Incidence of and Factors Associated With Recurrent Firearm Injury Among Patients Presenting to St. Louis Trauma Centers, 2010 to 2019

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

This study was designed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology Statement.

“This study was designed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology Statement.20”

• cites [20] von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. International journal of surgery (London, England). 2014; 12(12): 1495– 1499. 25046131 sourceDisputed

  Section 2, “Aims and use of the STROBE Statement,” says STROBE provides guidance on reporting observational research and explicitly says its recommendations are not prescriptions for designing or conducting studies. The cited paper therefore does not support describing STROBE as a standard in accordance with which the study was designed. (LLM, conf=0.86)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

May combine two claims.

The study patients experienced much higher rates of non-fatal firearm injuries than reported elsewhere; the fatal to non-fatal firearm injury rate was 1:14 in the index injury population and 1:7 in the recurrent injury population, compared to rates of 1:2 reported elsewhere.

“Additionally, our patients experienced much higher rates of non-fatal firearm injuries than reported elsewhere; the fatal to non-fatal firearm injury rate was 1:14 in the index injury population and 1:7 in the recurrent injury population, compared to rates of 1:2 reported elsewhere.10,31”

• cites [10] Kaufman EJ, Wiebe DJ, Xiong RA, Morrison CN, Seamon MJ, Delgado MK. Epidemiologic Trends in Fatal and Nonfatal Firearm Injuries in the US, 2009-2017. JAMA internal medicine. 2021; 181(2): 237– 244. 33284327 PMC7851729 sourceSupported
• cites [31] Kaufman EJ, Delgado MK. The Epidemiology of Firearm Injuries in the US: The Need for Comprehensive, Real-time, Actionable Data. Jama. 2022; 328(12): 1177– 1178. 36166012 sourceNot checked — no full text of the source

May combine two claims.

The association between reinjury and SVI was not significant in the multivariable model due to the likelihood of SVI serving as a proxy for structural disparities and place-based racism among these young, Black men, resulting in high collinearity between SVI and both age and sex.

“We believe the association between reinjury and SVI was not significant in the multivariable model due to the likelihood of SVI servings as a proxy for structural disparities and place-based racism among these young, Black men, resulting in high collinearity between SVI and both age and sex.53”

• cites [53] Rees CA, Monuteaux MC, Steidley I, Trends and Disparities in Firearm Fatalities in the United States, 1990-2021. JAMA network open. 2022; 5(11): e2244221. 36445703 PMC9709653 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

• AssumptionThe authors state this as an assumption: The CDC Social Vulnerability Index and US Census data are valid proxies for patient-level social determinants of health unavailable in the EHR.

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

Most decedents were less than 40 years old at time of death.

“Most decedents were less than 40 years old at time of death.”

May combine two claims.

The fatal to nonfatal firearm injury ratio was approximately 1 to 14 in the index injury population and 1 to 7 in the recurrent injury population.

“The fatal to nonfatal firearm injury ratio was approximately 1 to 14 in the index injury population and 1 to 7 in the recurrent injury population.”

• Also stated in: § Discussion · plain

  “the fatal to non-fatal firearm injury rate was 1:14 in the index injury population and 1:7 in the recurrent injury population, compared to rates of 1:2 reported elsewhere.”

• AssumptionRests on an assumption: The Missouri Hospital Association universal identifier stably links patients across health systems and over time.

May combine two claims.

The majority of firearm injured patients were young, un- or under-insured Black men living in areas with a high SVI.

“The majority of firearm injured patients were young, un- or under-insured Black men living in areas with a high SVI.”

• AssumptionThe authors state this as an assumption: The CDC Social Vulnerability Index and US Census data are valid proxies for patient-level social determinants of health unavailable in the EHR.

May combine two claims.

The number of unique acutely firearm injured individuals increased over time from a total of 983 in 2010 to 1,217 in 2019, peaking in 2017 (n=1,340).

