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Cited by 3Gun Ownership and Violence ResearchTrauma and Emergency Care StudiesHomicide, Infanticide, and Child Abuse

Firearm injuries in Missouri

Open access
Rivara, Frederick P., Hink, Ashley B., Kuhls, Deborah, Banks, Samantha, Agoubi, Lauren L., Kirkendoll, Shelbie, Winchester, Alex, Hoeft, Christopher +2 more·2023·PLOS ONE
DOI 10.1371/journal.pone.0294737PMC PMC10664957
Open this paper in CoChat — free accountOpen PDF

Abstract

Firearm deaths continue to be a major public health problem, but the number of non-fatal firearm injuries and the characteristics of patients and injuries is not well known. The American College of Surgeons Committee on Trauma, with support from the National Collaborative on Gun Violence Research, leveraged an existing data system to capture lethal and non-lethal injuries, including patients treated and discharged from the emergency department and collect additional data on firearm injuries that present to trauma centers. In 2020, Missouri had the 4th highest firearm mortality rate in the country at 23.75/100,000 population compared to 13.58/100,000 for the US overall. We examined the characteristics of patients from Missouri with firearm injuries in this cross-sectional study. Of the overall 17,395 patients, 1,336 (7.7%) were treated at one of the 11 participating trauma centers in Missouri during the 12-month study period. Patients were mostly male and much more likely to be Black and uninsured than residents in the state as a whole. Nearly three-fourths of the injuries were due to assaults, and overall 7.7% died. Few patients received post-discharge services.

AI snapshot

Written from the paper’s full text.

TL;DR

This cross-sectional study characterized 1,336 firearm injury patients with Missouri residential zip codes treated at 11 participating ACS trauma centers from March 2021 to February 2022. Patients were disproportionately young, male, Black, uninsured, and from highly distressed communities; most injuries were assaults, 7.7% died, and few received post-discharge services.

Key findings

  • Of 17,395 patients in the data system, 1,336 (7.7%) were treated at one of 11 participating Missouri trauma centers; median age was 29.0 years, 83.0% were male, 78.8% were Black versus 11.8% of Missouri residents, and 53.1% were uninsured versus 9.3% statewide.
  • Injury intent was 72.9% assault, 10.8% unintentional, and 3.9% self-inflicted; among 708 patients with context data, assault injuries commonly involved community violence, self-inflicted injuries were associated with intoxication in 25.8%, mental illness in 48.4%, and personal crisis in 45.2%, while unintentional injuries usually involved firearm handling (78.5%).
  • Overall, 7.7% died (103/1,336), including 66 deaths in the ED; 43.4% were discharged alive from the ED, and among survivors only 12.3% received any discharge care, 4.3% received social work/mental health services, and 5.4% received violence intervention/IPV services.
  • Patients lived in more distressed communities than the state overall: mean Distressed Community Index score 81.1 versus 61.5, with 69.4% in the most distressed quintile versus 24.6% of Missouri; urban patients were more likely than rural patients to be in the most distressed quintile (71.9% vs 39.8%).

Methods

  • Cross-sectional study using ACS Trauma Quality Improvement Program data from 11 Missouri trauma centers; eligible patients were any age, arrived alive, had a Missouri residential zip code, and had a firearm injury between March 1, 2021 and February 28, 2022. Centers started participation at varying times and may not have contributed 12 months of data.
  • Data were abstracted from the electronic health record by trained personnel, with expanded inclusion of patients discharged from the ED and additional variables on demographics, risk factors, injury circumstances, firearms, and discharge outcomes; RUCA codes and the Distressed Community Index were linked by ZIP code.
  • Analysis used descriptive tables, Pearson chi-squared tests, two-sided t-tests, and Fisher’s exact tests when cells had fewer than 10 observations; p-values were significant at 0.05. Sex and alcohol screen results were imputed, and several select-all variables were recoded; analyses were done in RStudio 4.2.2.

