Injuries from firearms in hunting activities

Accepted Manuscript Title: Injuries From Firearms In Hunting Activities Author: Randall T. Loder Neil Farren PII: DOI: Reference:

S0020-1383(14)00207-1 http://dx.doi.org/doi:10.1016/j.injury.2014.04.043 JINJ 5728

To appear in:

Injury, Int. J. Care Injured

Received date: Revised date: Accepted date:

9-2-2014 27-4-2014 28-4-2014

Please cite this article as: Loder RT, Farren N, Injuries From Firearms In Hunting Activities, Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.04.043 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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INJURIES FROM FIREARMS IN HUNTING ACTIVITIES

Randall T. Loder, MD Neil Farren, BA, MS

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From the

Department of Orthopaedic Surgery, Indiana University School of Medicine,

Randall T. Loder, M.D.

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Address all correspondence to

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and the James Whitcomb Riley Children’s Hospital, Indianapolis, Indiana

Riley Children’s Hospital

705 Riley Hospital Drive, ROC 4250

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Indianapolis, Indiana 46202 317-278-0961

FAX 317-274-7197

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[email protected]

This research was supported in part by the Garceau Professorship Endowment, Indiana University,

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Department of Orthopaedic Surgery, and the Rapp Pediatric Orthopaedic Research Endowment, Riley

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Children’s Foundation, Indianapolis, Indiana.

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*Blinded Manuscript (Incl title, abstract, keywords, text, references. NOT tables or figures) Click here to download Blinded Manuscript (Incl title, abstract, keywords, text, references. Click NOT tables here toorview figures): linkedblinded References manus

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INJURIES FROM FIREARMS IN HUNTING ACTIVITIES

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ABSTRACT Background: Recreational hunting is a very popular sport, and frequently involves firearms. Few studies address the pattern of firearm injuries occurring with hunting and how they differ from firearm injuries not associated with hunting. Purpose: A nation wide data base will provide an overall perspective of the scope of the problem and

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types of injuries.

Methods: Our data was obtained from the Inter-University Consortium for Political and Social Research

Firearm Injury Surveillance Study 1993-2008 (ICPSR 30543). It was statistically analyzed for demographic

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and injury patterns using SUDAAN 10™ software. A p < 0.05 was considered to be statistically significant.

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Results: There were 1,841,269 ED visits for firearm related injuries 1993-2008; 35,970 were involved in hunting (1.95%). Hunters were older than non-hunters (34.5 vs 26.7 yrs, p < 0.0001). Handguns were involved in 48% of the non-hunters and 5.3% of the hunters (p <0.0001). The injury was unintentional in

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99.4% of hunters; for non hunters 32.1% were unintentional and 60.7% assaults. The majority of the hunting injuries presented to small hospitals (65.9%) while the majority of non-hunting injuries presented to the large (27.0%) and very large (35.0%) hospitals. Hunters were nearly all Caucasian (92%). In

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hunters, 57% were shot compared to 77% in non-hunters. The most common diagnosis in hunters was a laceration (42%) compared to a puncture in non-hunters (41%). The head and neck accounted for nearly one-half of the injuries in hunters (47%); for non-hunters it was the head and neck (29%) and the leg/foot

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(24%). Mortality was 0.6% for hunters and 5.3% for non-hunters. The use of alcohol and being involved

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in antisocial behaviors was much higher in the non-hunters. The estimated incidence of a firearm injury associated with hunting activities was 9 per 1 million hunting days.

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Conclusion: Hunters injured by firearms were nearly all Caucasian, older than non-hunters, did not involve handguns, presented to small hospitals, often sustained unintentional injuries and were not shot; most commonly injured in the head and neck, and had an overall mortality of 0.6%. These data can be a reference for future studies regarding hunting injuries associated with firearms.

Keywords: firearm – injury – hunting – not hunting – demographics

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Recreational hunting is a popular sport in the United States and frequently involves firearms. The US Fish and Wildlife Service estimated that ~13 million people were annually involved in hunting activities 1991 through 2011

1-5

. This exposes millions to potential injury from firearms, estimated to be

6.3% of the entire US population

1-5

. No study has investigated the pattern of firearm injuries from

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hunting activities and how they differ from firearm injuries not associated with hunting. None have used a national data base to include all patients, both those admitted and discharged from the hospital. It was the purpose of this study to address this question. This will provide a global perspective of this issue and the

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types of injuries. MATERIALS AND METHODS

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The data for this study was obtained from the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2008 (ICPSR 30543)

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collected by the National

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7 Electronic Injury Surveillance System (NEISS) . This study was determined to be exempt by the local Institutional Review Board. The NEISS, a branch of the US Consumer Product Safety Commission, collects data from a probability sample of hospitals in the United States and its territories that have at least six beds and an emergency department (ED). (Unfortunately it does not include those who only get care at

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acute care facilities not associated with a hospital or care in their own physician’s offices). The sample contains five strata, four based on size (the total number of emergency room visits reported by the hospital

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and are small, medium, large, and very large) and one stratum consisting of children’s hospitals. Currently there are 100 hospitals in the NEISS. Patient information is collected daily from each NEISS hospital for

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every patient treated in the ED due to an injury associated with consumer products. For this particular study, the ICPSR data set consists of any patient seeking care in and ED for any firearm related injury,

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regardless of activity involved during the injury (eg hunting, drill practice, committing a crime, suicide, assault), and whether or not the patient had been shot by the firearm or injured in some other way (eg laceration while cleaning a firearm, head trauma from being pistol whipped, a clavicle fracture from a rifle recoil, etc).

