title: The rural-urban continuum: variability in statewide serious firearm injuries in children and adolescents.
abstract: OBJECTIVE
  To compare rates of serious firearm injuries among children and adolescents treated in a statewide trauma system.
  
  
  METHODS
  We reviewed the Pennsylvania Trauma Systems Foundation (Mechanicsburg) registry from January 1, 1987, through December 31, 2000, for all pediatric and adolescent patients (age 0-19 years) who sustained a serious firearm injury. Data included age, sex, weapon, geographic region, injury circumstance, and outcome.
  
  
  RESULTS
  During the 14-year period, 3781 children and adolescents sustained a serious firearm injury and were treated at a participating Pennsylvania trauma center. The population was 90.7% male, with a mean age of 16.5 years. Adolescents (age 15-19 years) represented more than 85% of the study population. There were 744 deaths (19.7%). The urban counties had an average annual population-based rate of serious firearm injury of 28.3/100 000; suburban counties, 2.8/100 000; metropolitan counties, 2.4/100 000; and nonmetropolitan counties, 2.4/100 000. Urban counties had a higher rate for all injury circumstances (unintentional, assault, and self-inflicted) than all nonurban counties. Assault was the most common overall injury circumstance (78.7%), and was the most common circumstance in urban counties (88.5%) and among adolescents (age 15-19 years [84.2 %]). Unintentional injuries predominated in nonmetropolitan counties (56.7%) and in young children (aged <5 years [50.6%] and 5-9 years [61.4%]). Handguns were the most common weapon type in all age groups, geographic regions, and injury circumstances.
  
  
  CONCLUSIONS
  Rates of serious firearm injuries among children and adolescents are 10-fold higher in urban than nonurban regions. Assaultive injury mechanisms predominated in urban areas, unintentional injuries in the nonurban counties. Firearm injury statistics are heavily influenced by events in the urban counties. Intervention and prevention strategies need to account for these regional discordances to optimize efficacy.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Philadelphia, PA 19104, USA. nance@email.chop.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Nance
authors.forename: Lex
authors.initials: L
authors.lastname: Denysenko
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Durbin
authors.forename: Charles C
authors.initials: CC
authors.lastname: Branas
authors.forename: Perry W
authors.initials: PW
authors.lastname: Stafford
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014505:Urban Population; D014948:Wounds, Gunshot / Q000453:epidemiology*