1002 — Firearm Injury Encounters in the Veterans Health Administration, 2010-2015

Lead/Presenter: Cynthia Lucero-Obusan, 
All Authors: Lucero-Obusan CA (VHA Office of Quality, Safety and Value, Public Health Surveillance and Research (10E2E)) Wendelboe A (VHA Office of Quality, Safety and Value, Public Health Surveillance and Reserach (10E2E)) Schirmer PL (VHA Office of Quality, Safety and Value, Public Health Surveillance and Reserach (10E2E)) Oda G (VHA Office of Quality, Safety and Value, Public Health Surveillance and Reserach (10E2E)) Holodniy M (VHA Office of Quality, Safety and Value, Public Health Surveillance and Reserach (10E2E))

Objectives:
Firearm violence is an issue of public health concern leading to over 30,000 deaths and 80,000 injuries in the United States annually. To date, firearm-related studies among Veterans have focused primarily on suicide and attempted suicide. The objective of this study was to broadly examine firearm-related encounters in VA for all intents, including assault, unintentional, and self-inflicted.

Methods:
Inpatient and outpatient encounters assigned ICD-9-CM firearm external-cause-of-injury codes (E-codes) from 1/1/2010-9/30/2015 were extracted from the VHA's Praedico Public Health Surveillance System, including demographics, era of service, encounter type, and deaths. E-codes were classified by intent/manner of injury based on the CDC's Web-based Injury Statistics Query and Reporting System (WISQARS) matrix. VHA rate of hospitalization for firearm-related admissions was calculated using the total VHA acute-care admissions for the same time period as the denominator.

Results:
During the time period evaluated, 5,205 unique individuals were seen with a firearm E-code for a total of 12,587 outpatient/emergency department encounters and 768 inpatient encounters. VHA firearm admission rate was 1.63 per 10,000 VHA admissions, compared to a national rate of 1.96 per 10,000 in 2010. For the 768 hospitalizations, median length of stay was 5 days (range 1-368 days) and there were 13 deaths recorded. Unintentional (3,110, 60%) was the most common manner of injury among unique individuals seen, followed by self-inflicted (901, 17%). Overall, the median age was 54 (range 19-100 years), and 96% were male. The highest percentage served in the Persian Gulf War Era (2,136, 41%), followed by Vietnam Era (1,816, 35%) and Post-Vietnam Era (716, 14%). The greatest number of patients resided in Texas (453), California (349), Florida (326), Arizona (214) and Ohio (212).

Implications:
Unintentional injuries were the most common form of firearm injury among VHA enrollees, representing over half of all outpatient firearm encounters and more than twice the number of firearm hospitalizations compared with any other manner/intent.

Impacts:
The majority of firearm injury encounters seen in VA are intents other than "self-inflicted". VA providers should more routinely screen Veterans for firearm access and safe practices. Additional study is needed to further understand the epidemiology of firearm-related injuries among Veterans.