Nonfatal Firearm-related Injuries Research Articles

Fatal and non-fatal firearm-related injuries in Canada, 2016–2020: a population-based study using three administrative databases

BackgroundFirearms are a substantial cause of injury-related morbidity and mortality in Canada and globally, though evidence from contexts other than the USA is relatively limited. We examined deaths, hospitalizations and emergency department (ED) visits due to firearm-related injuries in Canada to identify population groups at increased risk of fatal and non-fatal outcomes.MethodsWe conducted a population-based study using three national administrative databases on deaths, hospitalizations, and ED visits. ICD-10 codes were used to identify firearm-related injuries from January 1, 2016, through December 31, 2020. Fatal and non-fatal firearm injuries were classified as suicide/self-harm, homicide/assault, unintentional, undetermined or legal intervention injuries. We analyzed the data with counts, rates and proportions, stratified by sex, age group, province/territory, and year.ResultsOver the 5-year period, we identified 4005 deaths, 3169 hospitalizations, and 2847 ED visits related to firearm injuries in various jurisdictions in Canada. Males comprised the majority of fatal and non-fatal injury cases. The highest rates of fatal and non-fatal firearm injuries were among 20- to 34-year-olds. The leading cause of fatal firearm injuries was self-harm (72.3%). For non-fatal firearm hospitalizations and ED visits, assault (48.8%) and unintentional injuries (62.8%) were the leading causes of injury. Rates varied by province and territory.ConclusionsOur results showed that males comprised the majority of fatal and non-fatal firearm injuries in Canada. The rates of both fatal and non-fatal firearm injuries were highest among the 20- to 34-year-old age group. This comprehensive overview of the epidemiology of firearm injuries in Canada provides baseline data for ongoing surveillance and policy evaluation related to public health interventions.

Annual Incidence of Hospitalization for Nonfatal Firearm-Related Injuries in New York From 2005 to 2016

In the US, approximately 40 000 people die due to firearm-related injuries annually. However, nonfatal firearm-related injuries are less precisely tracked. To assess the annual incidence of hospitalization for nonfatal firearm-related injuries in New York and to compare the annual incidence by sex, race/ethnicity, county of residence, and calendar years. This retrospective cross-sectional study used data from the New York Statewide Planning and Research Cooperative System for patients aged 15 years or older who presented to an emergency department in New York with nonfatal firearm-related injuries from January 1, 2005, to December 31, 2016. Data were analyzed from January 15, 2019, to April 21, 2021. A nonfatal firearm-related injury, defined by International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. The annual incidence of nonfatal firearm-related injuries was calculated by determining the number of patients with a nonfatal firearm-related injury each year divided by the total population of New York. The study included 31 060 unique patients with 35 059 hospital encounters for nonfatal firearm-related injuries. The mean (SD) age at admission was 28.5 (11.9) years; most patients were male (90.6%) and non-Hispanic Black individuals (62.0%). The overall annual incidence was 18.4 per 100 000 population. Although decreasing trends of annual incidence were observed across the state during the study period, this trend was not present in all 62 counties, with 32 counties (51.6%) having an increase in the incidence of injuries between 2005 and 2010 and 29 (46.8%) having an increase in the incidence of injuries between 2010 and 2015. In 19 of the 30 counties (63.3%) that had a decrease in incidence in earlier years, the incidence increased in later years. The annual incidence of hospitalization for nonfatal firearm-related injuries in New York during the study period was 18.4 per 100 000 population. Reliable tracking of nonfatal firearm-related injury data may be useful for policy makers, hospital systems, community organizers, and public health officials as they consider resource allocation for trauma systems and injury prevention programs.

Non-fatal firearm injuries, Incidence and Circumstances: Presenting in DHQ Hospital Rawalpindi