“The number of unique acutely firearm injured individuals increased over time from a total of 983 in 2010 to 1,217 in 2019, peaking in 2017 (n=1,340) (Supplement B).”

May combine two claims.

Of the 10,293 acute firearm injured patients, 693 suffered fatal injury and 47 were missing identifiers, leaving 9,553 patients in the analytic sample at-risk for a recurrent firearm injury.

“Of the 10,293 acute firearm injured patients, 693 suffered fatal injury and 47 were missing identifiers allowing follow-up within the STL-HVIP-DR or NDI, leaving 9,553 patients in the analytic sample at-risk for a recurrent firearm injury (Figure 1).”

• Also stated in: § Results · plain

  “of whom 9,553 survived the injury and comprised the analytic sample”

May combine two claims.

A multivariable model including all covariates simultaneously yielded the same conclusions, except that the association of SVI category with risk of reinjury largely disappeared after controlling for the other variables.

“A multivariable model including all covariates simultaneously yielded the same conclusions, except that the association of SVI category with risk of reinjury largely disappeared after controlling for the other variables(Supplement D).”

• AssumptionRests on an assumption: The Missouri Hospital Association universal identifier stably links patients across health systems and over time.
• AssumptionThe authors state this as an assumption: The CDC Social Vulnerability Index and US Census data are valid proxies for patient-level social determinants of health unavailable in the EHR.

May combine two claims.

Male sex, Black race, age <30, government-sponsored or no insurance, and high SVI were at statistically significant increased risk for recurrent injury.

“Male sex, Black race, age <30 , government-sponsored or no insurance, and high SVI were at statistically significant increased risk for recurrent injury.”

• AssumptionRests on an assumption: The Missouri Hospital Association universal identifier stably links patients across health systems and over time.
• AssumptionThe authors state this as an assumption: The CDC Social Vulnerability Index and US Census data are valid proxies for patient-level social determinants of health unavailable in the EHR.

May combine two claims.

Nearly half of deaths were due to a recurrent firearm injury, with 42 patients surviving more than one firearm injury encounter prior to firearm injury death.

“Nearly half of deaths were due to a recurrent firearm injury, with 42 patients surviving more than one firearm injury encounter prior to firearm injury death.”

• AssumptionRests on an assumption: The Missouri Hospital Association universal identifier stably links patients across health systems and over time.

May combine two claims.

Individuals with recurrent firearm injuries were mean age 25 years (SD 10), 93% male, 96% Black, 50% uninsured, and 65% resided in a high SVI region.

“Individuals with recurrent injuries were mean age 25 years (SD: 10), 93% male, 96% Black, 50% uninsured, and 65% resided in a high SVI region.”

• Also stated in: § Results · plain

  “Individuals experiencing recurrent firearm injury were young (25.3 +/− 9.5 years), and predominantly male (93%), Black (96%), uninsured (50%), and resided in high social vulnerability regions (65%).”

• AssumptionRests on an assumption: The Missouri Hospital Association universal identifier stably links patients across health systems and over time.
• AssumptionThe authors state this as an assumption: The CDC Social Vulnerability Index and US Census data are valid proxies for patient-level social determinants of health unavailable in the EHR.

May combine two claims.

Among reinjured patients, 1,016 (88%) had one unique firearm reinjury encounter, 127 (11%) had two additional unique firearm reinjury encounters, and 12 (1%) had three.

“Among reinjured patients, 1,016 (88%) had one unique firearm reinjury encounter, 127 (11%) had two additional unique firearm reinjury encounters, and 12 (1%) had three.”

• AssumptionRests on an assumption: The Missouri Hospital Association universal identifier stably links patients across health systems and over time.

May combine two claims.

Based on Kaplan-Meier analyses, the probability of firearm reinjury was estimated to be 7% at one year, 13% at five years, and 17% at eight years following index injury.

“Based on KaplanMeier analyses, the probability of firearm reinjury was estimated to be 7% at one year, 13% at five years, and 17% at eight years following index injury (Figure 3).”

