Review highlights significant need for comprehensive care for gun violence survivors

A new review article published in JAMA underscores the critical need for comprehensive long-term medical care for patients treated for firearm injuries, which has become an epidemic in the U.S., fueled by years of rising gun violence.

More than 48,000 people died of firearm injuries in the U.S. in 2022, according to the Centers for Disease Control and Prevention, with 120,000 suffering from gunshot wounds from which they recovered.

While emergency care protocols are well established, long-term recovery pathways for survivors—particularly in the outpatient setting—remain poorly defined and inconsistently applied, according to the review paper authors, who are all professors of surgery at the University of Maryland School of Medicine (UMSOM).

This review consolidates the latest evidence on the physical, neurological, psychological, and social consequences of firearm injury, excluding injuries to the brain and spinal cord.

“We wanted to provide guidance for primary care physicians, psychiatrists, and rehabilitation specialists to help them manage the long-term care of these patients to help facilitate a full recovery,” said study first author Bethany Strong, MD, an assistant professor of surgery at UMSOM who practices at the R Adams Cowley Shock Trauma Center.

Key findings from the review include:

• Chronic pain: Nearly 68% of firearm injury survivors report daily pain 6 to 12 months after injury, a higher rate than those severely injured in motor vehicle crashes. A multimodal pain management approach is recommended, combining pharmacologic treatments with physical and alternative therapies.
• Peripheral nerve injury: Approximately 75% of gunshot wound survivors are discharged with bullet fragments still in their bodies. These fragments pose a risk for lead poisoning, particularly if located near joints or vital structures. Regular blood lead level testing is recommended, and surgical removal should be considered when medically feasible.
• Psychological impact: Over 50% of survivors screen positive for posttraumatic stress disorder (PTSD) within a year of injury. Doctors should screen patients recovering from firearm wounds for this condition. Effective treatments include trauma-focused cognitive behavioral therapy, antidepressant medication, and treatments for sleep issues.
• Functional decline and social impact: A significant portion of survivors report long-term functional limitations, with nearly 60% not returning to work within a year. Quality of life measures are notably lower than in other trauma populations.
• Risk of reinjury: Nearly 10% of survivors suffer a second firearm injury, with young Black men at the highest risk. Hospital-linked violence intervention programs have shown promise in reducing recidivism through holistic support services.

“This review serves as a wake-up call,” said corresponding author Thomas Scalea, MD, Professor of Trauma Surgery at UMSOM and Physician-in-Chief at the R Adams Cowley Shock Trauma Center. “We can apply our best trauma surgery skills to our patients, but the medical community must go beyond our acute care efforts to address the lasting effects of firearm injury—pain, disability, mental health, and risk of reinjury.”

UMSOM Dean Mark T. Gladwin, MD added, “Every day, 125 people in the U.S. are killed with guns, and more than 200 are shot and wounded. Gun violence costs our nation $557 billion every year, equivalent to 2.6% of our gross domestic product. These costs can be reduced by improving access to long-term health care and supportive services for gun violence victims, a disproportionate percentage of whom come from low-income communities where adequate health care is lacking.”

Margaret Lauerman, MD, Clinical Associate Professor of Surgery at UMSOM, was an additional author on the paper.