Injuries caused by firearms treated at Brazilian urgent and emergency healthcare services

Ribeiro, Adalgisa Peixoto; Souza, Edinilsa Ramos de; Sousa, Carlos Augusto Moreira de

doi:10.1590/1413-81232017229.16492017

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ARTICLE • Ciênc. saúde colet. 22 (9) • Sept 2017 • https://doi.org/10.1590/1413-81232017229.16492017 copy

Injuries caused by firearms treated at Brazilian urgent and emergency healthcare services

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper analyzes the medical care given at Brazilian urgent and emergency healthcare services to people injured by firearms in 2014. A cross-sectional study was carried out on care given to patients with firearms injuries in 24 capital cities of Brazilian states and in the Brazilian Federal District, included in the VIVA Survey. Simple and relative frequencies of the variables related to the patients and to the event were calculated, and a logistic model for complex samples was applied adopting care for firearms injuries patients as outcome. The results show the following percentages of care events as caused by firearms: 0.7% for the category ‘other accidents (other than transport-related accidents)’, 1.5% for self-inflicted injuries, 15.9% for injuries due to assault, and 65.1% of cases arising from legal intervention. The care given was predominantly to young male adults (age 20-39), of mixed race and with a low level of schooling. The most common injuries were: to arms and legs; and to multiple organs. The paper concludes by discussing the efforts to control firearms held by the public in Brazil, and how they can lead to severe and lethal outcomes in quarrels and interpersonal disputes.

Firearms; Health survey; Urgent and emergency care

Subgroups of specific external causes	Number of care events

	Total	Due to firearms

	N	N	%
Other accidents (excluding transport)	17,450	128	0,7
Self-harm injuries	477	7	1.5
Assault	4,406	697	15.9
Legal intervention	66	43	65.1
TOTAL	22,399	875	3.9

		Subgroups of specific external causes (N = 875)

		Other accidents (excl. transport)	Self-harm injuries	Assault	Legal intervention
Gender	Male	89.1	100.0	90.2	93.0
Gender	Female	10.9	0	9.8	7.0
Age group	0-9	0.0	0.0	1.2	0.0
	10-19	23.8	28.6	26.1	31.7
	20-39	59.5	57.1	61.4	68.3
	40-59	14.3	0.0	9.5	0.0
	60 and over	2.4	14.3	1.8	0.0
Skin color/race	White	14.2	14.3	17.3	19.0
	Black	25.2	28.6	16.7	16.7
	‘Yellow’	0.8	0.0	1.0	7.1
	Mixed-race	59.0	57.1	64.1	57.2
	Indigenous	0.8	0.0	0.9	0.0
Level of schooling	0-4 years	32.4	60.0	31.7	18.2
	5-8 years	33.4	20.0	35.5	54.6
	9-11 years	29.6	20.0	28.9	22.7
	12 +	4.6	0.0	3.9	4.5
Has remunerated activity	Yes	52.3	42.9	45.6	23.3
	No	41.4	42.9	42.3	32.6
	Not known	6.3	14.2	12.1	44.1

		Subgroups of specific external causes (N = 875)

		Other accidents (excl. transport)	Self-harm injuries	Assault	Legal intervention
Location of the event	Home	26.6	42.8	15.9	2.3
	School	0.8	0.0	0.3	0.0
	Recreation area	4.7	0.0	1.9	0.0
	Public street	40.5	28.6	65.7	93.0
	Other	21.1	28.6	13.2	4.7
	Not known	6.3	0.0	3.0	0.0
Day of the week of the event	Sunday	22.6	0.0	18.8	14.0
	Monday	14.1	14.3	10.0	16.3
	Tuesday	13.3	14.3	13.1	16.3
	Wednesday	15.6	0.0	14.1	16.3
	Thursday	13.3	28.6	10.8	7.0
	Friday	8.6	14.2	15.6	23.1
	Saturday	10.2	28.6	16.5	7.0
	Not known	2.3	0.0	1.1	0.0
Event took place on the way to or from work?	Yes	22.2	20.0	17.3	0.0
Event took place on the way to or from work?	No	77.8	80.0	82.7	100.0
Intentionality, in the patient’s view	Intentional	36.6	28.6	83.5	85.0
	Not intentional	57.7	71.4	11.9	10.0
	Don’t know	5.7	0.0	4.6	5.0

		Subgroups of specific external causes (N = 875)

		Other accidents (excl. transport)	Self-harm injuries	Assault	Legal intervention
Location of injury in the body	Legs	28.3	14.3	26.8	34.8
	Multiple organs	11.7	14.3	20.0	20.9
	Arms	25.0	42.8	15.4	4.7
	Chest/back	10.9	0.0	12.3	16.3
	Abdomen/thigh	7.8	14.3	10.8	9.3
	Other region of head/face	10.9	14.3	10.1	4.7
	Neck	2.3	0.0	2.3	0.0
	Genitals/anus	0.0	0.0	0.9	2.3
	Mouth/teeth	2.3	0.0	0.7	2.3
	Spine/medulla	0.8	0.0	0.7	4.7
Development of case	Hospitalization	42.6	42.9	49.0	64.3
	Discharge	44.3	42.9	31.4	16.7
	Referral to outpatient facility	5.7	14.2	7.3	0.0
	Referral to other service	6.6	0.0	6.4	7.1
	Death	0.0	0.0	4.7	9.5
	Avoidance / flight	0.8	0.0	1.2	2.4

Variable	Category	OR	Lower limit (OR)	Upper limit (OR)	Wald F	p-value
(Intercept)					434.419	< 0.001
Gender	Male	1.00			30.455	< 0.001
	Female	0.34	0.23	0.50
Age	Young (age 0-29)	1.00			31.241	< 0.001
	Adult (30+)	0.48	0.37	0.62
Schooling	1-8 years’ schooling	1.00			8.969	< 0.003
Schooling	9+ years’ schooling	0.66	0.51	0.87
Aggressor	Legal agent/unknown/other	1.00			55.389	< 0.001
	Father/mother/partner/former partner/other family member	0.03	0.01	0.07
	Friend/acquaintance	0.19	0.13	0.29
Location of event	Public street	1.00			10.599	< 0.001
	Home	1.14	0.76	1.72
	School/recreation area/other	0.46	0.32	0.66

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

AP Ribeiro and ER Souza worked on all aspects from conception to final write-up of the article; and CAM Sousa was responsible for the methodology and statistical analyses.