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Background: The burden of firearm injury (FI) extends beyond hospitalization; however, literature focuses mostly on short-term physical outcomes. This study aimed to assess changes in patient-reported outcomes following firearm-related trauma. We hypothesized long-term patient-reported socioeconomic, mental health, and quality-of-life (QoL) outcomes are worse post-FI compared to pre-FI.Methods: This was a retrospective study where a phone survey was conducted with FI survivors admitted between January 2017 and August 2022 at a level 1 trauma center. Survey questions assessed demographics, socioeconomics, and mental and physical health pre-FI vs ≥ 6 months post-FI; the McNemar test was used for comparisons. The PROMIS-29 + 2v2.1 NIH validated instrument was used to assess long-term QoL. Standardized NIH PROMIS T-scores were calculated using the HealthMeasures Scoring Service.Results: Of 204 eligible FI survivors, 71 were successfully contacted and 38 surveyed. Respondents were male (86.8%), Black (76%), and aged 18-29 (55.3%), and 68.4% had high school level education. Post-FI, patients were more likely to be unemployed (55.2% vs 13.2%, P < .001) and report increased mental health needs (84.2% vs 21%, P < .001) compared to pre-FI. Most (73.7%) also reported lasting physical disability. Similarly, the PROMIS instrument demonstrated largely worse health-related QoL scores post-FI, particularly high anxiety/fear (T-score 60.2, SE 3.1, CI 54.6-66.3, Table 2), pain resulting in life interference (T-score 60.0, SE 2.3, CI 55.7-63.9), and worse physical function (T-score 42.5, SE 3.0, CI 38.2-46.9).Conclusions: Firearm injury survivors had more unemployment and worse mental health post-FI compared to pre-FI. Firearm injury survivors also reported significantly worse health-related QoL metrics including pain, anxiety, and physical function 6 months following their trauma. These long-term patient-reported outcomes are a framework to build future outpatient resources.Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The purpose of this study was to investigate temporal trends in gunshot wound (GSW)-associated orthopedic injuries among children, adolescents, and young adults in New York State, and to determine the impact of the onset of the COVID-19 pandemic on the incidence of these injuries. Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) inpatient database was reviewed to identify patients ≤ 21 years of age who presented to a hospital with GSW-associated injuries from January 2016 to December 2020. Patient diagnosis codes were cross-referenced with the list of the International Classification of Diseases Version 10 Clinical Modification (ICD-10-CM) codes for orthopedic injuries to determine the incidence of GSW-associated orthopedic injuries among this cohort. The number of cases was cross-referenced with New York State census population estimates to calculate incidence per million. The geographic incidence was plotted over a map of New York State with sub-division based on facility Zone Improvement Plan (ZIP) codes. Poisson regression was used to compare the injury incidence in 2020 (pandemic onset) versus the preceding years (pre-pandemic). Results: Between 2016 and 2020, there were 548 inpatient admissions for GSW-associated orthopedic injuries, representing an incidence of 5.6 cases per million. Injury incidence decreased from 2016 to 2019, with an increase in 2020 representing almost 28% of the total cases identified. There was a statistically significant difference in the incidence rate ratio for 2020 compared to 2016–2019 (p < 0.001). The majority of patients were male (94%), African–American (73%), and covered by either Medicare (49%) or Managed Care (47%). Most cases were clustered around large metropolitan areas with low incidence in suburban and rural regions of the state. Conclusions: There was a two-fold increase in the incidence of GSW-associated orthopedic injuries among patients ≤ 21 years old in New York State during the onset of the COVID-19 pandemic.

Introduction: Indirect intra-abdominal injury with an intact peritoneum following close passage of highly energized projectiles is an uncommon but clearly described phenomenon; likewise delayed gastrointestinal perforation hours or days after passage of a high-energy stress wave from primary blast injury is uncommon. Awareness of these two rare occurrences is required to ensure delayed perforations are diagnosed and managed in a timely manner. Case report: An 8-year-old male child sustained a shotgun injury to the right elbow and the abdominal wall only of the right hypochondrium. Due to a non-salvageable joint injury, he underwent amputation of the right upper limb above the elbow, but on the third day of admission, he developed peritonitis and an X-ray revealed pneumoperitoneum. On abdominal exploration, two small ileal perforations were found without penetration of the peritoneum or diaphragm. The ileal injuries were primarily repaired and the postoperative course was uneventful. Conclusion: Indirect injury to abdominal viscera from the primary blast effect of close passage of high-energy projectiles resulting is rare and can have significant consequences if not diagnosed and managed early. [ABSTRACT FROM AUTHOR]

Objective: This study retrospectively evaluates Ankara Emergency Medical Services' (EMS) prehospital responses to firearm injuries concerning demographic characteristics, response times, and outcomes. Materials and Methods: Data were extracted from the Ankara EMS database (ASOS) encompassing firearm injury cases from January 1, 2019, to December 31, 2023, totaling 2,764 cases. Descriptive statistics were analyzed across years, focusing on EMS response times. Results: Of the 2,764 cases analyzed, 92.1% involved male patients and 7.9% female patients. Most incidents (71.2%) occurred on weekdays compared to weekends (28.8%). Soft tissue traumas accounted for 53.5% of cases, followed by interhospital transports (21.3%), medical cases (13.7%), and suicides (11.4%). Regarding outcomes, 65.6% of cases were transported to a hospital, 21.3% underwent interhospital transfers, and 11.4% were declared dead on arrival. The average call center response time was 324.6 seconds, ambulance team response time was 45.1 seconds, and time to scene arrival averaged 502.9 seconds. Conclusion: Ankara EMS demonstrated prompt and effective responses to firearm injuries, predominantly involving male patients. Most cases were directed to training and research hospitals, highlighting these institutions' pivotal role in EMS operations. These findings provide valuable insights for enhancing EMS protocols and future research. This study aims to inform and guide future investigations in this field. [ABSTRACT FROM AUTHOR]

Reversing physical disinvestment, e.g., by remediating abandoned buildings and vacant lots, is an evidence-based strategy to reduce urban firearm violence. However, adoption of this strategy has been inconsistent across US cities. Our community-academic partnership sought to support adoption in Toledo, OH, USA, by generating locally relevant analyses on physical disinvestment and firearm violence. We used a spatial case–control design with matching. Physical disinvestment measures were derived from a citywide parcel foot audit conducted by the Lucas County Land Bank in summer 2021. Firearm violence outcomes were incident-level shootings data from the Toledo Police Department from October 2021 through February 2023. Shooting locations were matched to controls 1:4 on poverty rate, roadway characteristics, and zoning type. Exposures were calculated by aggregating parcels within 5-min walking buffers of each case and control point. We tested multiple disinvestment measures, including a composite index. Models were logistic regressions that adjusted for the matching variables and for potential spatial autocorrelation. Our sample included N = 281 shooting locations and N = 1124 matched controls. A 1-unit increase in the disinvestment score, equal to approximately 1 additional disrepair condition for the average parcel within the walking buffer, was associated with 1.68 times (95% CI: 1.36, 2.07) higher odds of shooting incidence. Across all other measures, greater disinvestment was associated with higher odds of shooting incidence. Our finding of a strong association between physical disinvestment and firearm violence in Toledo can inform local action. Community-academic partnership could help increase adoption of violence prevention strategies focused on reversing physical disinvestment. [ABSTRACT FROM AUTHOR]