Objective: To describe the incidence and manner of nonfatal firearm injuries in Rawalpindi District Study design: Observational retrospective study Place and Duration: District Head Quarters Hospital Rawalpindi. Duration of 6 months, from July 2020 to Dec 2020. Methodology: Total 82 patients with nonfatal firearm injuries were included. After approval from ERC committee of DHQ Hospital Rawalpindi, data was obtained from the duplicate copies of medicoleagal reports kept at the Forensic Medicine department t of IIMCT. These reports were carried out by cross ponding author and the demonstrators of Forensic Medicine department of IIMCT. The data was entered on a pre-designed Performa having variables such as demographics, time & place of death, region of body involved, weapon used & month of the year. Results: A total of 82 nonfatal firearm injuries were reported during these 6 months. 87% of the victims of were males encountering injuries 1 to 11 in number with an average of 3 injuries per person. 3o% of these injuries were received on the upper trunk, 32% on the lower trunk, 16% the lower limbs, 13% the upper limb, 3% the head and neck and 6% on the other regions. 68% of the injuries were lacerations, an exit wound was detected in 19% of cases and in 13% only entry wounds were found. Tattooing and burning of the adjacent skin were common in wounds on the upper and lower trunk while comminuted intra articular and shaft fractures were important varieties in the limbs. 86% of the victims were vitally stable, others being critically unstable with GCS ranging till 6/15. Conclusion: The public health issue of firearm-related injuries continues to be a concern. The necessity for a district-based, nationwide reporting system for fatal and nonfatal firearm-related injuries is critical. In Pakistan, these data could be used in the design, implementation, and assessment of preventative programs. Key words: Non fatal, Firearm injuries, Regional injuries

Economic and Educational Impact of Firearm-Related Injury on an Urban Trauma Center.

As nonfatal firearm-related injuries continue to increase, calculating the financial cost these injuries have on an urban trauma center may help justify funding for intervention programs. The impact these injuries have on orthopedic resident education may lead to changes in the training of some urban-based programs. This is a retrospective review of patients with an acute firearm-related injury from 2007 to 2013 at Louisiana State University Interim Public Hospital in New Orleans, Louisiana. All patients with a diagnosis of an acute gunshot wound on presentation to the emergency department were included in the study. Patients with complications from a previous gunshot wound or treatment of that wound were excluded. A total of 3617 patient encounters were identified that met this criteria. The total amount billed by the hospital over the study period was $141,995,682 while collecting $30,922,953. The actual hospital costs from these encounters was $73,572,892, giving the hospital a loss of $42,649,938. Of the 3617 patient encounters, 59% required orthopedic consultation. Of that consultation group, 25% required inpatient orthopedic surgical intervention. Acute gunshot wounds accounted for 23% of orthopedic trauma consultations and 13% of the orthopedic daily census. The financial data provide justification from an economic perspective for funding intervention programs aimed at decreasing firearm-related injury. In addition, the proportion of orthopedic surgical training spent on firearm-related injury provides program directors of urban-based programs with valuable information, although no conclusions can be drawn as to the effect on orthopedic surgical education.

Americans shooting themselves in the foot: the epidemiology of podiatric self-inflicted gunshot wounds in the United States.

To examine the epidemiology of Americans shooting themselves in the foot. Data from the Firearm Injury Surveillance Study (1993-2010) collected using the National Electronic Injury Surveillance System were examined. Non-fatal firearm-related injuries were recorded during patients' initial emergency department visits. United States hospital emergency departments, 1993-2010. 69 111 individuals admitted to US emergency departments after non-fatal firearm-related incidents. Demographic and incident characteristics of patients presenting with self-inflicted gunshot wounds to the foot. Of the 69 111 reported firearm-related injuries, 667 (1.0%) were self-inflicted gunshot wounds to the foot. Of these, 597 of the patients (89.6%) were men and 51.7% (345) were aged between 15 and 34 years. Patients generally presented with puncture wounds (265 patients, 39.7%), foreign bodies (164 patients, 24.6%) and bruised egos. Those who shot themselves in the foot were significantly more likely than individuals with other firearm-related injuries to be male (odds ratio [OR], 1.28) and married (OR, 2.6). As the festive season approached, the number of incidents increased; November and December were peak months for shooting oneself in the foot. The nature of and the circumstances surrounding self-inflicted gunshot wounds to the foot were unique when compared with other firearm-related injuries. Through the large-scale examination of the characteristics of these incidents, trends in the nature of Americans shooting themselves in the foot have been elucidated. Young married men are at particular risk of shooting themselves in the foot. Particular caution must be taken during the festive season to avoid being caught under the missing toe.