The hospitals selected to be in the NEISS reflect the current distribution of all hospitals in the

USA and its territories. Each hospital has an associated weight based on its ED size and geographic location. The hospital weight used by NEISS is equal to the inverse of the probability of selection for the hospitals in each stratum. The inverse of the probability of selection is simply the total number of hospitals on the sampling frame divided by the total number of hospitals in the sample calculated at the stratum level. Adjustments to these basic weights are made for non-response and hospital mergers. Annual estimates of injuries are derived by summing the monthly estimates for all months of the year. In order to produce national estimates of injuries, the statistical weights must be used rather than raw case counts. Because the statistical design provides different statistical weights for hospitals by its strata, weighted data (rather than raw counts) must also be used when analyzing for proportions or ages. Estimates across the entire data set (in this instance the USA and its territories) are thus calculated using appropriate statistical software which

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accounts for the stratified, weighted data. Further details regarding the acquisition of the ICPSR/NEISS data and guidelines for use of such data can be accessed from their respective web sites (ICPSR www.icpsr.umich.edu, NEISS -www.cpsc.gov/library/neiss.html). The detailed data for emergency department (ED) visits for the period 1993 through 2008 due to firearms were downloaded from the ICPSR website. It was analyzed for age, diagnosis, gender, race,

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marital status, type of firearm, perpetrator of injury (stranger, self, friend/acquaintance, spouse/ex, other relative, not seen/other), intent of injury (unintentional, assault, suicide, law enforcement), anatomic

location of the injury, the geographic location of where the injury occurred, method of transportation to the

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ED, disposition from the ED, was the patient shot, and behavioral circumstances involved

(drugs/crime/fight/argument/alcohol). Regarding the diagnosis, the one recorded in the data set is the final

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diagnosis given by the ED attending physician. If there is more than one diagnosis, the most severe 8 diagnosis is recorded . For example, a bullet injury could be coded as either a laceration or a puncture.

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However, unless it was simply a superficial grazing laceration, a puncture diagnosis would be recorded, as that is more severe. Regarding the perpetrator of the injury, a self inflicted occurs only when the patient injures himself; any one else is described by on of the other groups (stranger, friend/acquaintance,

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spouse/ex, other relative, not seen/other). With firearm injuries the common thinking is that the patient was shot; however that is not necessarily true, as the injury could have occurred by a different mechanism (eg. a clavicle fracture during recoil from a rifle, beaten with a hand gun, etc). Race was classified as White,

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9 Black, Amerindian (Hispanic and Native American) and Indo-Malay (Asian origins) . Anatomic location

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of the injury was grouped into head/neck, upper and lower trunk, arm/hand, and leg/foot. The individual comments for each case were analyzed to determine if either hunting or alcohol was involved by searching the ICPSR data set using the FIND command in Microsoft Excel™ (Microsoft®

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Office 2003, Microsoft Corporation 1985-2003). The key words used to search for any injury involving hunting were: hunt(ing), deer, elk, moose, bear, antelope, coyote, lion, wolf, boar, hog, groundhog, prairie dog, squirrel, rabbit, coon, beaver, waterfowl, goose/geese, turkey, duck, quail, coon, pheasant, bird, sparrow. The key words used to search for alcohol were: alcohol, EtOH, intoxicated, drinking, drank, drunk, club, ethanol, saloon, tavern, liquor, booze, beer, whiskey, brandy, rum, vodka, scotch, tequila, wine, sake, champagne, and cognac. Statistical Analyses

Due to the stratified and weighted nature of the ICPSR data, statistical analyses were performed

with SUDAAN 10™ software (RTI International, Research Triangle Park, North Carolina, 2008). This software accounts for the weighted and stratified nature of the data, and calculates an estimated value across the population encompassed by the data set (the entire United States of America in this case) and 95% confidence intervals (given in brackets as [lower 95%, upper 95% intervals]). Continuous data are reported as the mean and discrete data as frequencies. Analyses between groups of continuous data were performed with the Student’s t-test (2 groups) or ANOVA (3 or more groups). Differences between groups

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of discrete data were analyzed by the 2 test. These tests for significance in SUDAAN are stratum adjusted for the weighted nature of the data and are analogous to their counterparts with non-survey, weighted data. RESULTS There were a total of 1,841,269 [1818437, 1864101] ED visits for firearm related injuries 19932008; 35,970 were involved in hunting (1.95%). Hunters were older than non-hunters (34.5 [32.5, 36.4] vs

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26.7 [ 26.2, 27.3] yrs, p < 0.0001) (Table 1). Hunters demonstrated a wide age range while non hunters

demonstrated a major peak at 15 to 24 years and markedly lower for other ages (Table 1). Handguns were involved in 48% of the non-hunters and 5.3% of the hunters (p <0.0001) (Table 2). The majority of the

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hunting injuries presented to small hospitals (65.9%) while the majority of non-hunting injuries presented to the large (27.0%) and very large (35.0%) hospitals.

