Why firearm injury surveillance?

Hospitalization for firearm-related injuries in the United States, 1997

BACKGROUND

Firearm-related injuries are a serious public health problem in the United States. Despite the magnitude of this problem, prior national estimates of nonfatal, firearm-related morbidity have been limited to an emergency department-based surveillance system. The objective of this study was to assess and report the information available on firearm-related injuries in an existing national database, derived from hospital discharge data.

METHODS

Cross-sectional analysis of the 1997 Nationwide Inpatient Sample (NIS), a stratified probability sample of 1012 nonfederal community hospitals from 22 states. The database was queried using E codes to identify firearm-related injuries. The SUDAAN software program was used to convert raw counts into weighted counts that represent national estimates and 95% confidence intervals (CIs).

RESULTS

An estimated 35,810 (95% CI, 32,615-38,947) cases nationwide were identified, of which 86% were male. Assault was the leading cause of firearm-related hospitalization, followed by unintentional injury. The mean length of stay (LOS) for patients with a firearm-related assault was 6 days. Seven percent of all firearm cases died during the hospitalization. The total estimated hospital charges for firearm-related injuries in the United States in 1997 was over $802 million, and 29% of the patients admitted for this condition were uninsured.

CONCLUSIONS

Firearm-related injuries rank highest among all conditions in the number of uninsured hospital stays, and the average LOS is much longer compared to other medical conditions. National estimates derived from the NIS are consistent with previous estimates, and NIS provides additional information not available from other data sources.

Identification and characteristics of victims of violence identified by emergency physicians, triage nurses, and the police

OBJECTIVES

The objectives of the study were threefold-to evaluate the identification and characteristics of victims of assault who attend an accident and emergency (A&E) department; to compare the total number of assaults recorded in the A&E department with the number recorded by the police; and to assess a system for collecting the location and method of assault.

SETTING

The A&E department of Chorley and South Ribble Hospital Trust, Lancashire, England.

METHODS

A three month prospective study was performed. Victims of violence recorded on computer by doctors at discharge were compared with those identified at initial nurse triage. A comparison of police data with the A&E data relating to Chorley residents was performed. Additional information on the method and location of assault was also collected.

RESULTS

During the period 305 (2.6%) of the patients attending A&E were identified as having been assaulted. Of the 305 individuals, 236 (77%) were identified by a doctor while 173 (57%) such patients were identified by a triage nurse. A&E identified twice the number of assaults involving Chorley residents as the police. Both men and women were most likely to have been injured on the street (44% and 37% respectively), although a greater proportion of women were injured at home (24%) than men (10%). The majority of injuries were sustained by blows from fists, feet, and heads (73%).

CONCLUSIONS

A&E doctors identify significantly more patients as the victims of violence than do nurses at triage. Using A&E data identifies assaulted individuals not identified by the police. Computer systems can be used in A&E to provide a more complete picture of the occurrence of violence in the community.

Unintentional gun injuries, firearm design, and prevention: what we know, what we need to know, and what can be done

The public health community has long recognized unintentional gun injuries as a public health issue. In 1998 in the United States, 866 people died from unintentional gunshot wounds, resulting in a crude death rate of 0.32 per 100,000. Unintentional gun deaths have been declining since at least 1920, yet the reasons for this downward trend are not understood. Possible explanations, such as changes in gun ownership and demography, changes in access to guns among population subgroups, safety practices, and artifactual influences are discussed. Intervention strategies for reducing the risk of unintentional gun injury are also discussed.

Community-level firearm injury surveillance: local data for local action

In the United States, firearms are used to commit homicide more frequently than all other methods combined. According to the US Department of Justice, firearms are used to commit more than 1 million crimes each year. Despite the magnitude of this problem, little is known about the epidemiology of firearm crimes and assaults. Many states require medical personnel to report all nonfatal shootings to law enforcement, but the rate of compliance with this requirement is unknown. To enhance cooperation between community emergency departments and law enforcement agencies, we created a unified firearm injury notification system for the City of Atlanta, Georgia, and 5 surrounding counties: Fulton, DeKalb, Cobb, Gwinnett, and Clayton. Our findings are reported here.