Firearm injuries are the leading cause of pediatric deaths. The objective of this study was to describe the location and timing of pediatric firearm injuries and to determine the proportion of these injuries that occur within schools in the United States. In this retrospective cohort study, we used national emergency medical services (EMS) data from 2019 to evaluate dispatches to firearm injuries involving school-aged children (age 5–18). We extracted incident location type, patient demographics, number of patients on scene, and injury intent. We identified 4764 EMS dispatches for firearm injuries in school-aged children during 2019. Assault was the most common cause of injury (53.9 %), followed by unintentional shootings (12.1 %) and self-inflicted injuries (6.1 %). Most incidents involved a single patient (91.4 %). Private residence (51.5 %) was the most common location, followed by street/road (23.8 %). 81 firearm injuries (1.7 %) occurred in a school. Private residence was the most common location of injury across all injury intents. During school hours, most firearm injuries occurred in a private residence (51.6 %) or on a street/road (19.9 %). A total of 63 dispatches (1.3 %) were considered a mass casualty incident, of which 9 (14 %) occurred in a school. Regardless of injury intent or time of day, the most common location for pediatric firearm injuries was a private home. Firearm injuries within schools were far less frequent. In designing prevention strategies, our data calls for renewed focus on preventing children from accessing firearms in the home and instituting comprehensive, community-based after school programs. Retrospective cohort. III. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The spectrum of firearm injuries (FI) is broad and challenging for physicians in terms of diagnosis and treatment. The bullets and pellet ammunition used in FI exhibit different ballistic patterns and cause quite different damage to the body. The aim of this study was to compare the outcomes of bullet and pellet injuries causing bone fractures in the extremities. Method: The files of patients who were injured in their extremities due to civilian FI between 2016 and 2020 and who were followed up by the orthopedic clinic due to bone fractures were retrospectively analyzed. Age, gender, injured extremity, presence of infection, presence of vascular injury, presence of nerve injury, total number of operations, length of hospital stay and permanent sequelae were evaluated. Cases with missing files were excluded from the study. Evaluation criteria were compared under two main headings for bullet and pellet ammunition types. Results: There were a total of 40 cases with a mean age of 43.5 years. The mean follow-up period was 41.5(24-61) months. 39 of the cases were male and 1 was female. There were 28 bullet injuries and 12 pellet injuries. Thirty-two of the cases were lower extremity injuries and 8 were upper extremity injuries. There were significant differences between ammunition type and number of operations (p=0.032). The length of hospital stay was significantly higher in the pellet group (p=0.024, p=0.024. Overall, 12.5% infection, 10% vascular damage, 17.5% nerve damage and 30% permanent sequelae occurred as a result of treatments. There were no significant differences between the groups in terms of infection, vascular injury, nerve injury and permanent sequelae. Conclusion: It was concluded that pellet injuries require longer hospital stays and a higher number of surgeries compared to bullet injuries. [ABSTRACT FROM AUTHOR]

Firearm injury poses a significant public health burden in the United States. The purpose of this systematic review was to provide a comprehensive accounting of the medical costs of firearm injuries in the United States. A systematic literature review was conducted to identify studies published between January 1, 2000 and July 13, 2022 that reported medical costs of firearm injuries. A search of Embase, PubMed, and the Cochrane Library databases was performed by a medical librarian. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate for risk of bias. Health care-related charges and costs per firearm injury were presented and trends were identified. Sixty-four studies were included in the analysis. Study sample sizes ranged from 18 to 868,483 patients. Reported costs per injury ranged from $261 to $529,609. The median cost reported was $27,820 (interquartile range [IQR] $15,133–$40,124) and median charge reported was $53,832 (IQR $38,890–$98,632). Studies that divided initial hospitalization costs and follow-up medical costs identified that initial hospitalization accounts for about 60% of total costs. We found a significant volume of literature about the medical costs of firearm injury, which identified a highly heterogeneous cost burden. A significant amount of cost burden occurs after the index hospitalization, which is the only cost reported in most studies. Limitations of this study include reporting bias that favors hospitalized patients as well as a large focus on hospital charges as measurements of cost identified in the literature. [ABSTRACT FROM AUTHOR]

IntroductionIn the United States, firearm-related injuries are the leading cause of death among children and adolescents 1–19 years of age. Although many pediatricians believe addressing firearm safety is important and have guidance from organizations like the American Academy of Pediatrics, few routinely screen and counsel on firearm safety. The goal of this project was to screen all patients presenting to the pediatric emergency department, pediatric floor, and pediatric intensive care unit for the presence of firearms in the home, firearm storage practices, and whether they had previously received any firearm counseling by medical professionals.MethodsA 13-item survey was administered to each participant. Items included demographic information, willingness to answer questions about firearms, practice of asking questions about firearms, previous counseling from medical professionals about the presence of firearms in the home and the presence of firearm in their personal home as well as storage practices.ResultsA total of 200 parents responded to the survey. Of those that responded to the survey, 171 (85.5%) did not have a firearm in the home and 28 (14%) did have a firearm in the home. 75% (n = 21) had never had a medical provider discuss firearm safety with them. 100% had never been asked by another parent about the presence of a firearm in their home when a child came over for a playdate. 39% (n = 11) of parents with a firearm in the home had asked other parents whether they have a firearm in the home where their child goes to play.DiscussionFindings from our study highlight a significant lack of screening of our pediatric patients both in the inpatient and outpatient settings, with the majority reporting that they had never been asked by a medical provider about firearm safety. In addition, three quarters of parents with a firearm in the home reported that they did not mind answering questions about firearms yet none had been asked by other parents about firearms. Thus, although firearm possession and safety is considered to be a sensitive topic, many parents are willing to discuss it with their health care providers and other parents.

Background: In the emergency department, many cases present with a bullet injury. Bullet injury accidents are highly sensitive cases due to the medico-legal aspect and political issues. Gunshot injuries have increased in the past few years because of the easy availability of guns and firearms. Young male adults are more involved in criminal activity and suicides. Gunshot injuries are high-energy injuries that lead to extensive soft tissue damage and bone fractures. Materials and Methods: This retrospective descriptive study was performed on eight patients with gunshot injuries between January 2021 and December 31, 2021. After initial first aid, patients underwent an X-ray and computed tomography for further assessment of soft tissue damage, surgical planning, and forensics. SPSS software was used to analyze the collected data and generate descriptive statistics, and the data were plotted in tabular format. Results: In this article, we discussed the imaging investigation modalities primarily used for firearm injury elaborated on the tissue damage due to firearms and secondary complications. Of eight patients, 87% had single bullet injuries, while 13% had shotgun injuries. In addition, 62% had head and neck injuries, whereas 38% had chest and abdomen injuries. Conclusion: There are many cases presented in the emergency department with firearm injuries. Radiological investigations are always essential for management or surgical planning to rule out the visceral damage and medico-legal aspects. For an accurate diagnosis, a radiologist must know about the essentials of firearm injuries.

