The Crisis of Adolescent Firearm Reinjury: A 14-Year Retrospective Cohort Analysis

Firearm injuries are the leading cause of death among US adolescents. Adolescents are among the highest risk, and those with nonfatal injuries experience high rates of reinjury. Identifying factors that predict firearm reinjury among adolescents may support tailored prevention strategies. This study sought to identify factors associated with firearm reinjury among adolescents who presented with acute nonfatal firearm injury in the St. Louis, Missouri region.

We conducted a multicenter observational cohort study of youth aged 15 to 17 years presenting to 2 adult and 2 pediatric trauma centers from 2010 through 2023. We collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. Analysis included descriptive statistics, time-to-event analyses estimating reinjury probability, and adjusted hazard ratios (HRs) and 95% CIs.

From 2010 through 2023, there were 1433 youth aged 15 to 17 years who experienced a firearm injury. Of the 1349 who survived their index injury, 233 (17.3%) experienced a reinjury during the study period. Estimated reinjury probability was 6.9% (95% CI 5.6-8.4) and 22.4% (95% CI 19.8-25.4) at 1 and 10 years, respectively. Youth who were male (HR: 4.4; 95% CI 2.1-9.3), Black (HR: 4.0; 95% CI 1.6-9.9), and treated at an adult hospital for index injury (HR: 1.5; 95% CI 1.1-2.0) had higher risk of reinjury over time.

Black male adolescents had high risk of firearm reinjury, highlighting the critical need for interventions addressing structural racism and other root causes of community firearm violence.