Pediatric Gun Violence: Pediatric Trauma Series 2017

Over the last 25 years, mortality from pediatric trauma has decreased by about 50%.

Trauma is still the single most common cause of death in the pediatric population and more common than all other causes combined.

Among pediatric injury deaths at trauma centers, motor vehicle crashes are the number one cause, followed by firearms and falls (National Trauma Data Bank 2016).

For children who reach a trauma center, firearms are the most lethal mechanism—the cause most likely to result in death.

The number of firearm deaths in the pediatric population now is about the same as at the beginning of this century, showing little progress.

Among pediatric firearm deaths by intent, homicides are most common, followed by suicide, then unintentional injuries.

In the 15-19 age group, firearms are responsible for 84% of homicides.

In the 15-19 age group, firearms are responsible for 46% of suicides.

In the 15-19 age group, 25% of all deaths involve a firearm.

Following Sandy Hook, the American Academy of Pediatrics, American College of Surgeons, and American Pediatric Surgical Association reviewed and updated their policy statements on firearm safety and injury prevention.

Eight organizations, including the American Academy of Pediatrics, American Academy of Family Physicians, American College of Surgeons, American Psychiatric Association, American Public Health Association, and American Bar Association, published a white paper in the Annals of Internal Medicine advocating multidisciplinary collaboration to reduce firearm injuries.

A survey of American College of Surgeons Committee on Trauma members showed that every advocacy topic related to firearms had over 50% support, and nearly half had over 90% support.

The American Pediatric Surgical Association submitted its firearm policy statement to the entire membership for review and discussion at the annual meeting, resulting in overwhelming approval.

Over the last 30-40 years, there has been a 17% reduction in motor vehicle-related deaths and a 77% increase in vehicle miles traveled, while firearm-related deaths increased by 15%.

Motor vehicle mortality has declined from about 5 deaths per billion vehicle miles traveled to 1.14 over the last five decades.

In the pediatric population, suicide is the third leading cause of death.

There are an estimated 25 suicide attempts for every completed suicide in youth.

In youth suicides, the use of a firearm is successful in 95% of cases.

Firearms are involved in almost 50% of completed youth suicides.

90% of patients who survive a suicide attempt do not ultimately die from suicide.

Most adolescent suicides occur in the home with a firearm owned by the parent.

Many youth suicides are quite impulsive, happening in less than 5 minutes from impulse to action.

Suicide mortality is not reduced with trigger locks or gun safes in some cases because teenagers may have been shown where the firearm is or given the combination to protect themselves.

In 1992, the National Center for Injury Prevention and Control was established under the CDC.

Art Kellerman published a paper demonstrating that gun ownership is a risk factor for homicide in the home, which became a target of the NRA.

In 1996, Jay Dickey successfully added an amendment to an annual spending bill that cut CDC funding to the National Center for Injury Prevention and Control by the specific amount allocated for firearm research.

Cancer research is funded at a rate of about $4,200 per year of potential life lost, while firearm-related research is funded at $2.70 per year of potential life lost from US sources.

Many medical organizations recommend that physicians counsel parents regarding the risks and benefits of keeping firearms in the home.

The majority of gun-owning parents feel that physician counseling about firearm safety is appropriate.

Florida passed the Firearm Owners Privacy Act (Docs vs Glocks law), which restricts healthcare providers from making written inquiries or asking questions about firearm ownership, with penalties including loss of license and up to $10,000 fine.

The Florida Supreme Court overturned the Docs vs Glocks law, but the state appealed to the 11th Circuit Court of Appeals, where a three-judge panel ruled in favor of the state; the full en banc 11th Circuit then overturned the law again.

The NRA has a 40-50 year head start on advocacy efforts and has been profoundly successful, particularly at the state legislative level.

Most firearm legislation and activity happens at the state level, not the federal level.

Firearm legislation efforts tend to happen in fits and starts, with outrage following events like Sandy Hook gradually dying down along with advocacy efforts.