Women with firearm injuries: A multicenter mixed-methods study

Am J Surg. 2026 Jun 22;260:117119. doi: 10.1016/j.amjsurg.2026.117119. Online ahead of print.

ABSTRACT

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.

PMID:42379119 | DOI:10.1016/j.amjsurg.2026.117119