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The Rural-Urban Continuum
Variability in Statewide Serious Firearm Injuries in Children and Adolescents
Michael L. Nance, MD;
Lex Denysenko, BS;
Dennis R. Durbin, MD, MSCE;
Charles C. Branas, PhD;
Perry W. Stafford, MD;
C. William Schwab, MD
Arch Pediatr Adolesc Med. 2002;156:781-785.
Objective To compare rates of serious firearm injuries among children and adolescents
treated in a statewide trauma system.
Materials and 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.
From the Departments of Pediatric Surgery (Drs Nance and Stafford)
and Pediatrics (Dr Durbin), Children's Hospital of Philadelphia, Division
of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania
(Mr Denysenko and Dr Schwab), and the Center for Clinical Epidemiology and
Biostatistics, University of Pennsylvania (Dr Branas), Philadelphia.
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