Firearm Reinjury and Subsequent Mortality: Identifying a High-Risk Population for Hospital-Based Violence Intervention

Background Survivors of firearm injury are at elevated risk for subsequent firearm trauma, yet firearm reinjury remains poorly characterized. We utilized a statewide trauma registry linked with vital records to characterize firearm reinjury epidemiology and risk factors. Methods Using the North Carolina Trauma Registry (2013-2023) linked with Vital Records death certificates, we identified patients with firearm injuries. Demographics were analyzed per-patient; injury data per-encounter. Reinjury rates were calculated and adjusted for mortality. Results Among 20,566 patients, 697 (3.4%) experienced reinjury. The adjusted reinjury rate was 4.2%; the adjusted rate of third firearm injury was 7.5%. Reinjured patients were younger (28.2 vs 32.0 years), more likely male (96.1% vs 85.9%), Black (83.9% vs 62.5%), and injured by assault (86.0% vs 71.6%; all P < 0.001). Overall mortality was higher in reinjured patients (35.5% vs 15.5%, P < 0.001), though in-hospital mortality was lower (7.8% vs 12.2%, P < 0.001). Discussion Firearm reinjury affects 4% of survivors with high out-of-hospital mortality. Those sustaining reinjury are more likely to be young, male, black, and injured by assault. Given the mortality rate of 35.5% associated with reinjury, this represents an at-risk population for which a critical period of intervention has been identified. This data represents an opportunity for intervention, supporting continued investment in violence intervention programs.