First responders, doctors, and hospital staff do everything they can to save the lives of gunshot wound (GSW) victims. At times, they succeed, resulting in about 70,000 survivors of firearm injuries annually in the United States. But once survivors walk out the hospital doors and away from attentive eyes, it’s a different story.
A new study from researchers at Penn Medicine reveals survivors of GSWs have negative physical, mental and emotional outcomes for years after injury. This first-of-its-kind study suggests a critical need for long-term longitudinal care for victims, as well as more research to understand the unique patient population.
Michael Vella, M.D., (Penn Medicine), and his co-authors studied a voluntary participant group of 183 victims of GSWs—all injured by assault. Participants were evaluated with 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments, which have traditionally been used to evaluate patients with orthopedic problems, traumatic brain injuries and spinal cord injuries.
Most participants in the study reported worse function in the PROMIS domains of Global Physical Health (67.4%), Global Mental Health (55.7%), and Physical Function (64.5%) when compared with the general population. Additionally, the researchers noted postinjury unemployment and increased substance use as common survivor characteristics. In the study, unemployment rates decreased by 14.3% after injury, with overall combined alcohol an substance use increasing by 13.2%.
Two factors appear to worsen the outcome for GSW survivors—time since injury and severity of injury. While the median time elapsed between injury and study was 5.9 years (4.7 was the lowest, 8.1 the highest), the authors reported outcomes in the domain of Global Physical Health were worse in those more than 5 years since injury. Vella and co-authors accounted for injury severity by comparing participants with respect to the need for hospital and ICU admission.
“Patients admitted to the hospital reported worse outcomes in physical function and social roles compared with those discharged from the emergency department, and patients admitted to the ICU reported worse physical function compared with those not requiring ICU care. Although the present study focuses solely on markedly underreported patients with GSWs and more prolonged time from injury, our results are consistent with prior studies that have evaluated long-term outcomes in patients primarily with blunt trauma requiring ICU admission,” the authors wrote in the paper published in JAMA Surgery.
Lastly, Vella and co-authors used the PC-PTSD-5 test, which was developed to access the probably of PTSD in U.S. veterans, as another screening tool. Nearly 49%, or 89 of 183 participants in the study, has screening findings indicative of probable PTSD. Surprisingly, 33.3% of the study participants with seemingly minor injuries who were discharged from the emergency department rather than the hospital or ICU actually had screen findings for probable PTSD. For comparison, in an unrelated study of survivors of emergency department thoracotomy with critical injuries, only 25% of respondents had screen findings positive for PTSD.