Limitations

  • The paper states that many firearm deaths occur at the scene, especially suicide attempts (about 90% lethal), so self-inflicted injuries are underrepresented (only 4.3% of patients); missingness may reflect inadequate resources, training, and documentation, plus extra abstraction burden during the COVID-19 pandemic; centers started at varying times and may not have contributed 12 months, underrepresenting all patients treated at participating centers; no additional funding supported data collection.
  • The text also makes evident substantial missingness in key variables, including drug screen (71.8%), prior arrest/incarceration (65.7%), context of injury (47.0%), and mental illness (29.0%), which limits interpretation.
  • The study relies on volunteer trauma centers and compares patients mainly with state residents rather than a matched control group, so findings may not generalize to all firearm injuries in Missouri.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0294737

Cites

17 of 17 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

6 of 20 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Interpretationcitation

    The data demonstrate the effects of long-standing structural racism on the epidemiology of firearm injuries.

    “Combined with the fact that the vast majority of firearm injuries in these urban areas were to Black males, the data demonstrate the effects of long-standing structural racism on the epidemiology of firearm injuries [9–11].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [9] M Siegel, 2022, Measuring Structural Racism and Its Association with Racial Disparities in Firearm Homicide., J Racial Ethn Health Disparities source

      The Discussion reports that county-level structural racism scores were associated with higher Black firearm homicide rates and greater Black–White disparities. That supports a relationship with firearm homicide, but the paper does not establish causal effects or address firearm injuries generally. Its Methods measure county-level homicide rates, not the urban injury patterns described in the citing sentence. Page numbers were not available in our copy. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [10] M Siegel, 2023, The relationship between state-level structural racism and disparities between the non-hispanic black and non-hispanic white populations in multiple health outcomes., J Natl Med Assoc source
    • cites [11] B Wong, 2020, Differences in Racial Disparities in Firearm Homicide across Cities: The Role of Racial Residential Segregation and Gaps in Structural Disadvantage., J Natl Med Assoc source
  • Premisecitation

    The currently available evidence suggests that hospital-based violence intervention programs do not prevent recidivism and subsequent violence.

    “While hospital-based violence intervention programs are often suggested as interventions to prevent recidivism and subsequent violence [17], the currently available evidence suggests otherwise [18, 19].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [18] DW Webster, 2022, Research on the efefcts of hosptial-based violence intervention programs: Observations and recommendations., Annals American Academy Policial Social Sciences source
    • cites [19] S Affinati, 2016, Hospital-based violence intyervention programs targeting adult populaitons: an Eastern Association for the Suergey of Trauma evidence-based review., Trauma Surgy Acute Care Open source

      The Results report that four studies found no effect and that no study demonstrated a statistically significant reduction in violent reinjury. But three studies suggested a positive effect, and the Conclusions say the weak aggregate evidence permits neither validation nor invalidation of HVIP efficacy. The review therefore does not support the broader inference that the available evidence suggests these programs do not prevent recidivism. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Findingown data

    Nearly three-fourths of the injuries were due to assaults.

    “Nearly three-fourths of the injuries were due to assaults, and overall 7.7% died.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Even fewer had access to violence prevention programs.

    “Very few had social work services post-discharge, and even fewer had access to violence prevention programs.”
    Quote in the paperSubstantial claim
  • Findingown data

    When patient outcomes were examined by insurance status, stratifying for injury intent, there were no significant differences in mortality.

    “When we examined patient outcomes by insurance status, stratifying for injury intent, there were no significant differences in mortality (Table 5).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 13
  • The quote only partly states this claim. 5

  • May combine two claims.

    Premisecitation

    Medicaid expansion has potential benefits including reduction of suicide rates and improving access to inpatient rehabilitation after acute hospitalization among those injured by firearms.

    “While Missouri expanded Medicaid in 2021, the high percentage of firearm injured patients without insurance is of great concern given the potential benefits of Medicaid expansion that include reduction of suicide rates and improving access to inpatient rehabilitation after acute hospitalization among those who are injured by firearms [20, 21].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [20] H Patel, 2022, Association of State Medicaid Expansion Status With Rates of Suicide Among US Adults, JAMA Netw Open source
    • cites [21] MR Ross, 2022, Impact of Medicaid expansion on young adult firearm and motor vehicle crash trauma patients., Surg Open Sci source

      The Results section (page not provided) reports that Medicaid expansion was associated with increased discharge to inpatient rehabilitation among young adult firearm trauma patients. It does not report a reduction in suicide rates; its mortality finding concerns deaths in hospital among firearm trauma patients, which is a different outcome. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior studies indicate that verified and/or designated trauma centers care for approximately 70% of medically treated firearm injuries in the U.S.

