Hospital Admission Status and Healthcare Services Among Adults with Firearm Injury: A Retrospective Cohort Study.

Abstract

Nonfatal firearm injuries (NFFI) are increasing nationwide. NFFI survivors experience physical disability, chronic pain, psychological trauma, and mental health disorders, requiring targeted interventions. Services available in Emergency Departments (ED) may differ from those provided upon admission. This study explored differences in services and healthcare utilization between NFFI patients admitted to hospital versus discharged from the ED. A retrospective cohort study of adults ≥18 years with NFFI was conducted at a Level 1 Trauma Center (2016-2020). Patients admitted to the hospital were compared to those discharged from the ED. Outcomes included hospital-based service use (psychology consultation, HVIP referral) and 90-day healthcare utilization (outpatient visits, ED revisits, readmissions). Multivariable logistic regression examined factors associated with admission and HVIP referral among eligible patients. Post-discharge utilization outcomes were analyzed as cumulative counts during a fixed 90-day window, with bivariate group comparisons (admitted vs. ED-discharged). Of 1,522 NFFI patients, 449 (29.50%) were discharged from the ED. Admitted patients had greater injury severity (mean 13.09 vs 5.07, p<0.0001) and were less likely to identify as racial/ethnic minorities (78.10% vs 83.07%, p=0.0282). In adjusted models, racial/ethnic minority status was not significantly associated with admission after accounting for injury severity. Admitted patients received more psychology consultations (28.80% vs 0.67%, p<0.0001) and higher HVIP referral rates when eligible (67.65% vs 54.95%, p=0.0217). In multivariable models restricted to HVIP-eligible patients, racial/ethnic minority status was associated with higher odds of HVIP referral (adjusted OR=3.127, p=0.0056). At 90-days post-discharge, admitted patients had significantly greater healthcare utilization across multiple domains, including injury-related follow-up appointments (mean 6.45 vs 1.89, p<0.0001), injury-related ED visits (mean 0.37 vs 0.20, p=0.0001), injury-related hospital readmissions (mean 0.28 vs 0.07, p<0.0001), and behavioral health visits (3.45% vs 0.89%, p=0.00549). Admission status was linked to greater receipt of psychology and psychiatry consultation as well as HVIP referral, reflecting opportunities more available during inpatient stays. As expected, admitted patients also had more follow-up medical appointments; however, ED-discharged patients infrequency received psychology consultation or HVIP referral, limiting recovery potential related to mental health and overall wellbeing. These gaps highlight missed opportunities to provide early psychological support and violence prevention services in the ED setting. Standardized ED-based protocols may help address this need, although causal inference is limited by study design.