Abstract Background Firearm injury is a significant public health concern in the United States. Methods Data on fatal and nonfatal firearm injuries were obtained from a cohort of N = 7,473,650 members of Kaiser Permanente Southern California, a large integrated healthcare system between 2010 and 2020. Age-adjusted rates of combined fatal and nonfatal firearm injury per 100,000 members were calculated by year, with the 2010 US census as the reference population. Trends were evaluated using Poisson or negative binomial regression. Results There was an increasing trend in overall firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system (p

Copyright of Turkiye Klinikleri Journal of Forensic Medicine & Forensic Sciences / Türkiye Klinikleri Adli Tıp ve Adli Bilimler Dergisi is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The correlation between mass shootings, firearm injuries, and mental health is an ongoing polarized debate within the U.S., making it essential to develop public policy on mental illness and firearm injuries exacerbated by a significant increase in firearm sales in March 2020. Although many mass shooters are labeled "mentally ill," mental illness is only present in a small minority of cases. Most mentally ill people are never violent but are more likely to be the victims of violence. Easy access to firearms and a triggering event deriving from social and economic inequalities are primary causes of mass shootings and growing online radicalization. Radicalization can easily lead to fatal firearm injuries, particularly for individuals with diagnosed or undiagnosed mental illness. Proposed solutions include permits for firearms purchase, including a 25-year-old age limit, universal background checks, and banning large-capacity magazines. Additionally, a speedy and effective law enforcement response is the sole factor and the most reliable way to stop a mass shooting once it has started. The research identified several other recommendations, including expanding Medicare and mental health care access, expanding school safety and law enforcement training, and promoting public education about mental health and firearm safety. • Easy access to firearms, triggering events, and online radicalization contribute to mass shootings. • Expanding mental health services and improving reporting systems can deter mass shootings. • Policy should incorporate steps to limit access to firearms. • A key solution is improved law enforcement response. • Public education on mental health and firearm safety is essential. [ABSTRACT FROM AUTHOR]

Background: Firearm injury is a significant public health concern in the United States. Methods: Data on fatal and nonfatal firearm injuries were obtained from a cohort of N = 7,473,650 members of Kaiser Permanente Southern California, a large integrated healthcare system between 2010 and 2020. Age-adjusted rates of combined fatal and nonfatal firearm injury per 100,000 members were calculated by year, with the 2010 US census as the reference population. Trends were evaluated using Poisson or negative binomial regression. Results: There was an increasing trend in overall firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system (p <.0001), primarily driven by non-self-inflicted firearm injuries (p <.0001). Self-inflicted injuries decreased during this time (p =.01). Injuries among youth showed no significant change. Conclusion: There was an increasing trend in firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system, primarily driven by non-self-inflicted firearm injuries; however, self-inflicted injuries decreased during this time. Injuries among youth showed no significant change. [ABSTRACT FROM AUTHOR]

BACKGROUND: The increase in firearm injuries at U.S. pediatric trauma centers is a national public health crisis. This spike in penetrating trauma has challenged even the most mature pediatric trauma centers. OBJECTIVE: This project aims to identify U.S. pediatric trauma center best practices for the evaluation and resources dedicated to pediatric firearm injuries. METHODS: This study used an exploratory cross-sectional survey design using a study-specific questionnaire. An electronic survey was distributed to 159 verified U.S. pediatric trauma centers targeting patients younger than 15 years with firearm injuries from 2017 to 2021. Trauma approaches to injury prevention, advocacy, and common performance improvement events were surveyed. A follow-up survey provided a drill-down on the top three performance improvement events. RESULTS: A total 159 surveys were distributed, of which 63 (40%) submitted partial responses and 32 (20%) completed the initial survey in full. A 49% increase in pediatric firearm injuries occurred between 2019 and 2020. Eighty-six percent of the trauma centers identified at least one to two opportunities for improvement events related to firearm injuries, with most of these events requiring a tertiary level of review. The top three performance improvement events included the massive transfusion protocol/fluid resuscitation, emergency department procedures, and operating room resource availability. CONCLUSIONS: This study provides the first known examination of U.S. pediatric trauma center quality improvement efforts to address the crisis of pediatric firearm injuries. Our results indicate that most pediatric trauma centers are engaged in quality improvement and resource enhancement to combat firearm injuries. [ABSTRACT FROM AUTHOR]

Hospital-based violence intervention programs (HVIPs) have shown promise in preventing reinjury and enhancing recovery from violent injuries, including those related to firearms. Historically, HVIPs have primarily focused on at-risk adolescents and young adults. The aim of this study is to perform a scoping review of HVIPs targeting children under the age of 18, describe the evidence supporting these programs, and deduce the potential impact of expanding HVIPs to younger children. A scoping review was performed utilizing PubMed database with search terms "violence intervention program" and pediatric, or children, or youth. Articles were screened for youth-inclusive violence programs, and the literature was analyzed for program descriptions, evidence supporting interventions, and barriers to evaluation. 36 studies (covering 23 programs) were identified that met criteria (including patients ≤18 years old), with only 4 programs including children under 10. Many HVIPs utilize brief hospital interventions with longitudinal wraparound outpatient services. Despite heterogeneity in programs and studied outcomes, many HVIPs demonstrated positive outcomes, such as reduction of risk factors, decreased reinjury, decreased violent behaviors, decreased criminal justice involvement, and positive attitude or behavioral changes. Only a few studies reported increased odds of enrollment and positive impact in younger patients specifically. Children are an impressionable population in which HVIPs may have significant impact; however, there remains a gap in targeted programs. Given that firearm injuries are the leading cause of death in children and adolescents, priority should be given to piloting, implementing, and evaluating HVIPs among younger age groups. Level IV. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether exposure to theUnited States discriminatory housing practice of redlining, which occurred in over 200 cities in the 1930s, is associated with modern-day, community-level incidence of firearm injury. Background: Firearm violence is a public health epidemic within the United States. Federal policies are crucial in both shaping and reducing the risk of firearm violence; identifying policies that might have contributed to risks also offers potential solutions. We analyzed whether 1930s exposure to the discriminatory housing practices that occurred in over 200 US cities was associated with the modern-day, community-level incidence of firearm injury. Methods: We performed a nationwide retrospective cohort study between 2014 and 2018. Urban Zip Code Tabulation Areas (ZCTAs) historically exposed to detrimental redlining (grades C and D) were matched to unexposed ZCTAs based on modern-day population-level demographic characteristics (ie, age, Gini index, median income, percentage Black population, and education level). Incidence of firearm injury was derived from the Gun Violence Archive and aggregated to ZCTA level counts. Our primary outcome was the incidence of firearm injury, modeled using zero-inflated negative binomial regression. Results: When controlling for urban firearm risk factors, neighborhoods with detrimental redlining were associated with 2.6 additional firearm incidents annually compared with nonredlined areas with similar modern- day risk factors. Over our study period, this accounts for an additional 23,000 firearm injuries. Conclusions: Historic, discriminatory Federal policies continue to impact modern-day firearm violence. Policies aimed at reversing detrimental redlining may offer an economic means to reduce firearm violence. [ABSTRACT FROM AUTHOR]