Status Epilepticus Due to Plumbism as a Result of Retained Bullet Fragments

INTRODUCTION: There are fewer than a hundred reported cases of lead toxicity from retained bullet fragments within the medical literature despite more than 475,000 nonfatal firearm related injuries in the US between 1993 and 1998. Symptoms may begin days to decades after the initial injury. Plumbism may go unrecognized until encephalopathy, with or without seizures, develops requiring admission to the Medical Intensive Care Unit (MICU). Increased lead absorption has been reported with intravertebral disc involvement, a large surface area of distribution, and osseous remodeling. We describe a case of plumbism complicated by encephalopathy and seizures from 20 year old retained bullet fragments with the aforementioned risk factors.

Nonfatal and fatal firearm-related injuries among children aged 14 years and younger: United States, 1993-2000.

To provide national estimates of fatal and nonfatal firearm-related (FA) injuries among children < or =14 years old and to examine the circumstances under which these injuries occurred. For nonfatal FA injuries among children, we analyzed data on emergency department (ED) visits from the National Electronic Injury Surveillance System for 1993 through 2000. National estimates of injured children who were treated in hospital EDs were examined by selected characteristics, such as age, gender, race/ethnicity of the patient, primary body part affected, intent of the injury, the relationship of the shooter to the patient, where the injury occurred, and activity at the time of injury. For fatal FA injuries among children, we analyzed mortality data from the National Vital Statistics System for 1993 through 2000. Data from both sources were used to calculate case-fatality rates. From 1993 through 2000, an estimated 22,661 (95% confidence interval [CI]: 16,668-28,654) or 4.9 per 100,000 (95% CI: 3.6-6.2) children < or = 14 years old with nonfatal FA injuries were treated in US hospital EDs. Assaults accounted for 41.5% of nonfatal FA injuries, and unintentional injuries accounted for 43.1%. Approximately 4 of 5 children who sustained a nonfatal, unintentional FA injury were reportedly shot by themselves or by a friend, a relative, or another person known to them. During this period, 5542, or 1.20 per 100,000 (95% CI: 1.17, 1.23), children < or =14 years old died from FA injuries; 1 of every 5 children who were wounded by a firearm gunshot died from that injury. Most FA deaths were violence related, with homicides and suicides constituting 54.7% and 21.9% of these deaths, respectively. For individuals < or =14 years old, the burden of morbidity and mortality associated with FA injuries falls disproportionately on boys, blacks, and children 10 to 14 years old. Both fatal and nonfatal injury rates declined >50% during the study period. Although rates of nonfatal and fatal FA injuries declined during the period of study, FA injuries remain an important public health concern for children. Well-designed evaluation studies are needed to examine the effectiveness of potential interventions aimed at reducing FA injuries among children.

Treating gun violence before the 911 Call*1

Treating gun violence before the 911 Call*1

Sex differences in the perpetrator-victim relationship among emergency department patients presenting with nonfatal firearm-related injuries

Study objective I examine whether female and male emergency department (ED) patients are equally likely to have been nonfatally shot or struck with a gun by someone they know versus by a stranger. Methods This case-control study examined patient records from US hospital EDs from 1993 to 1999. The records of patients aged 15 years or older who presented with nonfatal firearm-related injuries were accessed from the National Electronic Injury Surveillance System. Patients were classified according to 2 firearm-related injury types (penetrating or nonpenetrating [eg, struck with gun] trauma) and 5 perpetrator types (injury inflicted by spouse or ex-spouse, other relative, friend or acquaintance, self, or stranger). Results Compared with male patients, female patients were 3.6 times (95% confidence interval [CI] 2.5 to 5.3) more likely to have been shot and 3.9 times (95% CI 1.6 to 9.4) more likely to have been struck with a gun wielded by a spouse or ex-spouse than by a stranger. Conversely, women were considerably less likely than men to have been struck with a gun or shot by another relative, to have been struck with a gun by a friend or acquaintance, or to have a gunshot injury that was self-inflicted. Conclusion The cause of firearm-related injuries varies by sex. Before releasing firearm-injury victims from the ED, health care providers should consider 2 important factors: (1) the patient's relationship to the perpetrator, and (2) the availability and previous use of firearms in the victim's home. This information may be helpful in formulating posttreatment plans to enhance the victim's safety.

