MORBIDITY AND INJURY RECURRENCE IN VICTIMS OF FIREARM INJURIES

Civilian violence has become an increasing problem in the industrial w orld. Gunshot wounds, fatal or nonfatal, are often considered as acute trauma episodes. However, our previous study, based on 820 firearm in juries, showed that this group of patients was characterized by a high mortality rate and a pronounced involvement in criminality when compa red to a control group. The aim of this study was to determine the gen eral morbidity in the same group of firearm victims. Our hypotheses we re that these patients consume a considerable amount of hospital care due to recurring trauma episodes and that their general morbidity is r aised. Information was collected concerning all episodes of in-patient care for victims of firearm injuries from 1972-1992 in Stockholm, Swe den. The victims were compared with a sex- and age-matched control gro up. During the study period, 69.9% of the 820 firearm victims were tre ated for other reasons than gunshot injuries, compared to 45.5% of the 820 controls. The former group was hospitalized 3,703 times and the l atter on 1,512 occasions. The firearm injury group showed an higher mo rbidity in almost all diagnostic subgroups according to ICD-9. The tra uma recurrence rate was high and suicide, homicide and assault were re latively more common in this group. We suggest that the gunshot episod e may be regarded as one expression of a 'chronic trauma syndrome'. Pa tients exhibiting this 'syndrome' are characterized by recurrent episo des of trauma, a risk-taking and destructive behavior, high morbidity and mortality as well as anti-social traits. Medical, social and legal complications are common making these patients extremely costly for s ociety and their identification a matter of concern. It is probable th at this 'syndrome' also exists in other groups of trauma patients. Sin ce hospitalization affords a unique opportunity of reaching patients w ho have a 'chronic trauma syndrome' risk profile, we believe, that the se patients should not only be treated for their acute injuries, but t hat they should be offered help in order to change their destructive l ife-style. Research should be undertaken to evaluate whether an interv ention program, such as counseling, could have an effect on morbidity and injury recurrence for these patients.