Geriatric Firearm Injuries Presenting to Level I Trauma Centers in St. Louis from 2016 to 2023: A Multi-Site Observational Cohort Study

Firearm injury (FI) is a public health epidemic in the US, yet there is limited understanding of FI in the geriatric population. To describe firearm injury among patients >55 years old who presented to a level I trauma center with an acute injury, and to understand age-related differences within the cohort. This is a multi-center, retrospective observational cohort study of all patients > 55 years old presenting to one of two Level 1 trauma centers between January 2016 and March 2023 with acute FI. We collected data on demographics, mortality, medical comorbidities, and FI intent. Comparative analysis was conducted using Chi- square and Fisher’s Exact tests. Between 2016 and 2023, 570 patients aged > 55 presented with acute FI. Patients were median age 60 (IQR 57-65), 83% male, 64% Black, and 99.3% non-Hispanic. Overall mortality was 6.3%. Younger patients (<65 years) were more likely to be Black (p<0.001), uninsured (p<0.001), suffer from substance abuse disorders (p=0.005), trend toward higher social vulnerability (p=0.067), and experience assault/homicide (p=0.001). Patients >65 years were more likely to be White, have significant medical problems (p<0.001), and experience unintentional FI (p =0.001). This study presents a unique cohort of geriatric FI patients in areas of high social vulnerability and high assault rates, indicating that community violence may impact this cohort. Significant medical problems and unintentional FI were more common amongst patients 65 and older. Interventions tailored to a geriatric population may be more effective if narrowed to patients 65 and older.