These Are The Trends in Fatal and Nonfatal Firearm Injuries in the United States

A study evaluating the incidence of fatal and nonfatal firearm injuries in the United States found that the nation’s most common cause of firearm injury death is suicide, and that the majority of those who die by suicide never reach the hospital.

“Firearm injury research in the US has focused on fatal injuries. The incidence and epidemiologic factors associated with nonfatal firearm injuries are less understood,” the researchers explained.

They collected fatal injury data from the Centers for Disease Control and Prevention and nonfatal injury data from the Nationwide Emergency Department (ED) sample on injuries that took place between 2009 and 2017. The main outcomes were incidence, case fatality rate, and trends over time of firearm injury, stratified by intent, age group, and location (urban vs. rural).

The mean number of ED visits each year for nonfatal firearm injury was 85,694, and number of deaths was 34,538. Three-quarters of the annual deaths (mean, 26,445 [76.6%]) happened outside of the hospital. The three most common overall mechanisms were assault (38.9%), unintentional injuries (36.9%), and intentional self-harm (19.6%). Nearly two-thirds of deaths were attributed to self-harm (n=21,128 [61.2%]), which had an 89.4% case fatality rate (95% confidence interval [CI], 88.5-90.4%)—the highest seen in this study. The case fatality rate for assault was 25.9% (95% CI, 23.7-28.6%), and for legal intervention was 23.4% (95% CI, 21.6-25.5%). The most common nonfatal injuries were unintentional ones (43,729 [51%]), which also had the lowest case fatality rate at 1.2% (95% CI, 1.1-1.3%).

Over the course of the study period, the rate of self-harm deaths increased in all age groups and areas; most of them happened outside the hospital (87.8%), and they were most common in people aged 55 years and older.

When looking at trends by location and age, fatal assault injuries were more common in urban areas than rural ones, with rates of 16.6 and 9 per 100,000 per year, respectively, and they were highest in the 15 to 34 years age group, at 38.6 per 100,000 per year. Unintentional injuries were more prevalent in rural areas, with 18.5 per 100,000, compared to urban areas, with 12.4 per 100,000.

The study appeared in JAMA Internal Medicine.

Orthopedic Care for Firearm Injuries

Orthopedic trauma surgeons may have to care for patients with firearm wounds, either with surgery or through nonoperative management.

A study that appeared in the Journal of the AAOS found that managing incomplete femur fracture as a result of a low-velocity gunshot wound may be able to be handled nonoperatively.

A study published in Injury earlier this year highlighted six management concepts when treating patients with lower-extremity gunshot wounds:

• Conservative management of soft tissue injuries if the projectile causes no discomfort
• Conservative management of non-complete fractures of the tibia or femoral shaft
• Prophylactic fixation of non-complete peri-trochanteric fractures
• Fixation of allcomplete fractures
• Removal of all intra-articular projectiles
• Treating as septic arthritis if the missile passes through large bowel (not small bowel) prior to penetrating a joint capsule