Abstract Background Violence due to firearms is a major global public health issue and vascular injuries from firearms are particularly lethal. The aim of this study was to analyse population-based epidemiology of firearm-related vascular injuries. Methods This was a retrospective nationwide epidemiological study including all patients with firearm injuries from the national Swedish Trauma Registry (SweTrau) from January 1, 2011 to December 31, 2019. There were 71,879 trauma patients registered during the study period, of which 1010 patients were identified with firearm injuries (1.4%), and 162 (16.0%) patients with at least one firearm-related vascular injury. Results There were 162 patients admitted with 238 firearm-related vascular injuries, 96.9% men (n = 157), median age 26.0 years [IQR 22–33]. There was an increase in vascular firearm injuries over time (P

Trauma during pregnancy is the leading cause of non-pregnancy-related maternal deaths, with some due to injuries from firearms. It was the purpose of this study to characterize the patterns and presentations of firearm-associated injuries in pregnant women using a national emergency department visit database. Data from the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993–2020 were utilized. The data include age, sex, race, type of firearm, perpetrator of injury, intent of injury (unintentional, assault, suicide, or law enforcement), anatomic location of the injury, incident locale, disposition from the emergency department (ED), and whether the patient was shot or not with the firearm. Of the 3.36 million ED visits over this time span for firearm injuries, 4410 were pregnant women. The mean age of the pregnant cohort was 23.6 years, with more Hispanic and fewer White women in the pregnant group compared to the non-pregnant cohort. Pregnant women were more likely to experience an injury involving the lower trunk and had a higher percentage of fatalities and hospital admissions compared to the non-pregnant cohort. Fetal demise occurred in at least 70% of cases. Nearly one half of the assaults (44%) occurred on Saturdays and Sundays. As the cause of these injuries is complex, prevention will require input from multiple sources, including health care providers, social agencies, government agencies, elected officials, and law enforcement.

Abstract Background What if you fire a bullet and, like a boomerang, it comes back towards you after hitting the target, leaving no trace in the body. Case presentation A similar case was presented to us for an autopsy at the district mortuary, Aligarh, with a bullet unusually ricocheting within the thoracic cavity and taking almost path of incidence after grazing over the 3rd rib and coming out just closure to the entry wound towards the musketeer. The presence of stippling at both the entrance and exit wounds poses a challenge to interpreting the track of the injury. Conclusion Thorough and detailed examination at autopsy and crime-scene investigation revealed a strange ricochet event within the chest cavity.

IntroductionFirearm injury is the leading cause of death in children. This study uses geospatial mapping to illustrate the burden of pediatric firearm injury in Philadelphia and assesses the relationship between Child Opportunity Index (COI) and injury, hypothesizing that lower COI zip codes would have higher injury and mortality rates.MethodsPediatric firearm injury data for children aged 0–19 years in Philadelphia, from 2015 to February 2023, was visualized by race/ethnicity, fatal versus non-fatal status, and COI for zip code. COI was then dichotomized as “High” or “Low” based on nationally normed scores and used to compare incidence and odds of mortality. Injury incidence rates by COI were calculated using weighted Poisson regression, to adjust for the total number of children in each COI category. Odds of mortality by COI, adjusted for age, sex and race/ethnicity, were calculated using multivariable logistic regression.ResultsOf 2,339 total pediatric firearm injuries, 366 (16%) were fatal. Males (89%), adolescents (95%) and Black children (88%) were predominately affected. Geospatial mapping showed highest burden in North and West Philadelphia, which corresponded with areas of low COI. The incidence rate ratio (IRR) of injury in low COI zip codes was 2.5 times greater than high COI (IRR 2.5 [1.93–3.22]; p

Objectives: Persons experiencing homelessness (PEH) are at high risk for violent victimization. This study leverages unique data from a national study in the United States of America to provide estimates of non-fatal firearm injury among PEH and to describe the contexts related to injury, such as substance use, intent of the injury, and precipitating interpersonal factors. Study design: Cross-sectional. Methods: Data from the 1993–2020 National Electronic Injury Surveillance System-Firearm Injury Surveillance Study (NEISS-FISS) were used to describe the context and characteristics of non-fatal firearm injury among PEH aged 16 years or older. Homeless status and substance use data were extracted from a de-identified narrative field. Estimates were weighted to account for the NEISS-FISS complex sampling design. Results: Probable homelessness was identified in 0.10% of cases (n = 3,225). Substance use was documented in 22.73% of cases. Assault comprised 82.64% of injuries. Patients were mostly male (81.38%). Missing data were common on contextual variables: verbal argument (64.62%), physical fight (54.48%) or other criminal activity (62.33%). Conclusions: Assault is a leading cause of non-fatal firearm injury for PEH and is greater than rates of assault in non-fatal firearm injuries in the general population. Substance use was documented in nearly one quarter of patients, although this is less than expected given prior evidence. Reliance on narrative fields for key variables likely underestimates rates of PEH and substance use.

Introduction: Firearm injury and death is increasingly prevalent in the United States. Emergency physicians (EP) may have a unique role in firearm injury prevention.The aim of this study was to describe EPs’ beliefs, attitudes, practices, and barriers to identifying risk of and counseling on firearm injury prevention with patients. A secondary aim was assessment of perceived personal vulnerability to firearm injury while working in the emergency department (ED).Methods: We conducted a cross-sectional survey of a national convenience sample of EPs, using questions adapted from the American College of Surgeons’ Committee on Trauma 2017 survey of surgeons. Descriptive statistics and chi-square tests were calculated as appropriate.Results: A total of 1901 surveys were completed by EPs from across the United States. Among respondents, 42.9% had a firearm at home, and 56.0% had received firearm safety training. Although 51.4% of physicians in our sample were comfortable discussing firearm access with their high-risk patients, more than 70% agreed or strongly agreed that they wanted training on procedures to follow when they identify that a patient is at high risk of firearm injury. Respondents reported a variety of current practices regarding screening, counseling, and resource use for patients at high risk of firearm injury; the highest awareness and self-reported screening and counseling on firearm safety was with patients with suicidal ideation. Although 92.3% of EPs reported concerns about personal safety associated with firearms in the ED, 48.1% reported that there was either no protocol for dealing with a firearm in the ED, or if there was a protocol, they were not aware of it. Differences in demographics, knowledge, attitudes, and behavior were observed between respondents with a firearm in the home, and those without a firearm in the home.Conclusions: Among respondents to this national survey of a convenience sample of EPs, approximately 40% had a firearm at home. The majority reported wanting increased education and training to identify and counsel ED patients at high risk for firearm injury. Improved guidance on personal safety regarding firearms in the ED is also needed.