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Although both groups demonstrated a male predominance, it was greater in the hunting group (Table 2). Hunters were nearly all Caucasian (92%), while Caucasians and Blacks were relatively equal (41%) in non-hunters. In hunters 57% were shot (either by themselves or someone else) compared to 77%

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in the non-hunters. The most common diagnosis in hunters was a laceration (42%) compared to a puncture in non-hunters (41%). The head and neck accounted for nearly one-half of the injuries in hunters (47%);

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for non-hunters it was the head and neck (29%) and the leg/foot (24%).

The injury was self inflicted (eg. caused by the hunter him/herself, and not by any one else) in 85% of hunters and 43% of non hunters (Table 3); unintentional in 99.4% of hunters and 32.1% of non

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hunters. The injury location was a recreational area (37%) or other property (39%) for hunters compared to the home (48%) and street/highway (29%) in non-hunters. Most of the hunters arrived at the ED by private

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vehicle (76%) and EMS (58%) for non-hunters. The fatality rate was 0.6% for hunters and 5.3% for nonhunters; more hunters were released (86%) from the ED compared to non-hunters (64%). The majority of

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hunters were married (68%) compared to non-hunters (23%) (Table 4). The use of alcohol and being involved in an argument, fight, crime, or drugs was much higher in the non-hunters compared to hunters. We further explored the injury intent for hunters and non hunters separately (Table 5). For

hunters, 99.4% were unintentional and 0.6% assaults, with no suicides or law enforcement injuries. For non hunters, 32.1% were unintentional and 60.7% assaults, 5.9% suicides, and 1.4% due to law enforcement. Within hunters, there were no differences by diagnosis, perpetrator, and being shot or not shot between the unintentional and assault groups. For the non hunters, those injured by themselves were more frequently unintentional while those injured in assaults were more frequently injured by strangers or unknown individuals. Injuries associated with suicides nearly always involved the individual (99.9%) although 0.1% of the people injured were others, not the actual suicide victim. Temporally, most of the hunting injuries occurred in the autumn as expected; 31.9% in November, 19.7% in October, and 17% in December; there was a very uniform distribution across all months for nonhunters (Figure 1). Although both hunters and non-hunters had more injuries on Saturday/Sunday, it was much higher for hunters (53.0%) compared to non-hunters (37.1%). No trend was noted in the proportion of hunting versus non-hunting injuries for each year from 1993-2008.

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Many studies have noted that fatalities and other more serious injuries are more common in younger hunters

10-13

. We analyzed the hunting group by itself by seven different age groups; statistically

significant differences were seen only for firearm type, marital status (clearly expected), transportation to the ED, perpetrator, body part, and month of injury (Table 6). Air propelled guns were involved in ~ 25%

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of all the injuries for patients 0-14 years old, and much less for all other age groups (p = 0.007). The proportion of patients who walked into the ED increased with increasing age (p = 0.023); the only group where some of the patients arrived at the ED by police transport was the 0-14 year olds. Although in all

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groups the injuries were most commonly self inflicted, the group having the lowest proportion of self

inflicted injuries was 55-64 years old (~65%) (p = 0.0006). With advancing age injuries to the leg and foot

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became less common: ~33% for those 0-14 years old and dropping to ~11% for those > 65 years old (p = 0.008). Most groups demonstrated a peak in the autumn months, but ~75% of all the hunting injuries in June were in those 0-24 years old (p < 0.0001).

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We estimated the incidence of these injuries using the US Fish and Wildlife Service data from 1991 through 2011. The average number of people involved in hunting per year was 13.54 million

1-5

. In

this study there were an estimated 35,902 firearm injuries associated with hunting over 16 years, or 2,244

days for those hunting was 18.4 days per year

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per year. This gives an incidence of 0.166 firearm injuries per year per 1000 hunters. The total number of 1-5

, giving an incidence of a firearm injury associated with

hunting activities of 9 per 1 million hunting days.

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DISCUSSION

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This is the first study to address the spectrum of firearm injuries in hunters using a national data base which includes all patients, not just those admitted to hospitals. The most frequent injury was a

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laceration (42.4%), which might be surprising to many, since being shot is the stereotype of a hunting injury. The actual number of people who were shot while hunting out of all the firearm injuries was 1.1% (20,504 of 1,841,269). Our data showed a greater proportion of young people involved in hunting activities than suggested by the US Fish and Wildlife Service (Figure 2). The US Fish and Wildlife Service data only gives data for those 16 year or older; however the NEISS collects all data for all ages. In this study, 11.9% of all the hunters were < 14 years of age. Clearly younger patients do sustain firearm injuries associated with hunting activities.