    “Prior studies indicate that verified and/or designated trauma centers care for approximately 70% of medically treated firearm injuries in the U.S [5].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] E Coupet, 2019, US Emergency Department Encounters for Firearm Injuries According to Presentation at Trauma vs Nontrauma Centers., JAMA Surg source

      The Results (p. not available) report that 309,930 of 445,915 US emergency-department encounters for firearm injury (69.5%) were treated at trauma centers. The Methods (p. not available) define these as level I–III trauma centers, but the paper does not establish their verification or designation status, and its estimate covers ED encounters rather than all medically treated firearm injuries. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Approximately 89% of firearm assaults and unintentional shootings are non-lethal, while only about 10% of suicide attempts are non-lethal.

    “Given the large proportion of firearm injuries that are non-lethal (approximately 89% of firearm assaults and unintentional shootings, although only about 10% of suicide attempts) [4]”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] SA Spitzer, 2020, Incidence, Distribution, and Lethality of Firearm Injuries in California From 2005 to 2015., JAMA network open source

      The Results > CFRs section (page unavailable) reports that the case fatality ratio for self-inflicted firearm injuries remained above 90%, supporting the claim that fewer than about 10% were nonfatal. But it reports fatality ratios of 23.3%–26.6% for assaults and 1.1%–5.3% for unintentional injuries; it does not support an approximately 89% nonfatal proportion for those categories. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Few patients received post-discharge services.

    “Few patients received post-discharge services.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among self-inflicted injuries with context data, 45.2% were associated with a personal crisis.

    “Personal Crisis | 14 (45.2%)”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    About 1 in 6 (16.2%) patients was intoxicated at the time of ED assessment.

    “About 1 in 6 patients was intoxicated at the time of the emergency department (ED) assessment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients with firearm injuries in Missouri lived in communities with much higher DCI scores and were much more likely to live in the most distressed communities (69.4% vs 24.6%) compared to the state as a whole.

    “Patients with firearm injuries in Missouri lived in communities with much higher DCI scores and were much more likely to live in the most distressed communities (69.4% vs 24.6%) compared to the state as a whole (Table 6).”
    • Also stated in: § Discussion · boosted
      “A striking finding is the much higher levels of distress in communities in which individuals are experiencing firearm injuries compared to residents of the state as a whole.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In this analysis of 1336 patients with Missouri residential zip codes treated at 11 trauma centers in Missouri, patients were mostly male and much more likely to be Black and uninsured than residents in the state as a whole.

    “In this analysis of 1336 patients with Missouri residential zip codes treated at 11 trauma centers in Missouri, patients were mostly male and much more likely to be Black and uninsured than residents in the state as a whole.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Data were collected on 17,395 patients, of whom 1,336 (7.7%) were treated at one of the 11 participating trauma centers in Missouri during the 12-month study period.

    “Data were collected on 17,395 patients of whom 1,336 (7.7%) were treated at one of the 11 participating trauma centers in Missouri.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of 165 provisionally enrolled trauma centers, 128 ultimately contributed data, of which 11 were in Missouri.

    “We recruited volunteer participation from the entire TQIP sample and provisionally enrolled 165 trauma centers to participate in this program; 128 ultimately contributed data, of which 11 were in Missouri.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    More than half (53.1%) of Missouri firearm injury patients were uninsured, compared to 9.3% of Missouri state residents.

    “More than half of the patients in Missouri were recorded as being uninsured, compared to 9.3% in the state as a whole.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients who sustained firearm injuries from assault had the highest mean DCI and were most likely to live in the most distressed communities.

    “Patients who sustained firearm injuries from assault had the highest mean DCI and were most likely to live in the most distressed communities.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among assault injuries with context data, interpersonal and random violence were also common.

    “Shootings related to interpersonal and random violence were also common.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Three-quarters of patients in urban areas were injured in assaults compared with less than half in rural areas.

    “Three-quarters of patients in urban areas were injured in assaults compared with less than half in rural areas.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Injuries occurred in a variety of settings, most commonly in homes, streets, motor vehicles and commercial areas.

    “The injuries occurred in a variety of settings, most commonly in homes, streets, motor vehicles and commercial areas.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The extra time required of trauma personnel to locate and extract the additional data may have limited their ability to do so.