Background: Firearm violence has increased nationwide, with recent surges linked to the COVID-19 pandemic. We measured traumatic assault trends at our urban Level I trauma center and assessed rates of firearm violence over time and pre/post local COVID-19 lockdown based on levels of socioeconomic disadvantage. Methods: We conducted a retrospective review (2016-2022) of assault patients 16 years and older. Demographics and hospital outcomes were assessed by assault mechanism (firearm, knife, blunt). Patient address was correlated to Area Deprivation Index (ADI), a measure of socioeconomic disadvantage. COVID-19 lockdown onset was defined as initial date of lockdown (3/19/2020). Trend and time-series analyses compared all assault mechanisms and firearm-specific assaults pre/post-lockdown. Poisson regression assessed firearm assault risk. Results: Of the 1583 total assaults, firearm patients (n = 335) were younger (median 29 years), had longer hospital stays (median 2 days), and greater mortality (12%) than other mechanisms. The 2 years post-lockdown had significantly more firearm assaults (27% vs 15% pre-lockdown, P <.001) and time-series analysis found this abrupt and significant increase in firearm assaults occurred at lockdown onset (P =.01). Also post-lockdown, the rate of firearm assaults increased by 10% for every unit increase in socioeconomic deprivation (P <.01). There was no change in assault type by race/ethnicity. Discussion: Firearm assaults increased dramatically immediately post-COVID lockdown at our center and have maintained higher rates through 2022. Greater ADI was associated with increasing firearm assaults and has magnified post-lockdown, demonstrating lower socioeconomic groups are disproportionately and increasingly affected by firearm violence. Graphical Abstract [ABSTRACT FROM AUTHOR]

High rates of firearm injury among urban Black men in the US can lead to long physical and psychological recovery times, worsened by limited access to mental health services. Spirituality can propel positive thoughts, actions, perceptions and behaviors about self and others yet how it is used among Black men recovering from firearm injury is underexplored. This study examined the role of spirituality in the recovery of Black male survivors of firearm injury. Ten injured urban Black men in Philadelphia were interviewed using descriptive phenomenology. A subset of participants from the Emotional Responses and Recovery from Injury in Urban Black Men study who agreed to be recontacted for future studies were enrolled. Informed consent was obtained, semi-structured interviews were conducted via phone and were audiotaped, transcribed, and de-identified. Thematic content analysis was used to understand perceptions of spirituality and to identify spiritual coping behavior themes. Findings suggest that injured urban Black men engaged in theistic and non-theistic spiritual activities that resulted in positive character development, reduced risk of re-injury, hope, improved mental health and social bonds. Spirituality may serve as a protective factor against firearm re-injury or retaliation by promoting desired behaviors and mental health among injured urban Black men. Combining culturally sensitive spiritual resources and psychotherapy may lead to effective trauma-informed care in addressing spiritual and existential challenges of injured urban Black men who may find spirituality important. • Spirituality helps Black male survivors of firearm injury cope with trauma. • Urban Black men benefit from spiritual activities during recovery. • Spiritual coping can enhance the ability of Black men to deal with mental health symptoms. • Spiritual coping skills promote social cohesion and safety. • Spirituality empowers and builds resilience in injured Black men. [ABSTRACT FROM AUTHOR]

This qualitative study examines how youth and adult members of 4‐H Shooting Sports clubs perceive firearm injury risk and risk reduction, and the applicability of a bystander intervention (BI) risk reduction framework in this community. Semistructured interviews were conducted with 11 youth and 13 adult members of 4‐H Shooting Sports clubs across nine US states from March to December of 2021 until thematic saturation was reached. Deductive and inductive thematic qualitative analyses were performed. Six overarching themes emerged: (1) The tendency to view firearm injury as predominantly unintentional in nature; (2) Acknowledgment of a wide array of risks for firearm injury; (3) Perceived barriers to bystander action to prevent firearm injury including knowledge, confidence, and consequences of action; (4) Facilitators of bystander action including a sense of civic responsibility; (5) Direct and indirect strategies to address potential risks for firearm injury; and (6) Belief that BI skills training would be useful for 4‐H Shooting Sports. Findings lay the groundwork for applying BI skills training as an approach to firearm injury prevention in 4‐H Shooting Sports, similar to how BI has been applied to other types of injury (i.e., sexual assault). 4‐H Shooting Sports club members' sense of civic responsibility is a key facilitator. Prevention efforts should attend to the broad array of ways in which firearm injury occurs, including suicide, mass shootings, homicide, and intimate partner violence, as well as unintentional injury. [ABSTRACT FROM AUTHOR]

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The SARS-CoV-2 (COVID-19) pandemic and implementation of stay-at-home orders led to changes in the daily lives of children. Subsequently, there have been reports of increases in pediatric violent traumatic injuries. This review summarizes the existing literature regarding pediatric violent injury temporally related to the COVID-19 pandemic, including demographic, injury, and hospital characteristics in addition to associated factors. Key findings include an increase in fatal and nonfatal firearm injuries, particularly in minority and socioeconomically disadvantaged populations. However, more comprehensive and long-term data are needed specific to pediatric violent injuries to fully understand how the COVID-19 pandemic impacted trends. [ABSTRACT FROM AUTHOR]