The actual incidence of injury during hunting with firearms is difficult to determine. We

estimated it to be 9 per 1 million hunting days. In a study of 725 big game hunters in Colorado visiting the ED

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, 229 (31%) of the visits were for medical illnesses and 327 (45%) for injuries. The majority of the

injuries were lacerations from knives during dressing of the animal. Only 4 of the 725 were for gunshot wounds; 5 for burns, 15 for fractures not related to horses or MVC/ATVs, and 18 contusions for a total of 42 visits. They estimated the overall incidence of visiting an ED was 1.7 per 1000 and 0.5 per 1000 hunting days. Assuming the 42 visits are the ones associated only with firearms, this gives an incidence of 25.5 per 1million hunting days, approximately double our estimate, but still similar when comparing the

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small size of the numerator to the massive size of the denominator (1 million hunting days). Of the 9 fatalities in the Colorado study, only 1 was from a firearm. Many hunting injury studies discuss falls from tree/hunting stands

. The average age of 34.5 years in this study was younger than most

in the literature; a median age of 24 years Germany, 66% were over 40 years of age the 90%

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; 96%

22

and 99%

25

12 23

, and average ages of 41

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, 44.4

22

, and 49.5 years

by others. Since we included all injuries, not just shootings, and all visits,

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, 12.3%

11

, 26%

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unlike several smaller studies

, and 28% 10-13

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. This suggests that at the national level, younger hunters are no more

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In this study 85% of the injuries were self inflicted. The literature notes 22%

times

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12

, and 25.5%

13

13

12

, 23 %

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, 34%

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. Alcohol involvement was 1.5% in our study; compared to 2.3%

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for all injuries, and 44.8% for fatalities , 20%

, 5.7%

. We noted no difference in the fatality rate by age group,

likely to sustain a fatal injury compared to older hunters.

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, 8%

. In

. We noted a strong male predominance of 90.6%, similar to

not just admissions, the mortality rate in this study of 0.6% is much smaller than others of 1.6% 10

25

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10-14, 21-25

but a few do review

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firearm associated injuries

15-22

by others. In Denmark alcohol use increased the odds of a firearm injury 1.9

. Association of other drugs was 0.3% in this study; the only other study noted a value of 4.6%

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.

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There are certain limitations to this study. One limitation of the NEISS is that it only identifies those individuals who sought care in the ED. It does not include those who might have been treated in

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urgent care centers, physician offices, or those patients who did not seek medical care. The overall number of injuries in this study is therefore lower than the real number of injuries. The NEISS is skewed to more

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serious injuries, since patients sustaining significant injuries will likely seek immediate care in the ED. Another potential limitation is the accuracy of the NEISS data. However two studies have demonstrated over 90% accuracy

26, 27

. We thus believe our numbers to be accurate. With this in mind, our results can

serve as a reference for future studies regarding hunting injuries associated with firearms.

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LEGENDS FOR FIGURES Figure 1: Distribution for firearm injuries comparing those who were hunting to those who were not hunting by month (A) and weekday (B) of injury. The values for the hunters are the filled squares and non hunters open triangles; the y left axis represents the hunters and the y right axis the non hunters.

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Figure 2. Age distribution for those involved in hunting activities with firearm associated injuries (present study) compared to the data for hunter involvement by age from the US Fish and Wildlife Service

.

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Note that our study had a much higher proportion of younger patients.

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REFERENCES 1.

US. Department of the Interior, Fish and Wildlife Service and U.S. Department of Commerce,

U.S. Census Bureau. 1991 National Survey of Fishing, Hunting, and Wildlife-Associated Recreation. March 1993. 2.

US. Department of the Interior, Fish and Wildlife Service and U.S. Department of Commerce,

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U.S. Census Bureau. 1996 National Survey of Fishing, Hunting, and Wildlife-Associated Recreation. November 1997. 3.

US. Department of the Interior, Fish and Wildlife Service and U.S. Department of Commerce,

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U.S. Census Bureau. 2001 National Survey of Fishing, Hunting, and Wildlife-Associated Recreation. October 2002.

US. Department of the Interior, Fish and Wildlife Service and U.S. Department of Commerce,

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4.

U.S. Census Bureau. 2006 National Survey of Fishing, Hunting, and Wildlife-Associated Recreation. October 2007.

US. Department of the Interior, Fish and Wildlife Service and U.S. Department of Commerce,

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5.

U.S. Census Bureau. 2011 National Survey of Fishing, Hunting, and Wildlife-Associated Recreation. September 2013.

United States Department of Health and Human Services. Centers for Disease Control and

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6.

