Injury patterns in fatal gun violence - time to death and cause of death

Abstract Introduction Firearm injuries increase globally. Gun-related mortality is affected by injury location and time to treatment, and haemorrhage and vascular injuries are particularly lethal. The aim of this study was to characterize injury patterns and association to time and cause of death. Method This was a nationwide observational study investigating all deaths after firearm injuries between 2012 and 2023 using data from the Swedish Trauma Registry, patient records, forensic protocols and police investigation reports. Statistical analyses included descriptive statistics, univariate and multivariable ordinal regression analyses. Result Firearm mortality increased annually (p<0.001). 58.2% (302/519) of all deaths occurred pre-hospital with 72.1% (233/323) of all deaths within the first hour of trauma. Bleeding was the most common cause of death in-hospital with 48.9% (106/217), representing 23.5% (71/302) in the pre-hospital group. 49.5% (257/519) of all victims had vascular injuries. Injury to head OR 1.75 (95% CI 1.28-2.40) (p=0.001), neck OR 3.30 (95% CI 1.75-6.23) (p<0.001) and thorax OR 2.87 (95% CI 1.93-4.26) (p<0.001) were associated with earlier death. Injury to abdominal OR 0.61 (95% CI 0.39–0.97) (p=0.04) and upper extremity vessels OR 0.27 (95% CI 0.11–0.68) (p=0.006) were associated with later death. Injury to thoracic aorta OR 2.45 (95% CI 1.52–3.97) (p<0.001) and pulmonary artery OR 2.39 (95% CI 1.11–5.13) (p=0.026) was significantly linked to shorter survival times. Discussion Firearm mortality has increased in Sweden the past decade. Injury to head, neck, thorax and thoracic vessels were associated with earlier death. Abdominal and upper extremity vascular injuries were associated with later time of death.