Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In a cross-sectional study examining a national injury surveillance system, the annual rate of nonpowder firearm injuries to children decreased by ~50% per year from 1990 to 2016.

2. The decrease in firearm injury rate was consistent across age groups, sexes, and injury types, but the rate of eye injuries increased by ~30% during the study period.

Evidence Rating Level: 3 (Average)

Study Rundown:

Nonpowder firearms are an important source of pediatric injury, but no studies have comprehensively investigated all types of nonpowder firearm injuries among children and adolescents nationally. In this cross-sectional study, researchers used the National Electronic Injury Surveillance System to estimate the number of children <18 years of age treated for nonpowder firearm injuries in US emergency departments (EDs) from 1990 through 2016 and examined trends over time using linear regression models. During the study period, the annual rate of firearm injury to children fell by more than half. The majority of injuries occurred in boys, and occurred at home. The rate of eye injuries in children from nonpowder firearms rose by a third during the study period.

These findings are limited by isolated inclusion of cases seen in the ED setting, potentially missing patients treated in urgent care facilities and private physician offices. Furthermore, researchers were not always able to identify the user of the firearm, intentionality, and other details of the incident from case narratives. Nonetheless, the study is strengthened by its comprehensive national data source and long study period. For physicians, these findings highlight the importance of prevention efforts to ensure proper firearm handling and use of protective eyewear in children.

Relevant reading: Injury Risk of Nonpowder Guns

In-Depth [cross-sectional study]:

Researchers used data from the National Electronic Injury Surveillance System, encompassing ~100 hospitals representing a stratified sample of hospitals in the US, to identify children and adolescents <18 years of age treated for nonpowder firearm injuries in US emergency departments from 1990 through 2016. Case narratives were reviewed to identify the user of the nonpowder firearm and type of firearm. Trends in nonpowder firearm injuries were examined using linear regression, stratified by age group, injury type, and body region.

In 1990 through 2016, 364 133 (95% confidence interval [CI]: 314 540-413 727) children <18 years of age were treated for nonpowder firearm injuries in US EDs, averaging 13 486 children annually. The average age was 11.8 years, boys accounted for 87.1% of injuries, and 89.4% of injuries occurred at home. Hospital admission occurred in 7.1% of cases. Injury intent was documented in 52.2% of cases, and 1.0% of the documented cases were noted to be intentional (assaults and self-injury). Over the study period, the annual rate of nonpowder firearm injuries per 100 000 children decreased by 54.5% (slope = -0.67; P < .001). The decreasing trend was consistent across all age groups, sexes, and firearm types. There was in increase in annual rate of eye injuries by 30.3% (slope = 0.46; P = .006) during the study period.

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