Prevention. National Center for Injury Prevention and Control. Firearm Injury Surveillance Study, 19932008 [Computer file]. ICPSR30543-v1. In:. version 1 ed: Ann Arbor, MI: Inter-university Consortium for

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Political and Social Research [distributor], 2011-08-09; 2008.

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Social Research [distributor], 2011-08-09; 2008. 7.

Division of Hazard and Injury Data Systems. US Consumer Product Commission. NEISS. The

8.

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National Electronic Injury Surveillance System. A tool for researchers. 2000. US Consumer Product Safety Commission. NEISS Coding Manual: National Electronic Injury

Surveillance System, 2013. 9.

Eveleth PB, Tanner JM. Worldwide variation in human growth. 2nd ed. Cambridge: University

Press, 1990. 10.

Smith JL, Wood GC, Lengerich EL. Hunting-related shooting incidents in Pennsylvania, 1987-

1999. J Trauma Inj Infect Crit Care 2005;58:582-590. 11.

Carter GL. Accidental firearm fatalities and injuries among recreational hunters. Ann Emerg Med

1989;18:406-409. 12.

Cole TB, Patetta MJ. Hunting firearm injuries, North Carolina. Am J Pub Health 1988;78:1585-

1586. 13.

Morrow PL, Hudson P. Accidental firearm fatalities in North Carolina, 1976-1980. Am J Pub

Health 1986;76:1120-1123. 14.

Reishus AD. Injuries and illnesses of big game hunters in western Colorado: a 9-year analysis.

Wilderness Env Med 2007;18:20-25.

Page 10 of 23

15.

Metz M, Kross M, Abt P, Bankey P, Koniaris LG. Tree stand falls: a persistent cause of sports

injury. South Med J 2004;97:715-719. 16.

Gates RL, Helkamp JC, Wilson SL, Denning DA, Beaver BL. Deer stand-related trauma in West

Virginia: 1994 through 1999. J Trauma Inj Infect Crit Care 2002;53:705-708. 17.

Crites BM, Moorman III CT, Hardaker Jr. WT. Spine injuries associated with falls from tree

18.

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hunting stands. J South Orth Assoc 1998;7:241-245.

Lawrence DW, Gibbs LI, Kohn MA. Spinal cord injuries in Louisiana due to falls from deer

stands, 1985-1984. J Lousiana St Med Soc 1996;148:77-79.

Urquhart CK, Hawkins ML, Howdieshell TR, Masnberger Jr. AR. Deer stands: a significant

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19.

cause of injury and mortality. South Med J 1991;84:686-688.

Fayssoux RS, Tally W, Sanfilippo JA, Stock G, Ratliff J, K., Anderson G, et al. Spinal injuries

after falls from hunting tree stands. Spine J 2008;8:522-528. 21.

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20.

Crockett A, Stawicki SP, Thomas YM, Jarvis AM, Wang CF, Beery PR, et al. Tree stands, not

22.

Halanski MA, Corden TE. Wisconsin firearm deer hunting season: injuries at a level 1 trauma

center, 1999-2004. Wis Med J 2008;107:20-24.

Karger B, Wissmann F, Gerlach D, Brinkmann B. Firearm fatalities and injuries from hunting

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23.

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guns, are the Midwestern hunter's most dangerous weapon. Am Surg 2010;76:1006-1010.

accidents in Germany. Int J Leg Med 1996;108:252-255. 24.

Stueland D, Carpenter WS, Cleveland D. Summary of hunting injuries in central Wisconsin: a 4-

Therbo M, Von Der Osten C. Firearm-related hunting accidents in Denmark. J Trauma Inj Infect

Crit Care 2009;67:1265-1269.

Annest JL, Mercy JA, Gibson DR, Ryan GW. National estimates of nonfatal firearm-related

Ac ce p

26.

te

25.

d

year experience at a rural referral center. Wilderness Env Med 1995;6:196-202.

injuries. Beyond the tip of the iceberg. JAMA 1995;273:1749-1754. 27.

Hopkins RS. Consumer product-related injuries in Athens, Ohio, 1980-1985: Assessment of

emergency room-based surveillance. Am J Prev Med 1989;5:104-112.

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*Conflict of Interest Statement Click here to download Conflict of Interest Statement: COI.doc

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The author’s declare no conflict of interest.

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Table 1 Click here to download Table: TABLE 1.doc

Total Age (yrs)

Hunting

1841269 [1818437, 1864101]

3597 [26330, 49162]

26.9 [26.4, 27.4]

34.5 [32.5, 36.4]

Age Group (yrs)

243467 [197758, 297735]

13.5

15 to 24

748773 [711745, 786270]

41.5

25 to 34

406901 [385444, 429207]

22.5

35 to 44

231299 [221013, 242070]

12.8

45 to 54

110784 [103640, 118288]

6.1

55 to 64

50101 [44312, 56581]

2.8

38765 [33875, 46693] 65+ * 95% CI in brackets

2.1

Not Hunting

%

p value

1805299 [1792107, 1814939]