Suicide, Firearms, and Data

Back to table of contents Previous article Next article LettersFull AccessSuicide, Firearms, and DataAndrew L. Brickman, Ph.D., and Devra C. Mintz, M.D., M.P.H.Andrew L. BrickmanSearch for more papers by this author, Ph.D., and Devra C. MintzSearch for more papers by this author, M.D., M.P.H.Published Online:1 May 2003https://doi.org/10.1176/appi.ps.54.5.749AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: We thank Dr. Berg for raising the issue of firearm availability in the interpretation of self-inflicted injury rates. In our Datapoints column, we intentionally made no reference to firearm availability as a factor contributing to the rise in self-inflicted injuries in the United States.During the six-year period between 1993 and 1998, the rate of suicide by firearm dropped by approximately 15 percent, while the rate of firearm-related homicides fell by 42 percent and the rate of unintentional firearm-related deaths fell by 47 percent. During the same period, the rate of nonfatal suicide attempts by firearm declined by 48 percent, compared with a 49 percent decrease in the rate of firearm-related assaults and a 37 percent decrease in unintentional, nonfatal firearm-related injuries (1). Given these data, it is safe to assume that the overall increase in self-inflicted injuries seen during this period in U.S. emergency departments was not due to an increase in firearm-related injuries. Furthermore, although we agree with Dr. Berg that firearm availability in the home has been shown to be associated with self-inflicted harm (2), domestic rifle and handgun sales have been decreasing over the past decade (3).Firearm-related injury remains a serious public health burden, accounting in 1998 for 31,000 deaths and 64,500 nonfatal injuries treated in hospital emergency departments (1). However, firearm-related injuries do not account for the increasing rate of self-inflicted injuries seen in emergency departments.

Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985–99

Objective: To characterize national trends in non-fatal BB/pellet gun related injury rates for persons aged 19 years or younger in relation to trends in non-fatal and fatal firearm related injury...

Incidence and circumstances of nonfatal firearm-related injuries among children and adolescents.

To describe the incidence and circumstances of nonfatal firearm-related injuries among children and adolescents treated in US emergency departments. Data were obtained from the Firearm Injury Surveillance Study, 1993-1997; data were collected through medical record review at hospitals participating in the National Electronic Injury Surveillance System. The hospitals participating in National Electronic Injury Surveillance System are a stratified probability sample of all US hospitals. Numbers and population rates for nonfatal firearm-related injuries among children and adolescents younger than 20 years old. An estimated 115,131 (95% confidence interval, 76,769-153,493) children and adolescents were treated for a nonfatal gunshot wound during the study period. The estimated annual rates of injury (per 100,000) were 2.0 (children 0-4 years old), 2.2 (children 5-9 years old), 15.4 (children 10-14 years old), and 106.5 (adolescents 15-19 years old). The ratios of nonfatal to fatal firearm-related injuries were 4.0 (children 0-4 years old), 4.4 (children 5-9 years old), 5.0 (children 10-14 years old), and 4.4 (adolescents 15-19 years old). An additional estimated 103,814 children (95% confidence interval, 69,223-138,405) were shot with a nonpowder firearm (BB or pellet gun). Boys 5 to 9 and 10 to 14 years old had the highest rates of injury related to nonpowder firearms, an estimated 36.2 and 99.8 per 100,000, respectively. Fifty-six percent of those 15 to 19 years old were assault victims. An estimated 48% of children and adolescents with powder firearm-related gunshot wounds and an estimated 4% with nonpowder firearm injuries were admitted to the hospital. Nonfatal injuries related to powder firearms and nonpowder firearms (BB or pellet guns) are an important source of injury among US children and adolescents. Ongoing surveillance of nonfatal firearm-related injury among children and adolescents is needed.

From the Feds: Research, programs, and products

From the Feds: Research, programs, and products

From the feds

Emergency nurses who deal with firearm-related injuries and their effect on victims and their families will be encouraged to learn that the rate of these injuries has decreased in recent years. The Centers for Disease Control and Prevention (CDC), in a recent issue of Morbidity and Mortality Weekly Report, published a report stating that overall, nonfatal and fatal firearm-related injury rates declined consistently from 1993 through 1997. In 1997, 32,436 deaths resulted from firearm injuries, down 18% from a record 39,595 deaths in 1993. Also in 1997, an estimated 64,207 persons sustained nonfatal firearm-related injuries and were treated in US hospital emergency departments. This figure dropped from 104,390 in 1993, representing a 41% decrease. 1 Hoyert DL Kochanek KD Murphy SL Deaths: final data for 1997. Natl Vital Stat Rep. 1999 Jun; 30: 1-104 Google Scholar This substantial decline was consistent by gender, race/ethnicity, age, and intent of injury, and coincides with a 21% decrease in violent crime for the same period. 2 Rand M Criminal victimization 1997: changes 1996-1997 with trends 1993-1997. US Department of Justice, Bureau of Justice Statistics, Washington, DC1998 December Google Scholar

