Women with firearm injuries: A multicenter mixed-methods study.

INTRODUCTION

Female firearm injury is rising yet remains understudied, particularly among survivors. We examined factors associated with mortality and the circumstances surrounding firearm injury in women.

METHODS

We performed a retrospective multicenter mixed-methods study of 208 women with firearm injuries from five trauma centers (2012-2016), using regression and qualitative thematic analysis.

RESULTS

Crude mortality was 14.4%; most patients were Black (70%) and injured by assault (72%). White women had higher unadjusted mortality than Black women (25.5% vs 9.9%; p = 0.008). In Firth-penalized multivariable analysis addressing complete separation, no variable independently predicted mortality; self-harm showed the strongest association but did not reach significance (OR 3.08, 95% CI 0.91-10.39; p = 0.07). Self-harm was far more common among white than Black women (31% vs 1%; p < 0.001) and predicted longer hospitalization. Qualitative themes included intimate partner violence, neighborhood violence, and self-harm.

CONCLUSIONS

Self-harm was race-patterned and associated with morbidity and mortality, though no factor independently predicted mortality after adjustment. Prospective multicenter study with injury-severity data is needed.