-

26.7 [26.2, 27.3]

<0.0001

4277

11.9

239190

13.3

8101

22.6

740672

41.3

6759

18.8

400142

22.3

6875

19.1

224424

12.5

4870

13.6

105914

5.9

2854

7.9

47247

2.6

2166

6.0

36599

2.0

<0.0001

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0 to 14

%

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All

%

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TABLE 1 AGE AND AGE GROUPS*

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Table 2 Click here to download Table: TABLE 2.doc

TABLE 2 GENERAL DEMOGRAPHICS* Total

%

Hunting

%

Not Hunting

%

p value

88.3

32606

90.6

1560850

86.5

0.0032

Gender Male 1593456 [1573255, 1612278]

247254 [228432, 267455]

13.7

3364

9.4

243890

13.5

White

661284 [522394, 808736]

36.6

27397

91.8

633887

41.1

Black 634267 [457644, 828380]

35.1

978

3.3

633289

41.1

255561 [142542, 431085]

14.2

1407

4.7

20406 [11001, 37875]

1.1

62

0.2

Handgun

498848 [415610, 583838]

27.6

1616

Rifle

109670 [78834, 150627]

6.1

11342

Shotgun

103475 [89288, 119690]

5.7

14487

Air Propelled

354767 [294639, 420517]

19.7

Asian Firearm

20344

1.3

48.0

37.5

98328

9.5

47.9

88988

8.6

2814

9.3

351953

34.0

20504

57.0

1388257

76.9

24.0

15466

43.0

417042

23.1

13.5

4548

16.1

239547

14.3

103546 [89574, 119488]

5.7

3017

10.7

100529

6.0

311461[250601, 383252]

17.3

11940

42.4

299521

17.9

38.6

8354

29.7

687610

41.0

19.6

5294

18.8

349078

20.8

543505 [502284, 586547]

30.1

16769

46.9

526736

29.3

Upper Trunk 267975 [230626, 310126]

14.8

2738

7.7

265237

14.8

Lower Trunk 199700 [175671, 226596] Arm/Hand 342575 305913, 382666]

11.1

1654

4.6

198046

11.0

19.0

5923

16.6

336652

18.7

Leg/Foot 444352 [4198486, 470227]

24.6

7926

22.2

436426

24.3

744

2.1

32964

1.8

No

432508 [389060, 479282]

Foreign Body

244095 [184275, 319319]

Fracture Laceration

te

d

Diagnosis

78.1

16.5

497232

M

Yes 1408761 [161987, 1452209]

254145

5.3

an

Shot

Puncture 695964 [559493, 841376] Other 354372 [245985, 494535]

Ac ce p

Anatomic Area

Head/Neck

Other

33708 [23447, 48177]

1.9

<0.0001

cr

Amerindian

us

Race

ip t

Female

<0.0001

<0.0001

<0.0001

<0.0001

Hospital Size^

Small

377098 [273244, 507454]

20.5

23690

65.9

4095

19.6

Medium

317928 215981, 454609]

17.3

353408

11.4

318333

17.4

Large

493111 [273981, 798742]

26.8

5147

14.3

488164

27.0

Very Large

634992 [420914, 889701]

34.5

2892

8.0

632100

35.0

<0.0001

17940 [11784, 27067] 1.0 146 0.4 17794 1.0 Children’s * 95% CI in brackets ^ based upon number of annual ED visits; 0- 16830 for small, 16831-21850 for medium, 28151-41130 for large, > 41130 for very large, and various numbers for children’s hospitals

Page 14 of 23

Table 3 Click here to download Table: TABLE 3.doc

TABLE 3 INJURY CIRCUMSTANCES*

Total

%

Hunting

%

Not Hunting

%

p value

Stranger

240659 [192394, 296930]

22.7

466

1.8

240193

23.3

<0.0001

Self

469554 [411453, 529163]

44.2

22509

85.0

447045

43.3

Friend/Acquaintance

138549 [122490, 156380]

13.0

487

1.8

133762

13.0

Spouse/Ex

13589 [11049, 16679]

1.3

114

0.4

13475

1.3

Other Relative

55904 [46850, 66504]

5.3

1373

5.2

54531

5.3

Not Seen/Other

144108 [114523, 179964]

13.6

1538

5.8

142570

13.8

Unintentional

540023 [428739, 664030]

33.6

34957

99.4

505066

32.1

Assault

955366 [823681, 1079250]

59.4

208

0.6

955158

60.7

Suicide

92623 [68238, 124888]

5.8

0

0.0

92623

5.9

Law Enforcement

21368 [15772, 28969]

cr

us

an

Injury Intent

ip t

Perpetrator

0.0

Strt/Hghwy

305153 [221657, 40506]

16.9

186

0.7

304967

29.4

Other Prop

202665 [164088, 247835]

11.2

9875

38.6

192790

18.6

Farm

6071 [3831, 9577]

0.3

2826

11.0

3245

0.3

EMS

831665 [685188, 977252]

