A prospective cohort study published in JAMA Surgery1 suggests that negative long-term psychosocial outcomes may follow recovery from gunshot wounds (GSWs), particularly alcohol and substance use disorders and posttraumatic stress disorder.

Physicians at the Perelman School of Medicine at the University of Pennsylvania assessed outcomes in GSW survivors after treatment at the Perelman trauma clinic. Investigators contacted all adult (>18 years) patients discharged after sustaining GSWs between January 2008 and December 2017. Patients who consented were evaluated via telephone with 9 instruments: Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, Severity of Substance Use, and the Primary Care Posttraumatic Stress Disorder Screen.

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Of 3088 patients treated for GSWs during the study period, 183 individuals participated. Participants were primarily young (median age at GSW, 27 years), black (91.8%), and male (92.3%), and a majority required hospital admission after GSW (82.0%). The median elapsed time between GSW and study participation was 5.9 years.

Compared with the pre-GSW period, combined alcohol and substance use increased by 13.2% (30.8% vs 44.0%) and employment decreased by 14.3% (76.0% vs 62.1%) post-GSW. Participants had mean scores below population norms for Global Physical Health (P <.001), Global Mental Health (P =.03), and Physical Function (P <.001), although Emotional Support (P <.001) was higher. Notably, pain (P =.04), alcohol use (P <.001), and substance use severity (P =.001) scores were lower in the GSW group.

Compared with participants with ≤5 years since GSW, participants with >5 years reported worse Global Physical Health mean scores (P =.04) and were less likely to positively screen for probable posttraumatic stress disorder (P =.03). More than half (56.1%) of participants who described their GSW as a traumatic event screened positive for probable posttraumatic stress disorder. Patients who required intensive care unit admission had worse mean Physical Function scores compared with those who did not require intensive care unit admission (P =.045).

These data reflect the lasting effect of GSWs on victims, with poor physical and psychosocial outcomes after 5 years, indicating that the burden of gun violence extends beyond mortality and economic cost. In a companion JAMA Surgery commentary piece, Rochelle A. Dicker, MD and Laurie J. Punch, MD emphasized the importance of research approaches that center the survivor’s voice.2 They noted that patient narratives identify “otherwise invisible structural and social determinants of health.”2

In 2019, the American College of Surgeons and the Committee on Trauma promoted a series of guidelines to address firearm injury, which included public education programs and hospital-based violence intervention. Formal trauma-focused patient-reported outcome measures are also in development, with intent to identify other postdischarge outcomes that may require intervention. Survey data from survivors of GSW allow for “scholarship toward a more complete treatment of firearm violence within individuals and communities.”2 Further research into the long-term outcomes of GSWs is necessary to elucidate all unmet treatment needs.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures

Reference

1. Vella MA, Warshauer A, Tortorello G, et al. Long-term functional, psychological, emotional, and social outcomes in survivors of firearm injuries [published online November 20, 2019]. JAMA Surg. doi:10.1001/jamasurg.2019.4533

2. Dicker RA, Punch LJ. Long-term consequences in trauma: at the center of the public health approach is the survivor’s voice [published online November 20, 2019]. JAMA Surg. doi:10.1001/jamasurg.2019.4560