.1001/jamasurg.2019.4533 |
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William ; Reilly, Patrick M ; Lane-Fall, Meghan ; Seamon, Mark J</creator><creatorcontrib>Vella, Michael A ; Warshauer, Alexander ; Tortorello, Gabriella ; Fernandez-Moure, Joseph ; Giacolone, Joseph ; Chen, Bofeng ; Cabulong, Alexander ; Chreiman, Kristen ; Sims, Carrie ; Schwab, C. William ; Reilly, Patrick M ; Lane-Fall, Meghan ; Seamon, Mark J</creatorcontrib><description>IMPORTANCE: The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. OBJECTIVE: To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019. EXPOSURES: A GSW sustained from January 1, 2008, through December 31, 2017. MAIN OUTCOMES AND MEASURES: Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. RESULTS: Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P < .001), Global Mental Health (48 [11]; P = .03), and Physical Function (45 [12]; P < .001) PROMIS metrics. Eighty-nine participants (48.6%) had a positive screen for probable PTSD. Patients who required intensive care unit admission (n = 64) had worse mean (SD) Physical Function scores (42 [13] vs 46 [11]; P = .045) than those not requiring the intensive care unit. Survivors no more than 5 years after injury had greater PTSD risk (38 of 63 [60.3%] vs 51 of 119 [42.9%]; P = .03) but better mean (SD) Global Physical Health scores (47 [11] vs 43 [11]; P = .04) than those more than 5 years after injury. CONCLUSIONS AND RELEVANCE: This study’s results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of GSWs may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount.</description><identifier>ISSN: 2168-6254</identifier><identifier>ISSN: 2168-6262</identifier><identifier>EISSN: 2168-6262</identifier><identifier>DOI: 10.1001/jamasurg.2019.4533</identifier><identifier>PMID: 31746949</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adult ; Age Distribution ; Clinical outcomes ; Cohort Studies ; Female ; Health Status ; Humans ; Injuries ; Male ; Mental Health ; Online First ; Original Investigation ; Pennsylvania - epidemiology ; Sex Distribution ; Stress Disorders, Post-Traumatic - epidemiology ; Substance-Related Disorders - epidemiology ; Survivors ; Trauma Centers ; Unemployment - statistics & numerical data ; Wounds, Gunshot - epidemiology ; Wounds, Gunshot - psychology ; Young Adult</subject><ispartof>Archives of surgery (Chicago. 1960), 2020-01, Vol.155 (1), p.51-9</ispartof><rights>Copyright American Medical Association Jan 2020</rights><rights>Copyright 2019 American Medical Association. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a449t-e4a8b1f10bd92d281c8fcd8fe971e9457bcf471cd976a1cdffe04ad511e5d39f3</citedby><cites>FETCH-LOGICAL-a449t-e4a8b1f10bd92d281c8fcd8fe971e9457bcf471cd976a1cdffe04ad511e5d39f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamasurgery/articlepdf/10.1001/jamasurg.2019.4533$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2019.4533$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,780,784,885,3338,27923,27924,76260,76263</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31746949$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vella, Michael A</creatorcontrib><creatorcontrib>Warshauer, Alexander</creatorcontrib><creatorcontrib>Tortorello, Gabriella</creatorcontrib><creatorcontrib>Fernandez-Moure, Joseph</creatorcontrib><creatorcontrib>Giacolone, Joseph</creatorcontrib><creatorcontrib>Chen, Bofeng</creatorcontrib><creatorcontrib>Cabulong, Alexander</creatorcontrib><creatorcontrib>Chreiman, Kristen</creatorcontrib><creatorcontrib>Sims, Carrie</creatorcontrib><creatorcontrib>Schwab, C. William</creatorcontrib><creatorcontrib>Reilly, Patrick M</creatorcontrib><creatorcontrib>Lane-Fall, Meghan</creatorcontrib><creatorcontrib>Seamon, Mark J</creatorcontrib><title>Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries</title><title>Archives of surgery (Chicago. 