    “Additionally, the extra time required of trauma personnel to locate and extract the additional data may have limited their ability to do so, notably during the data collection period when trauma centers reported an increase in trauma volume as a result of the COVID-19 pandemic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Mechanisms to capture these data have been developed through the CDC National Violent Death Reporting System (NVDRS) but are limited to injuries that result in death.

    “For this reason, mechanisms to capture these data have been developed through the CDC National Violent Death Reporting System (NVDRS) but are limited to injuries that result in death [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] National Violent Death Reporting System. 2023 [cited 2023]. Available from: https://www.cdc.gov/violenceprevention/datasources/nvdrs/index.html.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was approved by an IRB, and consent for the registry to abstract data from the medical record was waived.

    “The study was approved by Advarr CIRBITM. Consent for the registry to abstract data from the medical record was waived by the IRB.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other studies have found half of firearm injured patients had an arrest in the prior 2 years.

    “other studies which have found half of firearm injured patients had an arrest in the prior 2 years [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] BM Mills, 2018, Prior arrest, substance use, mental disorder, and intent-specific firearm injury., AM J Prev Med source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Centers started participation at varying times during the study period and may not have contributed 12-months of data.

    “Centers started participation at varying times during the study period and may not have contributed 12-months of data.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The missing data was not a failure of chart abstraction by the coders but lack of collection and documentation of this data by health care providers.

    “We do not think this was a failure of chart abstraction by the coders but lack of collection and documentation of this data by health care providers.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In 2020, Missouri had the 4th highest firearm mortality rate in the country at 23.75/100,000 population compared to 13.58/100,000 for the US as a whole.

    “In 2020, Missouri had the 4th highest firearm mortality rate in the country at 23.75/100,000 population compared to 13.58/100,000 for the US as a whole”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] National Center for Health Statistics. National Vital Statistics System, Provisional Mortality on CDC WONDER Online Database., 2023

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Many patients with firearm injuries die at the scene, especially those who used a firearm to attempt suicide.

    “First, many patients with firearm injuries die at the scene, especially those who used a firearm to attempt suicide, 90% of which result in death [22].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Z Cai, 2022, The lethality of suicide methods: A systematic review and meta-analysis, J Affect Disord source

  • May combine two claims.

    Interpretationreasoning

    The limitation of NVDRS to fatal injuries has the potential to significantly bias understanding of risk factors and circumstances surrounding firearm injury events, therefore limiting understanding of potential interventions to prevent re-injury or death.

    “this is a significant limitation and has the potential to significantly bias our understanding of risk factors and the circumstances surrounding the firearm injury event, therefore limiting our understanding of potential interventions to prevent re-injury or death.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    The data missingness may represent inadequate resources, training and practices of the entire healthcare team.

    “the data missingness may represent inadequate resources, training and practices of the entire healthcare team, all of whom gather medical and social histories and document in the EHR.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The DCI is a validated index of prosperity that includes variables related to education, housing, unemployment, poverty, and changes in business establishments.

    “The DCI is a validated index of prosperity that includes variables related to education, housing, unemployment, poverty, and changes in business establishments [8].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Distressed Coimmunities: Methodology. 2022. Available from: https://eig.org/distressed-communities/2022-dci-methodology.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    The difference in prior arrest rate may be due to the large amount of missing data in our study for prior assaults and prior arrests.

    “This difference may be due to the large amount of missing data in our study for prior assaults and prior arrests.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The amount of time required to extract data was significant and may have been difficult for centers.

    “The amount of time required to extract data was significant and may have been difficult for centers especially since it occurred when hospitals may have been very busy with patients during the pandemic and no additional funding was available to support this data collection at the center level.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    As of 2020, the rate of firearm deaths in Missouri had risen 70% over the prior 10 years compared to 33% across the country.

    “As of 2020, the rate of firearm deaths in Missouri had risen 70% over the prior 10 years compared to 33% across the country [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] National Center for Health Statistics. National Vital Statistics System, Provisional Mortality on CDC WONDER Online Database., 2023

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    The number of non-fatal firearm injuries and the characteristics of patients and injuries is not well known.

    “However, the number of non-fatal firearm injuries and the characteristics of patients and injuries is not well known, as documented by a recent report from NORC at the University of Chicago [2].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] NORC, 2020

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Individuals and characteristics unique to patients who experience firearm suicide are largely missing from these data, reflected in that only 4.3% of the patients in this study had self-inflicted injuries.