• Though poorly understood, a small number of studies have noted an increase in pediatric firearm injuries during the COVID-19 pandemic. • In this study, the frequency and mortality of pediatric firearm injuries was found to have significantly increased during the COVID-19 pandemic. • The rise in pediatric firearm injuries was driven by an increase in firearm assaults/homicides, primarily amongst Black youths. • Spikes in pediatric firearm assaults were found to occur during or within three months of COVID-19 death-rate surges. The COVID-19 pandemic has been associated with increased firearm injuries amongst adults, though the pandemic's effect on children is less clearly understood. This cross-sectional study was performed at a Level 1 Pediatric Trauma Center and included youths 0–19 years. The trauma registry was retrospectively queried for firearm injuries occurring pre-COVID-19 pandemic (March 2015-February 2020). Baseline data was compared to prospectively collected data occurring during the COVID-19 pandemic (March 2020-March 2022). Fischer's exact, Pearson's Chi-square and/or correlation analysis was used to compare pre and post-COVID-19 firearm injury rates and intent, victim demographics and disposition. Temporal relationships between firearm injury rates and local COVID-19 death rates were also described. 413 pre-COVID-19 firearm injuries were compared to 259 pandemic firearm injuries. Victims were mostly Black males with a mean age of 13.4 years. Compared to the 5 years pre-pandemic, monthly firearm injury rates increased 51.5% (6.8 vs 10.3 shootings/month), including a significant increase (p = 0.04) in firearm assaults/homicides and a relative decrease in unintentional shootings. Deaths increased 29%, and there were significantly fewer ED discharges and more admissions to OR and/or PICU (p = 0.005). There was a significant increase in Black victims (p = 0.01) and those having Medicaid or self-pay (p <0.001). Firearm injury spikes were noted during or within the 3 months following surges in local COVID-19 death rates. The COVID-19 pandemic was associated with an increase in the frequency and mortality of pediatric firearm injuries, particularly assaults amongst Black children following surges in COVID death rates. Increased violence-intervention services are needed, particularly amongst marginalized communities. This is a prognostic study, evaluating the effects of the COVID-19 pandemic on pediatric firearm injuries, including victim demographics, injury intent and mortality. This study is retrospective and observational, making it Oxford Level III evidence. [ABSTRACT FROM AUTHOR]

Trauma during pregnancy is the leading cause of non-pregnancy-related maternal deaths, with some due to injuries from firearms. It was the purpose of this study to characterize the patterns and presentations of firearm-associated injuries in pregnant women using a national emergency department visit database. Data from the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993–2020 were utilized. The data include age, sex, race, type of firearm, perpetrator of injury, intent of injury (unintentional, assault, suicide, or law enforcement), anatomic location of the injury, incident locale, disposition from the emergency department (ED), and whether the patient was shot or not with the firearm. Of the 3.36 million ED visits over this time span for firearm injuries, 4410 were pregnant women. The mean age of the pregnant cohort was 23.6 years, with more Hispanic and fewer White women in the pregnant group compared to the non-pregnant cohort. Pregnant women were more likely to experience an injury involving the lower trunk and had a higher percentage of fatalities and hospital admissions compared to the non-pregnant cohort. Fetal demise occurred in at least 70% of cases. Nearly one half of the assaults (44%) occurred on Saturdays and Sundays. As the cause of these injuries is complex, prevention will require input from multiple sources, including health care providers, social agencies, government agencies, elected officials, and law enforcement. [ABSTRACT FROM AUTHOR]

The ideal animal model of abdominal firearm injury is essential for conducting research on the war injury rescue techniques, the training in injury control surgery, and the trauma ballistics research. But so far, there is no standardized animal model that can realistically simulate abdominal firearm injuries in domestic and foreign research. This article reviews the common animal models of abdominal firearm injury from the aspects of injury weapons, experimental animals and modeling purposes, and expounds the advantages and disadvantages of each model, in order to provide reference for the research on abdominal firearm injury. [ABSTRACT FROM AUTHOR]

Background: Violence due to firearms is a major global public health issue and vascular injuries from firearms are particularly lethal. The aim of this study was to analyse population-based epidemiology of firearm-related vascular injuries. Methods: This was a retrospective nationwide epidemiological study including all patients with firearm injuries from the national Swedish Trauma Registry (SweTrau) from January 1, 2011 to December 31, 2019. There were 71,879 trauma patients registered during the study period, of which 1010 patients were identified with firearm injuries (1.4%), and 162 (16.0%) patients with at least one firearm-related vascular injury. Results: There were 162 patients admitted with 238 firearm-related vascular injuries, 96.9% men (n = 157), median age 26.0 years [IQR 22–33]. There was an increase in vascular firearm injuries over time (P < 0.005). The most common anatomical vascular injury location was lower extremity (41.7%) followed by abdomen (18.9%) and chest (18.9%). The dominating vascular injuries were common femoral artery (17.6%, 42/238), superficial femoral artery (7.1%, 17/238), and iliac artery (7.1%, 17/238). Systolic blood pressure (SBP) < 90 mmHg or no palpable radial pulse in the emergency department was seen in 37.7% (58/154) of patients. The most common vascular injuries in this cohort with hemodynamic instability were thoracic aorta 16.5% (16/97), femoral artery 10.3% (10/97), inferior vena cava 7.2% (7/97), lung vessels 6.2% (6/97) and iliac vessels 5.2% (5/97). There were 156 registered vascular surgery procedures including vascular suturing (22%, 34/156) and bypass/interposition graft (21%, 32/156). Endovascular stent was placed in five patients (3.2%). The 30-day and 90-day mortality was 29.9% (50/162) and 33.3% (54/162), respectively. Most deaths (79.6%; 43/54) were within 24-h of injury. In the multivariate regression analysis, vascular injury to chest (P < 0.001) or abdomen (P = 0.002) and injury specifically to thoracic aorta (P < 0.001) or femoral artery (P = 0.022) were associated with 24-h mortality. Conclusions: Firearm-related vascular injuries caused significant morbidity and mortality. The lower extremity was the most common injury location but vascular injuries to chest and abdomen were most lethal. Improved early hemorrhage control strategies seem critical for better outcome. [ABSTRACT FROM AUTHOR]

Background: Invention of fire was the greatest invention for the human from primitive matchlock system to the present automatic weapons. It has become the most dreaded killing tool used by human being. Proper examination of the victims of firearm injuries needs to ascertain the characteristics of wound and body part involved to correlate with fatalities. Methods: A total of 115 cases of gunshot injury were included in this study carried out at the Department of Forensic Medicine, SMS Medical College and Hospital, Jaipur over a period of 17 months from mid of May 2014 to beginning of August 2015, after seeking permission and ethical clearance. Results: During Study period total 115 cases were included in study. We observe finding after dividing human body in five body region for better understanding. The commonest targeted body parts were the peripheries including the upper and lower limbs (33.04%). The next to follow was the chest in 36 cases (31.30%). Abdomen including pelvis was targeted in 18.26% cases and head was the soft target in only 14.78% cases. Lease affected body part was neck with only 3 cases. Conclusion: In 73.04% (84) cases, only a single body region was inflicted upon by use of firearm weapon. In fatal cases (11) of firearm injuries, head (54.55%) was the most commonly targeted body part followed by chest (36.36%) and abdomen (9.09%). This study indicated that the most common victims of firearm injuries were young males of bread earning age. Certain changes may minimize mortality and disability due to firearm injuries, also reducing the costs to the community. So, there is a need to decrease the number of firearms used and sold in India. [ABSTRACT FROM AUTHOR]

