title: A population-based study of severe firearm injury among children and youth.
abstract: 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 patterns of severe, nonfatal pediatric firearm-related injuries are not as well defined.
  
  
  OBJECTIVE
  To determine the epidemiology of severe firearm-related deaths and injuries among a statewide population of children 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 for 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 gunshot 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 occurring in Connecticut's five largest cities. Most firearm homicides occurred among urban residents; most firearm suicides occurred among nonurban residents; and unintentional shootings were evenly distributed between urban and nonurban residents. The total cost of firearm-related hospitalizations averaged $864,000 per year.
  
  
  CONCLUSIONS
  Firearms are a major cause of mortality and morbidity of Connecticut children and youth, exceeded only by motor vehicles as a cause of death among those 1 to 19 years of age. Handguns were responsible for a disproportionate amount of trauma compared with other firearm types. The epidemiology of pediatric gunshot injuries requires a range of strategies for prevention. Physicians caring for families with children must include firearm injury prevention counseling as a routine part of anticipatory guidance.
authors.affiliation: Connecticut Childhood Injury Prevention Center, Hartford 06102-5037, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Zavoski
authors.forename: G D
authors.initials: GD
authors.lastname: Lapidus
authors.forename: T J
authors.initials: TJ
authors.lastname: Lerer
authors.forename: L I
authors.initials: LI
authors.lastname: Banco
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D003365:Costs and Cost Analysis; D003644:Death Certificates; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011159:Population Surveillance; D016728:Self-Injurious Behavior / Q000191:economics / Q000453:epidemiology; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data; D014948:Wounds, Gunshot / Q000191:economics / Q000453:epidemiology* / Q000401:mortality