Damian McNamara

November 01, 2013

ORLANDO, Florida — Trends in gun ownership in the United States are associated with hospital admissions and deaths related to firearm injuries, 2 new studies show. Children and younger teens are more likely to be shot at home and present with multiple injuries, say researchers.

Each year in the United States, about 7500 children are hospitalized because of gun-related injuries, and about 500 die.

In an effort to understand these statistics, investigators assessed data from the Kids' Inpatient Database of more than 36 million pediatric hospitalizations. They presented their findings here at the American Academy of Pediatrics 2013 National Conference and Exhibition.

The researchers estimated gun ownership using the most recent data available from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System.

On a state-by-state basis, they compared the percent of homes with guns with the percent of gunshot wounds in children that occurred in the home, as opposed to another location.

"We found a direct significant relationship (P = 0.02)," reported Arin Madenci, MD, from the University of Michigan Medical School in Ann Arbor.

Pediatric hospitalizations for gunshot wounds rose from 4270 in 1997 to 7730 in 2009. During the same period, in-hospital deaths related to gunshot wounds increased from 317 to 503.

"When we broke things down by type of gun, we found that the vast majority — almost 80% — were inflicted by handguns," Dr. Madenci said. "Only a minority were inflicted by hunting or military-type rifles, including assault rifles."

Table. Type of Firearm Related to Childhood Gunshot Wounds

Type of Gun      Percent     
Handgun 77.2
Shotgun 18.5
Hunting rifle 3.9


Given the higher prevalence of handgun-related gunshot wounds, injury-prevention efforts for children that target this type of firearm might be the most effective, the researchers note.

In a second study, investigators assessed the characteristics of firearm injuries seen at a level 1 trauma center.

They analyzed the charts of 448 pediatric patients with firearm-related injuries. Investigators compared 70 patients who were 14 years and younger with 378 patients 15 to 18 years of age.

Overall, 86% of the patients were male, 80% were black, and approximately 7% died from their injuries.

Lead investigator Phyllis Hendry, MD, from the University of Florida College of Medicine in Jacksonville, had a message for emergency physicians, who are often the first to encounter these children and adolescents. "Consider making a referral to child protective services on pediatric firearm injuries to assess the safety of the home. In our study, only 13% of patients 0 to 14 years of age had child protection referrals documented."

Preliminary findings reveal that firearm injuries differ in older and younger children.

Consider making a referral to child protective services on pediatric firearm injuries to assess the safety of the home.

For example, patients 14 years and younger were more likely to be shot at home than those 15 to 18 years of age (odds ratio [OR], 3.76; 95% confidence interval [CI], 2.29 - 6.19).

Also, children 5 to 9 years of age were more than 6 times as likely to present with multiple injuries than children 10 to 14 years of age (OR, 6.26; 95% CI, 1.26 -31.09).

Patients 14 years and younger were more likely to arrive at the trauma center by ambulance, whereas older children, in general, walked in or arrived by car.

Interestingly, the shooter and type of firearm were unknown in more than 60% of cases. "Future firearm injury-prevention initiatives must explore improved methods of linking emergency medical services, hospital, and law enforcement records," said study coauthor Andrea Suen, MD, from the University of Florida College of Medicine.

Among the limitations of this study is the difficulty matching law enforcement, emergency medical response, and hospital records to gather information to target injury-prevention initiatives in the future. In addition, the database does not include children and adolescents who died at the scene.

Each of these studies feature limitations in methodology, but they are worthwhile, given the overall paucity of such research, said Denise Dowd, MD, from the division of emergency and urgent care at Children's Mercy Hospital in Kansas City, Missouri.

The study by Dr. Madenci's team "is what we call an ecologic study. It looks at a relationship between household ownership of guns and hospitalizations, but there are a lot of other factors potentially involved, so we cannot say one caused the other," she explained.

Despite that limitation, "this is very consistent with other studies that have looked at gun ownership and unintentional injuries. The more kids with access to guns, the more unintentional injuries — that makes sense, and it's consistent," she told Medscape Medical News.

Dr. Dowd said she agrees with the conclusion of Dr. Hendry's team — more data are needed. "This study is at one trauma center. We need studies like this for the entire United States."

"For years we have not been able to do publicly funded research on firearm-related injuries," said Dr. Dowd. "We have to do this research. This is a big public health priority, and we need ways to prevent such injuries."

Dr. Madenci, Dr. Hendry, and Dr. Dowd have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2013 National Conference and Exhibition: Presented October 27 and October 28, 2013.


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