BOSTON -- Firearm-related injuries to patients younger than 19 accounted for an estimated 186,000 emergency department (ED) visits over the period from 1999 to 2007, investigators reported here.
As a proportion of total ED visits for that age group, firearm injuries accounted for 30% more visits than documented in earlier studies.
The findings could reflect differences in the data and methods used to calculate firearm-injury rates, but might also reflect a true increase, Saranya Srinivasan, MD, said at the American Academy of Pediatrics meeting.
"Pediatric firearm injuries remain a significant cause of morbidity and mortality," said Srinivasan, of Children's Hospital Boston. "We reported 24 nonfatal injuries per 100,000 children, which compares with 16 per 100,000 in previous reports. That represents a 30% increase in the rate of pediatric firearm-related injuries as compared with earlier studies."
The findings came from an analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS), a database of clinical information related to ED and ambulatory care visits at 600 participating hospitals. During the period reviewed, about 279 million visits involved patients ages 0 to 19.
Srinivasan and colleagues searched the data for all visits related to firearm injuries to patients in the age group of interest. They excluded injuries caused by air guns and paintball guns.
The query turned up 185,950 firearm injuries involving children, adolescents, and teenagers, an average of 20,661 incidents per year. The injuries led to 19,339 hospitalizations. Srinivasan reported that 63% of the firearm injuries were intentional and 37% unintentional.
The records revealed 8,368 deaths, representing 4.5% of the total number of firearm-related injuries.
"For comparison, the fatality rate for all other causes of ED visits was 0.05%, which was significantly less than the fatality rate for firearm injuries [P<0.001]," Srinivasan noted.
The 185,920 firearm injuries involving pediatric patients translated into 20,661 per year, at rate of 25/100,000 per year, consisting of one fatal and 24 nonfatal firearm-relate injuries.
Subgroup analysis showed that:
- 60% of the ED visits for firearm injuries involved patients older than 11
- 90% of the patients were male
- 50% of the patients were black
- 54% had nonprivate insurance
- 92% of the visits occurred in metropolitan areas
The firearm injury rate varied substantially by region. The Northeast had the lowest rate (7/100,000), followed by the South (19/100,000), West (32/100,000), and Midwest (40/100,000). NHAMCS employs the same geographic divisions as the U.S. Census, Srinivasan noted.
Multivariate analysis identified several independent predictors of pediatric firearm injury: male sex (OR 8.7), black race (OR 3.0), age greater than 11 (OR 12.5), and geographic region other than the Northeast (Midwest, OR 5.2; West, OR 3.9; South, OR 3.8).
Ask why her group's data differed from previous estimates of the pediatric firearm injury rate, Srinivasan pointed out that NHAMCS comprises a much larger sample of the population, as previous estimates were derived from more limited sample sizes.
However, Srinivasan acknowledged that NHAMCS contains limited clinical data and that factors such as misclassification and coding errors could not be ruled out in the interpretation of her group's findings.
Srinivasan and co-investigators had no relevant disclosures.
Zalman S. Agus, MD Emeritus Professor
University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
American Academy of PediatricsSource Reference: Srinivasan S, et al "The epidemiology of fatal and nonfatal pediatric firearm injuries in the United States from 1999 through 2007" AAP 2011; Abstract 13482.