• Also stated in: § Results · hedged

  “The estimated risk of firearm reinjury was 7% at one year and 17% at eight years.”

• AssumptionRests on an assumption: The Missouri Hospital Association universal identifier stably links patients across health systems and over time.

May combine two claims.

Total follow-up time for all patients was 38,896 person-years with a recurrent firearm injury rate of 3.0 per 100 person-years (95% CI 2.8-3.1).

“Total follow-up time for all patients was 38,896 person-years with a recurrent firearm injury rate of 3.0 per 100 person-years (95% CI: 2.8-3.1).”

• AssumptionRests on an assumption: The Missouri Hospital Association universal identifier stably links patients across health systems and over time.

May combine two claims.

The model used to classify encounters for acute injury rather than follow up of prior injury improves accurate identification of acute and recurrent firearm injuries from ICD codes alone and may be useful to other researchers.

“The model we used to classify encounters for acute injury rather than follow up of prior injury improves accurate identification of acute and recurrent firearm injuries from ICD codes alone and may be useful to other researchers.”

Classified as probably not a substantial claim. May combine two claims.

The comprehensive and representative patient sample, data from multi-system adult and pediatric level I trauma hospitals, and linkage with the NDI strengthen the estimates provided by this study.

“The comprehensive and representative patient sample, data from multi-system adult and pediatric level I trauma hospitals, and linkage with the NDI strengthen the estimates provided by this study.32”

• cites [32] Census Reporter. St. Louis, MO-IL Metro Area. 2020-2021; https://censusreporter.org/profiles/31000US41180-st-louis-mo-il-metro-area/. Accessed December 7, 2022.Not matched

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

• AssumptionRests on an assumption: The four St. Louis level I trauma hospitals care for the majority of violently injured patients in the St. Louis region.

Classified as probably not a substantial claim.

This is a multi-center retrospective observational cohort study of all adult and pediatric patients who presented to a St. Louis level I trauma hospital for acute firearm injury care between January 1, 2010 and December 31, 2019.

“This is a multi-center retrospective observational cohort study of all adult and pediatric patients who presented to a St. Louis level I trauma hospital for acute firearm injury care between January 1, 2010 and December 31, 2019.”

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

Some patients likely sustained an index injury prior to 2010, which could underestimate recurrent injury rates over time.

“Additionally, some patients likely sustained an index injury prior to 2010, which could underestimate recurrent injury rates over time.”

May combine two claims.

Identification of patients included in this cohort depended on accurate diagnostic coding, and it is possible that patients who presented with a firearm injury but did not receive a corresponding ICD diagnosis code were missed.

“Identification of patients included in this cohort depended on accurate diagnostic coding. It is possible that we missed patients who presented with a firearm injury, but did not receive a corresponding ICD diagnosis code.”

May combine two claims.

A small number of patients (n = 60) received HVIP services during the final 17 months of the study; removing these patients from the index study sample did not change the reinjury incidence reported above.

“A small number of patients (n = 60) received HVIP services during the final 17 months of our study; removing these patients from the index study sample did not change the reinjury incidence reported above.”

May combine two claims.

The analyses are limited by the retrospective nature of the study design and potential misclassification bias.

“Our analyses are limited by the retrospective nature of this study design and potential misclassification bias.”

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

Data were gathered from a single urban area, and may not be applicable to other geographic regions.

“Finally, data were gathered from a single urban area, and may not be applicable to other geographic regions.”

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

Funders were not involved in the design, conduct, analysis, or reporting of the study.

“Funders were not involved in the design, conduct, analysis, or reporting of the study.”

May combine two claims.

Acquisition of NDI data for out-of-hospital deaths was dependent on index injury patient identifiers, and thus not available for index fatal to nonfatal injury calculations.

“The fatal to non-fatal firearm injury ratio is presented for both index and recurrent injuries; however, acquisition of NDI data for out-of-hospital deaths was dependent on index injury patient identifiers, and thus not available for index fatal to nonfatal injury calculations.”