Violence Perpetration Among Patients Hospitalized for Unintentional and Assault-Related Firearm Injury: A Case-Control Study and a Cohort Study.

Abstract

Hospital-based violence intervention programs typically focus on patients whose firearm injury occurred through interpersonal violence (assault). Knowledge of violence perpetration by victims of unintentional (accidental) firearm injury is limited. To examine violence perpetration before and after a patient becomes hospitalized for firearm injury according to injury intent (intentional [assault] or unintentional [accidental]). A case-control study and a retrospective cohort study. Hospitals in Washington. Persons aged 15 years or older hospitalized for a firearm injury, other injuries, or a noninjury reason from 2006 to 2007. In the case-control study, the odds of violence-related arrest from 2001 through hospitalization by injury intent among 3 groups were compared. In the cohort study, the rates of violence-related arrest from hospitalization through 2011 by injury intent among 3 groups were compared. Patients with unintentional firearm injuries (n= 180) were more likely than those with other unintentional injuries (n= 62795; odds ratio [OR], 2.01 [95% CI, 1.31 to 3.09]) and no injuries (n= 172830; OR, 3.43 [CI, 2.22 to 5.32]) to have been arrested for a violent crime before hospitalization. Prior violence-related arrest did not differ between patients with assault-related firearm injuries (n= 339) and those with other assault-related injuries (n= 2342; OR, 1.10 [CI, 0.84 to 1.46]). During follow-up, the cumulative incidence of violence-related arrest for patients with unintentional and assault-related firearm injuries was 10% and 15% (subhazard ratio, 1.88 [CI, 1.11 to 3.17] and 1.61 [CI, 1.08 to 2.44]), respectively, compared with 1% for those without injuries. Exclusion of self-inflicted injuries, misclassification of intent, and ascertainment bias. Some firearm injuries classified as accidental may indicate involvement in the cycle of violence and present an opportunity for intervention. City of Seattle and the University of Washington Royalty Research Fund.