Background: What if you fire a bullet and, like a boomerang, it comes back towards you after hitting the target, leaving no trace in the body. Case presentation: A similar case was presented to us for an autopsy at the district mortuary, Aligarh, with a bullet unusually ricocheting within the thoracic cavity and taking almost path of incidence after grazing over the 3rd rib and coming out just closure to the entry wound towards the musketeer. The presence of stippling at both the entrance and exit wounds poses a challenge to interpreting the track of the injury. Conclusion: Thorough and detailed examination at autopsy and crime-scene investigation revealed a strange ricochet event within the chest cavity. [ABSTRACT FROM AUTHOR]

Pediatric firearm injuries are the leading cause of death among American children. While assault is the most commonly cited cause, few studies have investigated circumstances surrounding such injuries. Violence intervention programs (VIPs) have been utilized to combat firearm violence, though a similar lack of knowledge exists regarding possible associations between firearm injury circumstances and youth VIP enrollment. This cross-sectional study included children aged 6-17 y who presented to an urban level 1 pediatric trauma center with firearm injuries from 2014 to 2017. Victim demographics and enrollment in a VIP were obtained from medical records, as well as circumstances surrounding the injuries based on account of the victim, victim's family/friends, and/or police present at the hospital. Circumstances included location of the shooting, if the shooter was known to the victim, and if the shooting was confirmed by the victim or their contacts to have been accidental or an intentional assault. Medical record numbers were used to locate victims in our trauma registry in order to obtain their assigned international classification of disease codes. Wilcox-rank sum, Pearson's chi-squared and Fisher's exact tests were used to detect associations between demographics, VIP enrollment, and shooting circumstances. 156 victims of firearm injury were described, including primarily Black adolescent males. 72% of victims were shot outdoors by an unknown shooter, the motivation of which was unknown in 93% of cases. 36% of these shootings were "drive-by". The majority of victims received international classification of disease codes for assault, though shootings that were confirmed by the victim to have been intentional assaults were relatively uncommon (13.4%). Most children lived in the same zip code in which they were shot (71%), and three particular zip codes accounted for 40% of shootings. 26% of victims chose to enroll in the VIP, and those that were victims of confirmed assaults (odds ratio 3.5) as well as those admitted to the hospital (odds ratio 2.4) were significantly more likely to enroll. Based on victim account, children living in an urban setting are more frequently victims of unclearly motivated, outdoor neighborhood shootings rather than intentional assaults. More accurate understanding of the causes of pediatric firearm injuries should inform both recruitment into VIPs, as well as a balancing of VIPs with community-level interventions to address firearm violence. • The leading cause of death among American youths is firearm injuries, most of which are classified as assaults. • In an urban setting, children are most frequently victims of unclearly motivated, outdoor shootings. • More accurate understanding of circumstances surrounding child shootings is essential for informing hospital and community-based violence intervention programs. [ABSTRACT FROM AUTHOR]

Summary: Background: Firearm injury (FI) is the leading cause of death in children and adolescents in the United States (US). We describe the epidemiology of pediatric FI-associated emergency department (ED) visits and hospitalizations in the US stratified by race and ethnicity. Methods: Data on pediatric (0–17-year-olds) FI were analyzed using the 2019 Nationwide Emergency Department Sample (NEDS) and Kids’ Inpatient Database (KID), the largest all-payer databases in the US for ED visits and pediatric hospitalizations, respectively. FI encounters were stratified by race and ethnicity. Poisson regression was used to identify factors associated with in-hospital mortality. Sampling weights were applied to generate nationally representative estimates. Findings: There were 7017 pediatric ED visits with FI (NEDS); 85.0% (5961/7017) were male and 73.0% (5125/7017) were adolescents (15–17 years). Overall, 5.5% (384/7017) died in the ED; 53.1% (3727/7017) of ED encounters did not result in hospitalization. There were 2817 pediatric FI hospitalizations (KID); 84.1% (2369/2817) were male and 71.6% (2018/2817) were adolescents; 51.4% (1447/2817) of FI were unintentional, 42.8% (1207/2817) were assault-related, and 5.8% (163/2817) were self-inflicted. Black children had the highest proportion (52.6%; 1481/2817) of hospitalizations among all race and ethnicities (p

Media reports on interpersonal firearm violence largely present it as a crime issue focused on individual shooting events. This episodic framing can undermine support for public health solutions to firearm violence. Potential harms of this narrative on firearm-injured people are unknown. We aimed to understand how recently firearm-injured people perceive the meaning and impact of news media reporting on their own injuries and on firearm violence in their communities. This study was conducted in the trauma clinic of the busiest trauma center for firearm injuries in Philadelphia, PA, USA. We consecutively recruited adult firearm-injured patients for semi-structured qualitative interviews within two months of their injury. Interview content was thematically analyzed. Twenty-six patients consented and participated. Results indicate that participants largely felt negative or conflicted about “making the news” and perceived several harms associated with media reports on their injuries, including dehumanization they connected with episodic-style reports, reliving trauma when viewing news, distress related to inaccuracies, threats to personal safety when specific details were included, harm to reputation, and negative impacts on public perceptions of safety and community. Participants who did not make the news often reported relief and generally did not expect their story to be reported. These findings suggest that firearm-injured people perceive multiple harms associated with episodic narratives that neglect their own viewpoints. Journalists and public health practitioners should work together with communities to identify strategies to reframe firearm violence as a public health problem through reporting that is trauma-informed and incorporates the perspectives of firearm-injured people.

