title: Firearm injury among urban youth during the last decade: an escalation in violence.
abstract: OBJECTIVE
  To better characterize firearm violence in urban youth, the authors investigated the circumstances and outcome of shootings among youths under 17 years of age.
  
  
  METHODS
  A retrospective case review was undertaken of all patients under 17 years of age treated for a gunshot wound at two adjoining level I Trauma Centers (adult and pediatric) administering to a predominantly lower socioeconomic population from January 1986 to December 1995. Demographics, injury severity, circumstances, and outcome of injury were analyzed.
  
  
  RESULTS
  323 youths were wounded by firearms. The mean age was 12.8 years, and 82.3% were boys. There was a 110% increase in frequency of wounding noted during the second half of study (219 v 104), predominantly in the adolescent subset (160% increase for age greater than 12 years v 30% increase for age 12 years and under). The mean injury severity score and trauma score were 9.3 and 14.4, respectively. Violent circumstances (assault, crossfire, drive-by shooting, suicide) accounted for 60.4% of injuries and more than doubled over the study period (26.7% of total in the first 2 years [n = 4], 68.8% in the last 2 years [n = 55]). Unintentional injuries (self nonsuicide, family, friend) accounted for 26.3% of the injuries and declined in relative frequency over the study period (46.7% of total in the first 2 years [n = 7], 20.0% in the last 2 years [n = 16]). Black boys had the highest wounding incidence (9.2/1,000 population), were most commonly injured by assault (29.0%), and had a higher mean number of wounds (1.8). White boys had a lower wounding incidence (3.1/1,000 population), were more often injured unintentionally by a friend (41.2%), and had a lower mean number of wounds (1.3), none as a result of violence. Girls had a wounding incidence of less than 2/1,000 and were most commonly injured in crossfire (40.7%). Ten percent of shootings were fatal. The assailant was known to the victim in 52.8% of children less than 6 years of age, but only 24.7% of children over 12 years of age.
  
  
  CONCLUSIONS
  The incidence of gunshot wounds in the youth of this urban population has increased substantially over the past decade. Adolescent black boys were the most frequent victims of these shootings. There has been a disproportionate growth in violent circumstances surrounding the shootings.
authors.affiliation: Department of Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania Medical Center, 19104, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Nance
authors.forename: P W
authors.initials: PW
authors.lastname: Stafford
authors.forename: C W
authors.initials: CW
authors.lastname: Schwab
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009026:Mortality; D010414:Pennsylvania / Q000453:epidemiology; D011203:Poverty; D012189:Retrospective Studies; D012307:Risk Factors; D014504:Urban Health; D014754:Violence / Q000706:statistics & numerical data*; D014948:Wounds, Gunshot / Q000453:epidemiology*