Lethality of firearm-related injuries in the United States population

Study objective: To characterize differences in the lethality of firearm-related injuries in selected demographic subgroups using national representative data on fatal and nonfatal firearm-related injuries. We also characterize the lethality of firearm-related injuries by intent of injury and anatomic location of the gunshot wound. Methods: We analyzed case-fatality rates (CFRs) of firearm-related injuries in the United States by using death data from the National Vital Statistics System and data on nonfatal injuries treated in US hospital emergency departments from the National Electronic Injury Surveillance System. National estimates of crude and age-adjusted CFRs are presented by sex, race/ethnicity, age, intent, and primary body part affected. Results: Each year during the study period (July 1992 through December 1995), an estimated 132,687 persons sustained gunshot wounds that resulted in death or treatment in an ED. The overall age-adjusted CFR among persons who sustained firearm-related injuries was 31.7% (95% confidence interval [CI] 27.7 to 35.6). The age-adjusted CFR for persons who were alive when they arrived for treatment in an ED (11.3%; 95% CI 9.4 to 13.2) was about one third as large as the overall CFR. The age-adjusted CFR varied by sex, race/ethnicity, and age, but these differences depended on intent of injury. For assaultive injuries, the age-adjusted CFR was 1.4 times higher for females (28.7%) than males (20.6%). For intentionally self-inflicted injuries, the age-adjusted CFR was 1.1 higher for males (77.7%) than females (69.1%). For assaults, the age-adjusted CFR was 1.5 times higher for whites (29.5%) than blacks (19.2%). For assaultive and intentionally self-inflicted injuries among persons 15 years and older, the age-specific CFR increased with age. Persons shot in the head (age-adjusted CFR, 61.0%) were 3.3 times as likely to die as those shot in other body parts (age-adjusted CFR, 18.7%). Conclusion: The lethality of firearm-related injuries was influenced strongly by the intent of injury and body part affected. The high lethality of firearm-related injuries relative to other major causes of injury emphasizes the need to continue prevention efforts and efforts to improve access to care and treatment (including emergency medical and acute care services) to reduce the number and increase survivability of firearm-related injuries. [Beaman V, Annest JL, Mercy JA, Kresnow M, Pollock DA. Lethality of firearm-related injuries in the United States population. Ann Emerg Med. March 2000;35:258-266.]

Nonfatal and Fatal Firearm-Related Injuries—United States, 1993-1997

In 1997, 32,436 deaths resulted from firearm-related injuries, making such injuries the second leading cause of injury mortality in the United States after motor-vehicle-related incidents (1). Also in 1997, an estimated 64,207 persons sustained nonfatal firearm-related injuries and were treated in U.S. hospital emergency departments (EDs); approximately 40% required inpatient hospital care. National firearm-related injury and death rates peaked in 1993, then began to decline (2). This report presents national data from 1993 through 1997, which showed that the decline in nonfatal and fatal firearm-related injury rates was substantial and consistent by sex, race/ethnicity, age, and intent of injury.

