title: Americans shooting themselves in the foot: the epidemiology of podiatric self-inflicted gunshot wounds in the United States.
abstract: OBJECTIVE
  To examine the epidemiology of Americans shooting themselves in the foot.
  
  
  METHODS
  Data from the Firearm Injury Surveillance Study (1993-2010) collected using the National Electronic Injury Surveillance System were examined. Non-fatal firearm-related injuries were recorded during patients' initial emergency department visits.
  
  
  METHODS
  United States hospital emergency departments, 1993-2010.
  
  
  METHODS
  69 111 individuals admitted to US emergency departments after non-fatal firearm-related incidents.
  
  
  METHODS
  Demographic and incident characteristics of patients presenting with self-inflicted gunshot wounds to the foot.
  
  
  RESULTS
  Of the 69 111 reported firearm-related injuries, 667 (1.0%) were self-inflicted gunshot wounds to the foot. Of these, 597 of the patients (89.6%) were men and 51.7% (345) were aged between 15 and 34 years. Patients generally presented with puncture wounds (265 patients, 39.7%), foreign bodies (164 patients, 24.6%) and bruised egos. Those who shot themselves in the foot were significantly more likely than individuals with other firearm-related injuries to be male (odds ratio [OR], 1.28) and married (OR, 2.6). As the festive season approached, the number of incidents increased; November and December were peak months for shooting oneself in the foot.
  
  
  CONCLUSIONS
  The nature of and the circumstances surrounding self-inflicted gunshot wounds to the foot were unique when compared with other firearm-related injuries. Through the large-scale examination of the characteristics of these incidents, trends in the nature of Americans shooting themselves in the foot have been elucidated. Young married men are at particular risk of shooting themselves in the foot. Particular caution must be taken during the festive season to avoid being caught under the missing toe.
authors.affiliation: Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK tdcosco@cantab.net.
authors.forename: Theodore D
authors.initials: TD
authors.lastname: Cosco
authors.affiliation: Physiological Laboratory, University of Cambridge, Cambridge, UK.
authors.forename: James H
authors.initials: JH
authors.lastname: King
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005389:Firearms; D018409:Foot Injuries / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000453:epidemiology*; D055815:Young Adult