Past research has shown us that improving the safety of motor vehicles led to a drop in children’s car accident deaths. A new study in Pediatrics proposes that preventive policies directed at reducing gun injuries among children could likely lead to fewer deaths as well – and such policies are much needed considering the study’s main findings.

The study found that one third of the children who died from gunshot wounds died before ever reaching the hospital — and that one in every five children who were shot died.

The researchers examined all 9-1-1 calls related to children’s injuries in five geographical areas to assess how firearm injuries compared to other types. More than 29,000 children under age 19 died from gunshots from 2001 to 2010, the authors noted.

Gunshot injuries accounted for only 1% of all children's injuries that were called into EMS -- but they accounted for one fifth of the deaths. Photo by Robert Linder

Gunshot injuries accounted for only 1% of all children’s injuries that were called into EMS — but they accounted for one fifth of the deaths. Photo by Robert Linder

There’s good news:

  • Following a peak in gunshot injuries in 1994, firearm deaths in children dropped by half (55%) by 2003.
  • The study found that firearm injuries accounted for only 1% of all the injuries to children leading to a 9-1-1 call.

But there’s bad news too:

  • Since that decline, firearm-caused death rates for children have stagnated since 2003.
  • 21% of the children in this study who died had been shot — making firearm deaths proportionally the highest death rate of all injuries.

Or, more plainly, kids who were shot were far more likely to die than kids injured in any other way.

Briefly, here’s how the researchers conducted the study: First they looked at all EMS and 9-1-1 calls coming in to 47 EMS agencies that serve more than 2.2 million children. The agencies cover emergency transports to 93 hospitals in the rural, suburban and metropolitan areas of five geographical regions: four counties around Portland/Vancouver on the Oregon/Washington border; King County in Washington; Sacramento, Calif.; Santa Clara, Calif.; and Denver County, Colo.

With this data, the researchers then determined what the injuries were for all children up to age 19 (a total of 49,983 children) calling in to those EMS centers. Then they compared the severity of injuries, major surgeries, blood transfusions, deaths and overall costs per child in each of six injury categories: gunshot, cut/piercing/stabbing, car accidents, getting hit by a car, falls, blunt objects and “other.”

Their main findings were sadly unsurprising: “Gunshot injuries were more severe, requiring more frequent major therapeutic interventions and resulting in higher mortality and per-patient costs than any other injury mechanism.” In fact, a child arriving at the hospital with a gunshot wound was four times more likely to die (8% in-hospital death rate) than a child coming in with the next most deadly injury, piercings and stabbings (2% rate).

Consider some of the specifics:
•    Children with gunshot injuries represented the highest proportion of severe injuries (23% of all the injuries categorized as most severe were due to firearms)
•    Abdominal/pelvic injuries and extremity injuries were proportionally far more common among gunshot victims than among victims of any other injury
•    One third of all the children who required major surgery (of total injuries) had been shot
•    Firearm victims were more likely than those injured any other way to need a blood transfusion

Although the rate averaged across all regions was 7.5 gunshot injuries per 100,000 children, the rates varied dramatically from one region to the next: from 2 cases to 31 cases per 100,000 children. The vast majority of gunshot injuries afflicted older teens, aged 15 to 19, who comprised 83% of all firearm injuries (though this age group only comprised 49% of total injuries of any kind). In addition, 84.5% of the firearm injuries occurred to males, though males were involved in only 59% of total injuries of any kind.

And getting shot is pretty expensive too. The highest per-patient average cost for any of the injuries was $28,510 — the average medical costs for treating children who had been shot. The next highest amount was for car accidents but was almost half as much: $15,566.

“These comparisons illustrate the immense per-patient impact of gunshot injuries in children,” the researchers wrote — yet these costs do not include any costs outside of the hospital. They do not include long-term outcomes, additional medical costs in follow-up or physical therapy, costs related to PTSD or other mental health repercussions, lost productivity in the children’s futures, lost productivity to society for the children’s deaths, lost productivity and related costs to the family, friends and other community members who grieved or were otherwise affected by these injuries and deaths, court costs in any cases that were filed as a result of the cases…

Like any study, this one throws a lot of numbers at us, but the big takeaway is pretty straightforward: firearm injuries may be relatively rare compared to other major injuries among children, but gunshots account for one in five deaths among children and have enormous personal, medical and financial impact.

But that does not mean the situation is hopeless. “Lessons in improving car motor vehicle safety (eg, booster seats, age-appropriate restraint systems and seat position, air bags) and the associated reductions in pediatric motor vehicle mortality provide important examples of the potential impact of injury prevention efforts,” the authors wrote.

If we can make it less likely for a car accident to kill children through smart, evidence-based policies, then we should also be able to develop smart, evidence-based policies that reduce children’s likelihood of dying from guns as well.

 

This study was funded by the National Institutes of Health, the Robert Wood Johnson Foundation, California Wellness Foundation, the Oregon Clinical and Translational Research Institute, the University of California Davis Clinical and Translational Science Center, the Stanford Center for Clinical and Translational Education and Research, the University of Utah Center for Clinical and Translational Science, and the University of California San Francisco Clinical and Translational Science Institute.

We’ve been covering a lot of medical association news related to the Newtown shooting and gun-related legislation, but that’s because we’re very focused on looking at what research can tell us about reducing firearm injury, and medical associations are closely involved with much of this research.

Just as the American Psychiatric Association issued their remarks last week, the American Academy of Pediatrics sent their own letter, which you can download here, to President Barack Obama and Congressional leaders on December 19.

The organization had published a report on firearm-related injuries affecting children in their journal Pediatrics in October, in which they wrote “The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use.”

Unsurprisingly, in their letter to political leaders, they were just as direct regarding policy proposals related to gun control, mental health and children’s exposure to violence:

•    ”New federal firearms legislation that bans assault weapon sales and the sales of high capacity magazines, strengthens mandatory waiting periods and background checks for all gun purchases and promotes strict gun safety policies is a necessary first step.
•    Next, the federal government must take action to improve access to services that meet the mental health and developmental needs of infants, children and adolescents, and ensures that children and families exposed to violence have access to a medical home and other community supports.
•    Finally, we must engage in a national dialogue designed to reduce children’s detrimental exposure to violence in their communities, environments and entertainment.”

We’ll be revisiting the full account of their policy report on firearms for a later blog post, but we also wanted to mention another article with similar recommendations. “Weapons of Mass Destruction,” published in the Archives of Internal Medicine, which is published by the American Medical Association, also offered commentary related to firearm regulation. More »