22.1

4605

19.5

827060

58.3

45356 [25838, 78821]

16.0

1037

4.4

44319

3.1

520711 [411931, 642998]

8.0

17841

75.7

502870

35.5

186860 [132459, 259685]

2.4

7963

33.8

178907

12.6

Police

43749 [25184, 75387]

28.9

90

0.4

43659

3.1

Other

6943 [2944, 15862]

2.5

0

0.0

6943

0.5

Released

1181291 [1051520, 31085]

65.5

31085

86.4

1150206

64.0

Admitted

555722 [452196, 671514]

30.8

4669

13.0

551053

30.7

95222 [78603, 115064]

5.3

216

0.6

95006

5.3

1.3

0

21368

1.4

498935 [428630, 570478]

27.6

3219

12.6

495716

47.7

51302 [40969, 64060]

2.8

9495

37.1

41807

4.0

ED Transport Air

Ac ce p

Private Vehicle

d

School/Rec

te

Home

Walk In

M

Location

<0.0001

<0.0001

<0.0001

Disposition from ED

Fatality

<0.0001

* 95% CI in brackets

Page 15 of 23

Table 4 Click here to download Table: TABLE 4.doc

TABLE 4 MARITAL STATUS AND BEHAVIORAL CIRCUMSTANCES* Total

%

Hunting

%

Not Hunting

%

p value

Never

669628 [593940, 735990]

37.1

5746

25.4

663882

70.3

<0.0001

Married

228860 [180949, 28778]

12.7

15407

68.0

213452

22.6

Divorce/Sep

44919 [32900, 61155]

2.5

1322

5.8

43597

4.6

Other

24238 [14031, 41415]

1.3

189

0.8

24049

2.5

Yes

121885 [99862, 147661]

6.8

79

0.3

No

626144 [600368, 648167]

34.7

31265

99.7

Yes

239538 [150373. 355020]

13.3

69

No

619244 [503762, 708409]

34.3

31226

Yes

58453 [28725, 113730]

3.2

No

630404 [575127, 660132]

34.9

Yes

149301 [119026, 185223]

No

651145 [615223, 681420]

Yes No

Drugs

cr

83.0

239469

28.9

99.8

588018

71.1

0.28

58367

8.9

30949

99.7

599455

91.1

8.3

79

0.3

149222

8.3

36.1

31147

99.7

619998

34.4

121290 [74387, 194622]

6.6

536

1.5

120754

6.7

1719979 [1646647, 1766882]

93.4

35434

98.5

1684545

93.3

<0.0001

0.0001

0.016

<0.0001

0.0019

Ac ce p

te

d

Alcohol

* 95% CI in brackets

594879

86

M

Fight

17.0

0.2

an

Crime

121806

us

Argument

ip t

Marital Status

Page 16 of 23

cr

ip t

Table 5 Click here to download Table: TABLE 5.doc

Hunting

-

%

M an

34957 208 [34602, 35088] 99.4 [77, 563] 0.6

Not Hunting

Law % Enforcement % 21368 505066 955158 92623 [15742, [399378, 624019 32.1 827722, 1073929] 60.7 [68164, 1215150] 5.9 28966] 1.4

Unintentional % Assault % p value Unintentional

All^

us

TABLE 5 DETAILS OF INJURY INTENT BETWEEN HUNTERS AND NON HUNTERS*

Assault

%

Ac

ce pt

ed

Diagnosis 4320 13.4 34 20.9 0.54 131271 28.7 62029 7.0 Foreign Body 2923 9.0 60 36.8 30801 6.7 59515 6.7 Fracture 11940 37.0 0 0.0 93278 20.4 167406 18.8 Laceration 8132 25.2 0 0.0 145275 31.8 393132 44.1 Puncture 4987 15.4 69 42.3 56452 12.4 209129 23.5 Other Shot 19570 56.0 163 78.4 0.34 372134 73.7 726701 76.1 Yes 15387 44.0 45 21.6 132932 26.3 228457 23.9 No Perpetrator 329 1.1 69 46.6 0.69 2507 0.6 231975 53.6 Stranger 22441 74.5 0 0.0 347390 77.1 385 0.1 Self 4753 15.8 0 0.0 58240 12.9 65766 15.2 Friend/Acquaintance 114 0.4 0 0.0 1816 0.4 10975 2.5 Spouse/Ex 1328 4.4 45 30.4 35399 7.9 13555 3.1 Other Relative 1148 3.8 34 23.0 5020 1.1 110176 25.5 Not Seen/Other * 95% CI in brackets ^ the % in this row are row percents, the % in all remaining cells are column percents for each separate column