BACKGROUND AND OBJECTIVES: Few studies have tested multiple socio-ecological risk factors associated with firearm injury among pediatric populations and distinguished self-inflicted from non-self-inflicted injury. To address this gap, the current study examined demographic, individual psychosocial, and neighborhood variables as risk factors for firearm injury among a large cohort of children and adolescents. METHODS: Retrospective cohort study. Data were obtained from the electronic health records of a large integrated healthcare system. The cohort included children <18 years with at least one clinical encounter between January 1, 2010 and December 31, 2018. Poisson regression was used to examine demographic (age, gender, race and ethnicity, Medicaid status), psychosocial (depression, substance use disorder, medical comorbidities), and neighborhood education variables as potential risk factors for non-self-inflicted and self-inflicted firearm injuries. RESULTS: For non-self-inflicted injury, the highest relative risk was found for children age 12-17 years old compared to 0-5 year olds (RR = 37.57); other risk factors included male gender, Black and Hispanic race and ethnicity (compared to White race), being a Medicaid recipient, lower neighborhood education, and substance use disorder diagnosis. For self-inflicted injury, only age 12-17 years old and male gender were associated with increased risk. CONCLUSIONS: These results reinforce the established higher risk for firearm injury among adolescent males, highlight differences between self-inflicted and non-self-inflicted injuries, and the need to consider demographic, psychosocial, and neighborhood variables as risk factors to inform interventions aimed to reduce firearm injuries among children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Suicide is a leading cause of death in the United States, particularly among Veterans. Nonfatal firearm injuries may indicate subsequent risk of suicide and, thus, provide important opportunities for prevention in emergency departments and other health care settings. We used a retrospective cohort design to analyze associations between nonfatal firearm injuries and subsequent suicide among all Veterans who used U.S. Department of Veterans Affairs (VA) health care, nationally, between 2010 and 2019. Methods: We linked VA health care and mortality data to identify VA users, nonfatal firearm injuries, and deaths. International Classification of Diseases (ICD)–10th Revision cause‐of‐death codes were used to identify suicides. Veterans' firearm injuries and their intent were categorized using cause‐of‐injury codes from the ICD Clinical Modification–9th and 10th Revisions systems. Using bivariable and multivariable regression, we estimated risk of subsequent suicide among Veterans with, versus without, nonfatal firearm injuries. Among Veterans with nonfatal firearm injuries, we examined characteristics associated with subsequent suicide; electronic health record (chart) reviews explored documentation about firearm access among those who died. Results: Among 9,817,020 VA‐using Veterans, 11,503 experienced nonfatal firearm injuries (64.9% unintentional, 12.3% intentional self‐harm, 18.5% assault). Of these, 69 (0.6%) subsequently died by suicide (42 involving firearms). The odds of subsequent suicide among Veterans with, versus without, nonfatal firearm injuries were 2.4 (95% confidence interval 1.9–3.0); odds were only slightly attenuated in multivariable modeling. Among Veterans with nonfatal firearm injuries, those with depression or substance use disorder diagnoses had twice the odds of subsequent suicide than those without. Chart reviews identified small proportions of suicide decedents who were assessed for (21.7%), and/or counseled about (15.9%), firearm access. Conclusions: Findings suggest that Veterans' nonfatal firearm injuries, regardless of injury intent, may be important but underutilized opportunities for suicide prevention. Future work should explore mechanisms to reduce risk among these patients. [ABSTRACT FROM AUTHOR]

Postmortem computed tomography (PMCT) has been integrated into the practice of many forensic pathologists. To evaluate the utility of PMCT in supplementing and/or supplanting medicolegal autopsy, we conducted a prospective double‐blind comparison of abnormal findings reported by the autopsy pathologist with those reported by a radiologist reviewing the PMCT. We reviewed 890 cases: 167 with blunt force injury (BFI), 63 with pediatric trauma (under 5 years), 203 firearm injuries, and 457 drug poisoning deaths. Autopsy and radiology reports were coded using the Abbreviated Injury Scale and abnormal findings and cause of death (COD) were compared for congruence in consensus conferences with novel pathologists and radiologists. Overall sensitivity for recognizing abnormal findings was 71% for PMCT and 74.6% for autopsy. Sensitivities for PMCT/autopsy were 74%/73.1% for BFI, 61.5%/71.4% for pediatric trauma, 84.9%/83.7% for firearm injuries, and 56.5%/66.4% for drug poisoning deaths. COD assigned by reviewing PMCT/autopsy was correct in 88%/95.8% of BFI cases, 99%/99.5% of firearm fatalities, 82.5%/98.5% of pediatric trauma deaths, and 84%/100% of drug poisoning deaths of individuals younger than 50. Both autopsy and PMCT were imperfect in recognizing injuries. However, both methods identified the most important findings and are sufficient to establish COD in cases of BFI, pediatric trauma, firearm injuries and drug poisoning in individuals younger than 50. Ideally, all forensic pathologists would have access to a CT scanner and a consulting radiologist. This would allow a flexible approach that meets the diagnostic needs of each case and best serves decedents' families and other stakeholders. [ABSTRACT FROM AUTHOR]

Firearm injuries are a leading cause of death for youth/young-adults. We utilized latent class analysis to identify distinct motivational/behavioral patterns of firearm possession in a youth/young-adult emergency department sample to inform prevention strategies. Cross-sectional data were obtained from surveys conducted among youth/young-adults (age = 16–29; n = 1311) seeking emergency department treatment (7/10/2017–6/25/2018). Latent class analysis was performed for individuals reporting firearm possession (n = 223) using five variables: carriage frequency, social carriage, risky firearm behaviors, ownership/carriage for protection, and recreational ownership/carriage. Descriptive statistics were examined. In this sample, 17.0 % reported having firearms (age-22.7; 48.0 %-male; 49.3 %-Black; 52.5 %-public assistance). Latent class analysis identified four classes: 1-recreational possession (n = 51); 2-possession for protection with low carriage (n = 60); 3-carriage for protection with low risky firearm behaviors (n = 76); and 4-carriage for protection with high risky firearm behaviors (n = 36). Class-1 (recreational possession) had low firearm victimization, violence exposure, and community violence. This class primarily kept long-guns with secure storage patterns. Class-2 (protection with low carriage) were mostly female youth/young-adults with children and reported moderately high rates of violence exposure. Nearly 20 % stored their firearm unlocked. Class-3 and -4 endorsed firearm carriage for protection, with Class-4 also engaging in risky firearm behaviors. Both classes had high violence exposure; however, Class-4 had higher risk profiles including higher marijuana misuse, mental health symptoms, and firearm victimization. Among an emergency department sample, four distinct firearm possession classes emerged with different risk levels. Understanding firearm behaviors and risk/protective factors is critical to tailoring healthcare-focused interventions to address individual needs and reduce injury risk. • Emergency room patients with firearms are heterogenous, with distinct subgroups. • Latent class analysis found four groups with low, moderate, and high-risk behaviors. • Interventions tailored based on group firearm habits and risk/protective factors. [ABSTRACT FROM AUTHOR]

• This article presented two cases of fatal injuries from rifled weapons with unconventional shapes of inlets and exits which mismatched with distance. • The size of the wounds mismatched with the distance that confirmed by the witness and the absence of any associates on the cloths. This article presents two cases of fatal injuries from rifled weapons with unconventional shapes of inlets and exits mismatched with the distance of firing. According to forensic literature, in long-distance ranges, we expected to see rounded entry wounds smaller than bullet size, circular in shape without associates with limited damage in the tissues. In the first case, there were large wounds which did not match a distance of more than 2 m, while in the second case, the distance was more than 30 m with large wounds 21 × 10 cm and massive damage to bones and lungs. In the first case, a 25-year-old male, he had multiple wounds in the front of the chest, the first one over the sternum end measuring 9 × 7 cm rounded in shape with fracture of the ribs, sternum and lung laceration. The second wound was 3 × 5 cm in the lateral aspect – mid axillary line and it was superficial due to tangential passage of the missile. In the left thigh, two inlets, each approximately 5 × 7 cm, were seen, the first one over the left iliac bone rounded and the second inlet was in the midshaft of the femur. The exit was below the left gluteus, rounded in shape 5 × 7 cm. The second case a 19-year-old male, he showed single oval wound in the middle third of the back, and it measured 21 × 10 cm. The missile passed tangentially and led to broken ribs and the vertebral column with a lung laceration. [ABSTRACT FROM AUTHOR]