In 2002-03, penetrating trauma in Ontario was responsible for about 3% of all ED visits for trauma, with more than 40 000 ED visits resulting from guns, knives and other sharp objects. The overall firearm-related injury rate of 4.7 per 100 000 is significantly lower than the estimated corresponding value reported by some states in the US (e.g., 34.3 in New Mexico and 30.9 in Massachusetts
4,
14); however, it is of concern in Canada nonetheless.
3 Our data reinforce an earlier article by Chapdelaine and colleagues
8 suggesting that penetrating trauma is most common among males and young people. Although about 10% of these ED visits are classified as intentional (assault or self-harm), the majority are coded as unintentional or of unknown intent. This percentage demonstrates a markedly different pattern from mortality data, where suicides make up about four-fifths of all firearm-related deaths in Canada.
10
Not all penetrating trauma falls within a triage category reflecting high acuity. Our data suggest that firearms cause more serious injuries on average than do knives. Overall, only 3.1% of knife-related injuries were triaged as high acuity in the ED and only 3.7% required hospital admission, compared with 39.9% and 25.7%, respectively, for firearm-related injuries. Surprisingly, 10.2% of the firearm-related injuries were classified as Non Urgent (Level V). This is likely because injuries due to BB guns and air rifles were included in the firearm-related category, and injuries due to this type of firearm may be less severe.
The injury rates found in this population-based study are lower than those reported in New Mexico. For example, the admission rate per 100 000 in our study was 1.2 and 11.7 for firearms and knives/sharp objects, respectively, compared with 34.3 and 35.1, respectively, in New Mexico.
4 This proportion was somewhat different from that reported in Sydney, Australia, where 30% of severe penetrating trauma was due to firearms.
15 However, the Australian study reported only patients with an Injury Severity Score of >15, whereas our study included all patients treated at an ED in Ontario.