Suicide

p value

-

2349 2602 18019 44999 23930

2.6 2.8 19.6 49.0 26.0

773 1701 3813 9652 3148

4.0 <0.0001 8.9 20.0 50.6 16.5

60599 32024

65.4 34.6

13080 8288

61.2 <0.0001 38.8

0 93260 0 0 0 120

0.0 99.9 0.0 0.0 0.0 0.1

984 0 34 0 0 18746

5.0 <0.0001 0.0 0.2 0.0 0.0 94.8

Page 17 of 23

cr

ip t

Table 6 Click here to download Table: TABLE 6.doc

TABLE 6 FIREARM INJURIES AMONGST HUNTERS – DIFFENCES BY AGE GROUPS 0 to 14

15 to 24

25 to 34

Male Female

3864 413

7560 541

6020 739

White Black Amerindian Indo-Malay

3280 54 312 0

6421 226 426 0

5011 86 391 0

Handgun Rifle Shotgun Air Propelled

68 1318 1572 1018

575 3222 2523 505

222 1766 3157 272

Yes No

2787 1490

4464 3637

Foreign Body Fracture Laceration Puncture Other

459 437 1375 1294 339

921 288 2673 2013 1617

2043 184 36 581 1364

Age Group (years) 35 to 44 45 to 54

Gender

2508 346

1908 258

0.80

1802 77 15 0

0.27

423 2102 3142 452

168 1495 2146 146

0 650 1285 261

160 721 662 160

0.007

4049 2710

3748 3048

3127 1822

1474 934

1380 1232

0.43

891 512 2043 1744 946

1080 620 2172 1223 1087

572 371 1457 1190 846

440 293 1372 476 254

185 496 780 414 185

0.22

3574 378 598 1084 2377

2931 600 17 1114 1685

3563 571 352 1163 1089

1923 459 585 1009 714

1480 417 0 476 481

1187 129 66 496 216

0.0081

ed

ce pt

Ac

p value

1790 101 0 0

Diagnosis

Hospital Size*

65+

3702 68 227 62

Shot

Head/Neck Upper Trunk Lower Trunk Arm/Hand Leg/Foot

55 to 64

5323 366 0 0

Firearm

Anatomic Area

4451 419

M an

Race

6227 648

us

Parameter

Small Medium Large Very Large Children’s

2962 364 619 228 104

5339 1177 851 692 42

4143 976 1057 583 0

4547 652 1073 603 0

3442 247 815 366 0

1851 268 487 248 0

1338 411 245 172 0

0.043 (0.10^)

Stranger Self Friend/Acq Spouse/Ex Other Relative

0 2573 388 0 427

138 5448 1343 0 165

187 4106 707 43 192

69 4384 945 0 231

16 2716 669 0 271

56 1517 512 71 87

0 1697 223 0 0

0.0006

Perpetrator

Page 18 of 23

ip t 76

172

791

121

203

175

0

4221 0

7759 0

6419 60

6634 69

4870 0

2820 34

2166 0

0.67

281 889 32 861 384

760 1970 0 1960 698

645 2005 0 2149 693

601 1662 0 1938 1330

421 1562 83 1330 302

223 982 0 957 239

288 425 71 567 231

0.44

498 124 2472 493 73

1201 202 4348 1567 0

1109 316 3004 1382 17

921 218 3072 1986 0

624 16 2430 985 0

144 161 1148 806 0

108 0 1299 744 0

0.023

3856 421 0

7110 876 115

5644 1048 67

6005 836 34

4061 809 0

2370 484 0

1971 195 0

0.63

0 0 0 0

2701 1016 115 0

1570 3350 309 0

603 4397 369 39

421 3393 179 0

257 1697 350 0

194 1554 73 77

<0.0001

0 3737

79 7251

0 5695

0 6016

0 4289

0 2359

0 1850

0.92

0 3737

0 7230

0 5746

69 5947

0 4289

0 2359

0 1850

0.98

0 3737

0 7170

19 5810

67 5753

0 4218

0 2343

0 1850

0.90

0 3737

79 7151

0 5746

0 5947

0 4289

0 2359

0 1850

0.92

0 4277

122 7979

78 6681

208 6667

128 4742

0 2854

0 2166

0.49

us

M an

ed

ce pt

Ac

Unintentional Assault Geographic Location Home School/Rec Strt/Hghwy Other Prop Farm ED Transport EMS Air Priv Vehic Walk In Police Disposition from ED Released Admitted Fatality Marital Status Never Married Divorce/Sep Other Argument Yes No Crime Yes No Drugs Yes No Fight Yes No Alcohol Yes No

cr

Not Seen/Other Injury Intent

* based upon number of annual ED visits; 0- 16830 for small, 16831-21850 for medium, 28151-41130 for large, > 41130 for very large, and various numbers for children’s hospitals ^ excluding children's

Page 19 of 23

Page 20 of 23

ed

ce pt

Ac M an

cr

us

ip t

Ac

ce

pt

ed

M

an

us

cr

i

Figure 1A Click here to download high resolution image

Page 21 of 23

Ac

ce

pt

ed

M

an

us

cr

i

Figure 1B Click here to download high resolution image

Page 22 of 23

Ac

ce

pt

ed

M

an

us

cr

i

Figure 2 Click here to download high resolution image

Page 23 of 23