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The tools used to cause intentional injury to children age 0-18 are commonly found. According to numerous surveys, over a third of American households own a firearm, making guns one of America’s most common consumer products. This is in spite of the fact that there are 43 fatal shootings of family members or acquaintances—in suicides, homicides, or “accidents,” for each instance in which a gun at home is used to kill in self-defense. The number of handguns in America is currently projected at about 200 million, with approximately five million new firearms manufactured in the United States annually.

Nationwide, guns rank a close second to motor vehicles as a cause of traumatic death. Even though gun deaths reached a 30-year low in 1998, there were still 30,708 gun-related deaths in the United States that year. At that reduced incidence, every two years far more Americans are killed by guns than in all 11 years of the Vietnam War. The most recent CDC estimate is that 64,484 gun-related injuries are treated annually in the USA. In a 1995 study, Kizer et al. projected that the national cost of firearm-related injuries reached the $4 billion mark. Projections from other sources have run even higher. canadian antibiotics

From the late 1980s until the early 1990s, the number of deaths due to intentional violence among school-aged children more than doubled, even as the death rates from other causes declined. In a 1991 national study, nearly 20%of students in grades 9-12 reported that they had carried a firearm, knife, or a club as a weapon at least once during the 30 days preceding the survey. The phenomenon seemed to peak during the study period around 1995, when 5,277 American children age 19 and under were killed by guns (aver age 14.46/day) Since then, the Federal Bureau of Investigation has reported that national crime rates have declined, and overall gun deaths have dropped more than 25%. Eight-thousand fewer murders were recorded in 1999 than in 1992, and recently reported murder rates are the lowest they have been for about 30 years. Consistent with the national trend, there was first a rise and then a decline in intentional injury rates during the study period in Washington, DC. During that time, we found that the onset of risk of major GSW and SW at age 14 remained constant.

Over the past decades, the social problem of serious violence, particularly among the youth of America, has gained increased recognition in medical literature. Often described as an epidemic, most of these cases are not really “accidents”: “The murder I’m in for… the guy I shot started to threaten me. He put the gun up to my jaw and said that he would shoot me if I messed around with another guy.” (female, age 16)

“I use guns for the right use. I wouldn’t just shoot someone for nothing. You use it if you can’t handle the situation.” (male, age 16)

In our study, the risk of being a victim of a major gunshot wound rose abruptly at age 14 during each year of the 1992-1999 study period. Similarly, an abrupt rise in the incidence of major stab-bings occurred at the same age. The risk of being a victim of a major gunshot wound or stabbing continued to rise sharply through the 18th birthday in each of the eight years studied. This pattern of increased risk of gunshot wounds and stabbing starting at age 14 stayed unchanged throughout the rise and subsequent fall of murder rates, overall intentional injury rates, and crime rates.

Although some violent antisocial behavior is fixed and not amenable to remediation, most is limited to adolescence and does not present a lifelong pattern of behavior. The data presented here demonstrate that a child’s risk of being the victim of a major gunshot wound or stabbing started to rise significantly in the year after a child’s 14th birthday. This is consistent with reports of other aspects of youth violence. The impact of this finding, including its cost in terms of human life and survivor suffering, challenges health professionals, community leaders, elected officials, and parents to respond. This challenge is particularly important, since recent work has demonstrated that violence prevention programs directed at children have proven to be effective.
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This study has a number of limitations. As with any retrospective review, it relies on the accuracy of previously inputted data. Additionally, fatalities that never arrived in the trauma center (patients dead at the scene and not resuscitated) were not included in our study, which introduces a possible source of selection bias. The vast majority of GSW and SW patients met our pre-established criteria for major trauma (See Table 1). Nevertheless, we did not study those who did not, and there exists the possibility that the increased risk of the most minor injuries from firearms and knives starts at a different age.

One of the notable findings of this study was that 44% of the pediatric major trauma patients were victims of penetrating injury—a marked distinction from the 4.8% penetrating injury seen in an average rural population and the 20% penetrating injury previously reported for pediatric trauma overall nationwide. Further research is necessary before our results can be generalized for other urban populations.

The degree to which violent, antisocial behavior is amenable to prevention is unknown. Although recent youth violence prevention programs have been shown to be partially effective, the cost-effectiveness, appropriate age, and optimal content of such programs remain largely unknown and open for future investigation. kamagra soft tablets


In this urban environment, there is a marked increase in the incidence of serious injuries caused by guns and knives starting in the year after a child’s 14th birthday. Even with fluctuating numbers of cases each year and a rise and subsequent fall in overall crime rates, the trend remains constant—the point at which the first statistically significant jump in the incidence of these injuries occurred at age 14 in each of the eight years studied. The data reported are potentially valuable for education and the targeting of injury prevention efforts.

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Tags: adolescents, epidemiology, firearms, injury surveillance, penetrating, penetrating injury, wounds

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