Oklahoma firearm-related injury surveillance

Context: The magnitude of firearm-related deaths is known, but few studies have evaluated the magnitude and epidemiology of nonfatal firearm-related injuries. The circumstances resulting in fatal versus nonfatal injury are likely very different. No single data source provides complete details on nonfatal shootings. Objective: To establish a surveillance system to define the epidemiology of fatal and nonfatal firearm-related injuries. Design: Data were collected on fatal and nonfatal firearm-related injuries that occurred in 1995. Setting: State of Oklahoma. Participants: Medical Examiner, Vital Statistics, hospital emergency and medical records departments, police departments, newspaper clipping service. Main Outcome Measures: Incidence rate of firearm-related injuries; case-fatality rate; demographic, medical, and epidemiologic data; sensitivity of each reporting source; completeness of reporting. Results: The incidence rate of firearm-related injuries was 45.5 per 100,000 population. The case fatality rate was 35%. Injury rates were highest among adolescents, young adults, males, and African Americans. The Medical Examiner and Vital Statistics reported 87% and 98% of fatal cases, respectively. Passive surveillance of hospital emergency departments identified 72% of patients seeking hospital treatment. Among inpatients, 81% were identified by medical records departments. Newspaper clippings were obtained for 31% of cases. Information on the victim-perpetrator relationship and the type of firearm was available for 79% and 80% of cases, respectively. Conclusions: Statewide surveillance of firearm-related injuries using multiple data sources is possible and provides a picture of the overall firearm-related injury problem. Strategies to enhance computer linkages of medical and police data should be pursued to maximize the sensitivity of reporting and minimize the costs of surveillance.

Recommended data elements for firearm-related injury surveillance

During 1994, the Centers for Disease Control and Prevention (CDC) funded seven states to develop and evaluate surveillance systems for firearm-related injuries. In addition, New York City and California had related experience with firearm-related injury surveillance. At the time these nine jurisdictions began developing their surveillance systems, no standardized definitions or recommendations were available about the best methods or procedures of collecting data or suggested data elements of a firearm-related injury surveillance system. The nine jurisdictions and CDC developed a list of recommended data elements (RDEs) for fatal and nonfatal firearm-related injuries. We describe the process used to develop the RDEs, the 21 data elements suggested by the funded projects, the data sources that may be able to provide those data elements, and an indication of which sources may be most useful. We encourage all developing surveillance systems to strive to include these data elements, although some of the elements will be more easily attainable for fatal injury events than nonfatal ones, and no single data source will be able to provide all the desired information about both morbidity and mortality from firearm-related injuries. The RDEs capitalize on the preliminary experiences of the small group of jurisdictions, but they need to be pilot tested and revised as we collect more information about how well these elements capture the desired information and whether the information obtained is useful.

Use of national data systems for firearm-related injury surveillance

Introduction: The purpose of this paper is to provide an overview of federal data systems that report national data on fatal and nonfatal firearm-related injuries and associated risk factors and behaviors. Results: There are 13 federal data systems that provide useful information for national surveillance of firearm-related injuries in the United States. Each data system has useful features and limitations. Each provides a different methodologic approach to capture data for monitoring and characterizing firearm-related deaths or injuries, or behavioral risks associated with unintentional and violent events. Conclusion: Although much progress has been made over the past decade to improve national data on firearm-related injuries, many gaps still remain. A mechanism is needed to better coordinate and integrate federal efforts to collect, analyze, and disseminate data on firearm-related injury.

Firearm-related injury surveillance in Colorado

Context: The Colorado Department of Public Health and Environment uses existing data sources to identify and assess firearm-related deaths and injuries statewide. Objective: Implementation and evaluation of a surveillance system for fatal and hospitalized nonfatal firearm-related injuries. Design: Electronic death certificate and hospital discharge data are used to identify firearm-related deaths and injuries. Cases are confirmed and supplemental information is obtained from the Colorado Uniform Crime Report/Supplemental Homicide Report, police investigations, medical records, and newspaper accounts. Electronic data sets are created containing the information manually abstracted from these sources. Setting: Statewide. Participants: Vital records, Colorado Hospital Association, medical records, Colorado Division of Criminal Justice, police departments Main Outcome Measures: Surveillance system simplicity, flexibility, sensitivity, and predictive value positive Results: System-identified cases were compared with deaths and injuries identified from external sources such as hospital trauma registries, emergency department logs, and paramedic trip reports. The surveillance system is flexible, acceptable to reporting agencies, and sensitive, detecting 69% to 77% of firearm-related hospitalizations identified from external sources. The system’s predictive value positive is high, with 89% of the potential cases confirmed as actual cases. Although simple in design, the surveillance system requires significant staff time to abstract information and because existing data sources are used, timeliness of the data is often delayed. Additionally, minor injuries (those requiring less than 24 hours or no hospitalization) are not detected. Conclusions: Despite these limitations, the surveillance system is a valuable resource for information about firearm-related deaths and injuries, and represents an important first step in reducing the number and severity of firearm-related injuries in Colorado.