1960)</title><addtitle>JAMA Surg</addtitle><description>IMPORTANCE: The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. OBJECTIVE: To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019. EXPOSURES: A GSW sustained from January 1, 2008, through December 31, 2017. MAIN OUTCOMES AND MEASURES: Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. RESULTS: Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P < .001), Global Mental Health (48 [11]; P = .03), and Physical Function (45 [12]; P < .001) PROMIS metrics. Eighty-nine participants (48.6%) had a positive screen for probable PTSD. Patients who required intensive care unit admission (n = 64) had worse mean (SD) Physical Function scores (42 [13] vs 46 [11]; P = .045) than those not requiring the intensive care unit. Survivors no more than 5 years after injury had greater PTSD risk (38 of 63 [60.3%] vs 51 of 119 [42.9%]; P = .03) but better mean (SD) Global Physical Health scores (47 [11] vs 43 [11]; P = .04) than those more than 5 years after injury. CONCLUSIONS AND RELEVANCE: This study’s results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of GSWs may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount.</description><subject>Adult</subject><subject>Age Distribution</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Health Status</subject><subject>Humans</subject><subject>Injuries</subject><subject>Male</subject><subject>Mental Health</subject><subject>Online First</subject><subject>Original Investigation</subject><subject>Pennsylvania - epidemiology</subject><subject>Sex Distribution</subject><subject>Stress Disorders, Post-Traumatic - epidemiology</subject><subject>Substance-Related Disorders - epidemiology</subject><subject>Survivors</subject><subject>Trauma Centers</subject><subject>Unemployment - statistics & numerical data</subject><subject>Wounds, Gunshot - epidemiology</subject><subject>Wounds, Gunshot - psychology</subject><subject>Young Adult</subject><issn>2168-6254</issn><issn>2168-6262</issn><issn>2168-6262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtLJDEUhYOMqKh_wIUUuJmF1ZNnVWUzMIitQoMDjuuQzqNNU5VoUmnw35ui7UYni9wb7ncOSQ4AFwjOEITo11oOMuW4mmGI-IwyQg7ACUZNVze4wT_2PaPH4DylNSyrg5ASfgSOCWppwyk_AXoR_KoeTRyqefZqdMHL_rr6m97VS-jDyqnpeDuE3UR6XT0F5WRfPeZRhcGkyvnqKceN24SYqmCruYtGFscHv87RmXQGDq3skzn_rKfgeX777-a-XjzePdz8WdSSUj7WhspuiSyCS82xxh1SnVW6s4a3yHDK2qWytEVK87aRpVhrIJWaIWSYJtySU_B76_ual4PRyvgxyl68RjfI-C6CdOL7xLsXsQob0XCIUYeLwc9PgxjeskmjGFxSpu-lNyEngQlqKIEt4QW9-g9dhxzLF00UZaxsGBYKbykVQ0rR2P1lEBRTjmKXo5hyFFOORXT59Rl7yS61AlxsgaLdT3HLGGkQ-QCO-6V_</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Vella, Michael A</creator><creator>Warshauer, Alexander</creator><creator>Tortorello, Gabriella</creator><creator>Fernandez-Moure, Joseph</creator><creator>Giacolone, Joseph</creator><creator>Chen, Bofeng</creator><creator>Cabulong, Alexander</creator><creator>Chreiman, Kristen</creator><creator>Sims, Carrie</creator><creator>Schwab, C. William</creator><creator>Reilly, Patrick M</creator><creator>Lane-Fall, Meghan</creator><creator>Seamon, Mark J</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200101</creationdate><title>Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries</title><author>Vella, Michael A ; Warshauer, Alexander ; Tortorello, Gabriella ; Fernandez-Moure, Joseph ; Giacolone, Joseph ; Chen, Bofeng ; Cabulong, Alexander ; Chreiman, Kristen ; Sims, Carrie ; Schwab, C. William ; Reilly, Patrick M ; Lane-Fall, Meghan ; Seamon, Mark J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a449t-e4a8b1f10bd92d281c8fcd8fe971e9457bcf471cd976a1cdffe04ad511e5d39f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Age Distribution</topic><topic>Clinical outcomes</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Health