Our Grants

Bridging the Gaps: Individual and Community-Level Risk Factors for Non-Lethal Firearm Injuries in the United States


This prospective, multi-center study will utilize the infrastructure of the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to develop a nationally-representative dataset of predominantly non-lethal firearm injuries, which will be used to better understand both individual and community-level risk factors associated with non-lethal firearm injuries.




This project aims to explicate the circumstances and risk factors of non-lethal firearm injuries across urban communities in the U.S. to identify potential modifiable factors, at both the individual and community level, for targeted interventions.


A nationally representative sample of ACS TQIP Level I and II trauma centers will be recruited to collect and submit additional data elements in the following categories: demographics, patient risk factors, circumstances of injury, and early functional outcome information. To optimize data quality, a detailed data dictionary will be developed, which will be accompanied by registrar training and a rigorous data validation protocol. The research team will perform descriptive analyses to characterize and quantify the population of patients with firearm injuries; will assess how these domains differ based on injury intent, victim age, and urbanicity; and will examine how victim characteristics, risk factors and circumstances differ between lethal and non-lethal firearm injuries. The collected patient data will then be linked by zip code to community- and neighborhood-level indices and data sources, to explore the association of injury and social determinants of health.


This study intends to fill a critical data gap in understanding the burden of non-lethal firearm related injuries and contextual information that can inform actionable policies and interventions. It will provide insights into the relationship of community-level social determinants of health with individual risk factors and adverse experiences for firearm injuries.

Published Research

  • Characteristics of Firearm Injury by Injury Intent: The Need for Tailored Interventions

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  • Firearm injuries in Missouri

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  • Firearm Injuries treated at Trauma Centers in the United States

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Investigator Bios

  • Avery B. Nathens is a professor of surgery at the University of Toronto, a scientist at the Sunnybrook Research Institute, and a faculty member of the Institute for Health Policy, Management, and Evaluation at the University of Toronto. He holds an endowed chair in trauma research. He is surgeon in chief at Sunnybrook Health Sciences Centre and is medical director of trauma quality programs at the American College of Surgeons and has led the trauma quality improvement program since 2010.
  • Deborah Kuhls is a professor of surgery at the UNLV School of Medicine, program director of the Surgical Critical Care Fellowship, chief for the section of Critical Care, and the ICU medical director at University Medical Center of Southern Nevada. She is immediate past chair of the Injury Prevention and Control Committee of the American College of Surgeons Committee on Trauma, which has embarked upon a public health approach to firearm injuries for several years.
Grant Amount
Award Type
American College of Surgeons, Committee on Trauma
Avery B. Nathens, professor of surgery at the University of Toronto; and Deborah Kuhls, professor of surgery at the UNLV School of Medicine.
Expected Completion Date
June 2022
Year Awarded
Focus Areas
Non-Lethal Firearm Injuries