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Beyond the Tip of the Iceberg

Joseph L. Annest, PhD; James A. Mercy, PhD; Delinda R. Gibson; George W. Ryan, PhD

JAMA. 1995;273(22):1749-1754.

Abstract
Objective.
—To describe the magnitude and characteristics of nonfatal firearm-related injuries treated in hospital emergency departments in the United States and to compare nonfatal injury rates with firearm-related fatality rates.

Design.
—Data were obtained from medical records for all firearm-related injury cases identified using the National Electronic Injury Surveillance System (NEISS) from June 1, 1992, through May 31, 1993.

Setting.
—NEISS comprises 91 hospitals that are a stratified probability sample of all hospitals in the United States and its territories that have at least six beds and provide 24-hour emergency service.

Main Outcome Measures.
—Numbers and population rates for nonfatal and fatal firearm-related injuries.

Results.
—An estimated 99 025 (95% confidence interval [CI], 56 325 to 141 725) persons (or 38.6 per 100000 population; 95% CI, 22.0 to 55.2) were treated for nonfatal firearm-related injuries in US hospital emergency departments during the study period. The rate of nonfatal firearm-related injuries treated was 2.6 (95% CI, 1.5 to 3.7) times the national rate of fatal firearm-related injuries for 1992.

Conclusions.
—Nonfatal firearm-related injuries contribute substantially to the overall public health burden of firearm-related injuries. NEISS can be useful to monitor the number of nonfatal firearm-related injuries in the United States. A national surveillance system is needed to provide uniform data on firearm-related injury morbidity and mortality for use in research and prevention efforts.

(JAMA. 1995;273:1749-1754)

Author Affiliations
From the Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Ga.

Footnotes
Reprints requests to Office of Statistics and Programming (K59), National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341-3724 (Dr Annest).

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