A POPULATION-BASED STUDY OF SEVERE FIREARM INJURY AMONG CHILDREN AND YOUTH

Background. Firearm injuries are a major cause of pediatric mortality and morbidity in the United States. To date, population-based studies describe the epidemiology of firearm-related deaths; however, the patt erns of severe, nonfatal pediatric firearm-related injuries are not as well defined. Objectives. To determine the epidemiology of severe fir earm-related deaths and injuries among a statewide population of child ren and youth ages birth to 19 years. Methods. Demographic, geographic , and cost data were analyzed from Connecticut death certificates for 1988 through 1992 and hospital discharge data for 1986 through 1990 fo r firearm-related unintentional, self-inflicted, and assaultive injury among children and youth ages birth to 19 years. Results. There were 219 firearm deaths: 68% homicides, 25% suicides, 6% unintentional, and 1% of undetermined intent, resulting in an annual age-specific death rate of 6.6 per 100 000 persons. There were 533 hospitalizations for g unshot wounds (16 per 100 000); 41% were assaults, 1% suicide attempts , 39% unintentional gunshot wounds, 1% legal interventions, and 18% of undetermined intent. More than 80% of deaths from gunshot wounds and hospitalizations occurred among 15- to 19-year-old males, most occurri ng in Connecticut's five largest cities. Most firearm homicides occurr ed among urban residents; most firearm suicides occurred among nonurba n residents; and unintentional shootings were evenly distributed betwe en urban and nonurban residents. The total cost of firearm-related hos pitalizations averaged $864 000 per year. Conclusions. Firearms are a major cause of mortality and morbidity of Connecticut children and you th, exceeded only by motor vehicles as a cause of death among those 1 to 19 years of age. Handguns were responsible for a disproportionate a mount of trauma compared with other firearm types. The epidemiology of pediatric gunshot injuries requires a range of strategies for prevent ion. Physicians caring for families with children must include firearm injury prevention counseling as a routine part of anticipatory guidan ce.