    “These individuals and characteristics unique to the patients that experience firearm suicide are thus largely missing from these data, reflected in that only 4.3% of the patients in this study had self-inflicted injuries.”
    Quote in the paperSubstantial claim
31 of 31

  • The paper relies on this without support.

    The ACS TQIP captures an estimated 90%-95% of all level 1 and 2 trauma centers and a less comprehensive sample of level 3 trauma centers.

    “The ACS Trauma Quality Improvement Program (TQIP) collects data for the purposes of performance benchmarking from over 700 centers, representing more than 800 distinct trauma programs, across the U.S., capturing an estimated 90%-95% of all level 1 and 2 (major trauma centers) and a less comprehensive sample of level 3 trauma centers.”

  • The paper relies on this without support.

    Prior to this initiative, the ACS TQIP only collected data on people with firearm injuries who met criteria for inclusion; patients assessed in the emergency department and discharged home were not routinely captured.

    “Notably, prior to this initiative, the ACS TQIP only collected data on people with firearm injuries who met these criteria; patients assessed in the emergency department and discharged home were not routinely captured.”

  • The paper relies on this without support.

    Most self-inflicted firearm injuries result in death at the scene.

    “The majority (72.9%) of firearm injuries were due to assaults with few due to self-inflicted injuries, since most such firearm injuries result in death at the scene.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Table 4 percentages for no discharge services use all patients instead of survivors

    Minor

    This section is labeled as covering those discharged alive. Among the 214 pediatric survivors, 146 receiving no services is 68.2%, not 64.6%; the adult and older-adult entries in the same row likewise use their full age-group totals rather than survivor totals.

    Reported 64.6 · recomputed 68.224299

  • Discussion misstates the count of patients with a prior assault

    Minor

    The discussion calls 114 patients 11.8% of the total, but 114 of 1,336 is 8.5%. Table 2 identifies 158 patients (11.8%) with any previous violent assault or injury; 114 is the count with a prior gunshot wound.

    Reported 11.8 · recomputed 8.532934

  • Opioid-positive percentage is understated

    Minor

    Four patients out of 1,336 is 0.3%, not 0.1%.

    Reported 0.1 · recomputed 0.299401

  • Table 5 gives the wrong survivor total for the government-insured assault group

    Minor

    The group's discharge-service categories contain 228 with no care, 69 with care, and one missing, totaling 298-not the stated N = 289. The mortality row also lists 298 survivors for this group.

    Reported 289 · recomputed 298

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. National Center for Health Statistics. National Vital Statistics System, Provisional Mortality on CDC WONDER Online Database., 2023, Data are from the final Multiple Cause of Death Files, 2018–2021, and from provisional data for years 2022–2023, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
  2. NORC, 2020, Firsat Report of the Expert Panel on Firearms Data Infrastructure. The State of Firearms Data in 2019.

Cited by

Sorted by citations

Related

Authors
Rivara, F. P., Hink, A. B., Kuhls, D., Banks, S., Agoubi, L. L., Kirkendoll, S., Winchester, A., Hoeft, C., Patel, B., & Nathens, A.
Affiliations
  • University of Washington (US)
  • Medical University of South Carolina (US)
  • University of Nevada, Las Vegas (US)
  • Northwestern University (US)
  • American College of Surgeons (US)
  • Sunnybrook Health Science Centre (CA)
Corresponding author
Rivara, Frederick P.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2023-11-22
Volume
18
Issue
11
Pages
e0294737
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0294737
PMC
PMC10664957
OpenAlex
W4388894665
Cited by
3
References
17
Citations by year
2026: 1 · 2025: 2
FWCI
0.77
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • OSF Preprints (OSF Preprints) (submittedVersion)
Funders
National Collaborative on Gun Violence Research
Topics
  • Social Sciences › Health › Gun Ownership and Violence Research
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
firearm injuries, firearm deaths, gun violence, trauma centers, emergency department visits, assault injuries, racial disparities, uninsured patients, Missouri
MeSH terms
Aftercare, Cross-Sectional Studies, Female, Firearms, Humans, Male, Missouri, Patient Discharge, Violence, Wounds, Gunshot

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-27.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-27.

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Statistics and arithmetic are recomputed, not judged.

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