Status</topic><topic>Humans</topic><topic>Injuries</topic><topic>Male</topic><topic>Mental Health</topic><topic>Online First</topic><topic>Original Investigation</topic><topic>Pennsylvania - epidemiology</topic><topic>Sex Distribution</topic><topic>Stress Disorders, Post-Traumatic - epidemiology</topic><topic>Substance-Related Disorders - epidemiology</topic><topic>Survivors</topic><topic>Trauma Centers</topic><topic>Unemployment - statistics & numerical data</topic><topic>Wounds, Gunshot - epidemiology</topic><topic>Wounds, Gunshot - psychology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vella, Michael A</creatorcontrib><creatorcontrib>Warshauer, Alexander</creatorcontrib><creatorcontrib>Tortorello, Gabriella</creatorcontrib><creatorcontrib>Fernandez-Moure, Joseph</creatorcontrib><creatorcontrib>Giacolone, Joseph</creatorcontrib><creatorcontrib>Chen, Bofeng</creatorcontrib><creatorcontrib>Cabulong, Alexander</creatorcontrib><creatorcontrib>Chreiman, Kristen</creatorcontrib><creatorcontrib>Sims, Carrie</creatorcontrib><creatorcontrib>Schwab, C. William</creatorcontrib><creatorcontrib>Reilly, Patrick M</creatorcontrib><creatorcontrib>Lane-Fall, Meghan</creatorcontrib><creatorcontrib>Seamon, Mark J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of surgery (Chicago. 1960)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vella, Michael A</au><au>Warshauer, Alexander</au><au>Tortorello, Gabriella</au><au>Fernandez-Moure, Joseph</au><au>Giacolone, Joseph</au><au>Chen, Bofeng</au><au>Cabulong, Alexander</au><au>Chreiman, Kristen</au><au>Sims, Carrie</au><au>Schwab, C. William</au><au>Reilly, Patrick M</au><au>Lane-Fall, Meghan</au><au>Seamon, Mark J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries</atitle><jtitle>Archives of surgery (Chicago. 1960)</jtitle><addtitle>JAMA Surg</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>155</volume><issue>1</issue><spage>51</spage><epage>9</epage><pages>51-9</pages><issn>2168-6254</issn><issn>2168-6262</issn><eissn>2168-6262</eissn><abstract>IMPORTANCE: The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. OBJECTIVE: To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019. EXPOSURES: A GSW sustained from January 1, 2008, through December 31, 2017. MAIN OUTCOMES AND MEASURES: Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. RESULTS: Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P < .001), Global Mental Health (48 [11]; P = .03), and Physical Function (45 [12]; P < .001) PROMIS metrics. Eighty-nine participants (48.6%) had a positive screen for probable PTSD. Patients who required intensive care unit admission (n = 64) had worse mean (SD) Physical Function scores (42 [13] vs 46 [11]; P = .045) than those not requiring the intensive care unit. Survivors no more than 5 years after injury had greater PTSD risk (38 of 63 [60.3%] vs 51 of 119 [42.9%]; P = .03) but better mean (SD) Global Physical Health scores (47 [11] vs 43 [11]; P = .04) than those more than 5 years after injury. CONCLUSIONS AND RELEVANCE: This study’s results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of GSWs may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>31746949</pmid><doi>10.1001/jamasurg.2019.4533</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Distribution Clinical outcomes Cohort Studies Female Health Status Humans Injuries Male Mental Health Online First Original Investigation Pennsylvania - epidemiology Sex Distribution Stress Disorders, Post-Traumatic - epidemiology Substance-Related Disorders - epidemiology Survivors Trauma Centers Unemployment - statistics & numerical data Wounds, Gunshot - epidemiology Wounds, Gunshot - psychology Young Adult |
| title | Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries |
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