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Research Letters |

Stray Bullet Shootings in the United States FREE

Garen J. Wintemute, MD, MPH; Barbara Claire; Vanessa McHenry; Mona A. Wright, MPH
[+] Author Affiliations

Author Affiliations: Violence Prevention Research Program, University of California, Davis, Sacramento (gjwintemute@ucdavis.edu).


JAMA. 2011;306(5):491-492. doi:10.1001/jama.2011.1066.
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To the Editor: Stray bullet shootings create fear and insecurity in affected communities13; entire populations have been advised to remain indoors at times of high risk.4 No nationwide information on these shootings is available.

We defined a stray bullet as having escaped the sociogeographic space or perimeter customarily set by the circumstances surrounding the firing of the gun from which it came, and cases as shooting events that involved at least 1 stray bullet injury to a person: a gunshot wound or injury by secondary mechanism. Cases could arise from violence, shooting sports, celebratory gunfire,4 or other activity. We included bystander shootings arising from violence if the bystander had no active role and was not targeted intentionally, shootings in which persons were injured by shooters targeting structures, and shootings from unintended gunfire when the shooter and the person shot were not the same person. We excluded shootings in which persons were targeted at random but shot intentionally.

Between March 1, 2008, and February 28, 2009, we conducted real-time surveillance using Google and Yahoo! news alert services, searching on stray bullet, and the news archives of GunPolicy.org. One year later, we searched for follow-up reports. We did not retrieve articles when payment or a subscription was required (<5%) or, in secondary searches, articles that had not been archived (~2%).

Proportions were calculated based on all cases identified. To detect reporting bias, we compared case-fatality ratios for persons injured by stray bullets in cases arising from violence with those for persons injured by nonstray bullets in those same cases and for firearm-related assaults in the United States in 2007,5 and we determined whether outcome severity and characteristics of persons injured were associated with the number of articles retrieved, using the Wilcoxon rank sum test with a 2-tailed P < .05 representing statistical significance. Data were analyzed using SAS version 9.1.3 for Windows (SAS Institute, Cary, North Carolina) and VassarStats (Vassar College, Poughkeepsie, New York). The University of California, Davis, institutional review board exempted this project from review.

We reviewed 1996 nonduplicate reports on 501 shooting events; 284 (56.7%) events met case criteria (Figure). Of these, 168 (59.2%) were incidental to violence (Table). Seven cases (2.5%) resulted from an unintended firing of a gun.

Place holder to copy figure label and caption
Figure. Flow Diagram for Case Identification
Graphic Jump Location
Table Graphic Jump LocationTable. Circumstances of Stray Bullet Shootings and Demographics of Persons Killed or Injured

Altogether, 317 persons received stray bullet injuries; 142 (44.8%) were female, and 176 (55.5%) were outside the age range 15 to 34 years (Table). Most individuals (258, 81.4%) were unaware of the events leading to the gunfire that caused their injuries. Many (129, 40.7%) were at home; most of these persons (88, 68.2%) were indoors. Sixty-five persons (20.5%) died, 18 (27.7%) of them at the shooting site and 55 (84.6%) on the day they were shot. Fourteen persons received nonfatal injuries by secondary mechanisms. The case-fatality ratio for stray bullet injuries did not differ from that for non–stray bullet injuries (20.8%; 11/53; difference, 0.3%; 95% confidence interval, −9.7% to 13.6%) or firearm-related assault nationwide (20.6%; 12 632/61 308; difference, 0.1%; 95% confidence interval, −5.7% to 4.2%).

Cases involving stray bullet fatalities yielded more reports than others (median, 8; interquartile range [IQR], 4-11, and 2; IQR, 1-4, respectively; P < .001). There was no difference by sex (median, 3; IQR, 2-6, for females and 3; IQR, 1-6, for males; P = .47) or age within or outside the range 15 to 34 years (median, 3; IQR, 2-6, and 3; IQR, 2-8, respectively; P = .32).

Most stray bullet shootings arise from violence, but they frequently affect females, children, and older adults. Those who are shot have little or no warning; opportunities for prevention once shooting starts are limited.

Several limitations deserve mention. Any definition of “stray bullet” contains an element of subjectivity. Underreporting by news media6 and failure of automated retrieval services to capture reports may have led to underascertainment and bias in our data. We do not report rates; the very similar case-fatality ratios suggest that reporting was not biased by severity. Missing information was common.

Author Contributions: Dr Wintemute had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Wintemute, Claire, McHenry, Wright.

Acquisition of data: Wintemute, Claire, McHenry, Wright.

Analysis and interpretation of data: Wintemute, Wright.

Drafting of the manuscript: Wintemute, McHenry.

Critical revision of the manuscript for important intellectual content: Wintemute, Claire, Wright.

Statistical analysis: Wintemute.

Obtained funding: Wintemute.

Administrative, technical, or material support: Wintemute, Claire, McHenry, Wright.

Study supervision: Wintemute.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. All of the authors are performing work under contract on a project funded by the California Department of Justice called the “Firearms and Domestic Violence Education and Intervention Project.” Funds are paid to the Regents of the University of California. No other disclosures were reported.

Funding/Support: This work was supported in part by grants from the California Wellness Foundation, the Joyce Foundation, and the Eli and Edythe L. Broad Foundation.

Role of the Sponsor: The funders had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Additional Contributions: We are grateful to Philip Alpers, School of Public Health, University of Sydney, for his observations on stray bullet shootings. Mr Alpers received no compensation for his contribution.

Howard DE, Kaljee L, Rachuba LT, Cross SI. Coping with youth violence: assessments by minority parents in public housing.  Am J Health Behav. 2003;27(5):483-492
PubMed   |  Link to Article
Horowitz K, McKay M, Marshall R. Community violence and urban families: experiences, effects, and directions for intervention.  Am J Orthopsychiatry. 2005;75(3):356-368
PubMed   |  Link to Article
Wolfer TA. Coping with chronic community violence: the variety and implications of women's efforts.  Violence Vict. 2000;15(3):283-301
PubMed
Centers for Disease Control and Prevention (CDC).  New Year's Eve injuries caused by celebratory gunfire: Puerto Rico, 2003.  MMWR Morb Mortal Wkly Rep. 2004;53(50):1174-1175
PubMed
 WISQARS (Web-based Injury Statistics Query and Reporting System). Centers for Disease Control and Prevention. http://www.cdc.gov/injury/wisqars/index.html. Accessed November 14, 2010
Sorenson SB, Manz JGP, Berk RA. News media coverage and the epidemiology of homicide.  Am J Public Health. 1998;88(10):1510-1514
PubMed   |  Link to Article

Figures

Place holder to copy figure label and caption
Figure. Flow Diagram for Case Identification
Graphic Jump Location

Tables

Table Graphic Jump LocationTable. Circumstances of Stray Bullet Shootings and Demographics of Persons Killed or Injured

References

Howard DE, Kaljee L, Rachuba LT, Cross SI. Coping with youth violence: assessments by minority parents in public housing.  Am J Health Behav. 2003;27(5):483-492
PubMed   |  Link to Article
Horowitz K, McKay M, Marshall R. Community violence and urban families: experiences, effects, and directions for intervention.  Am J Orthopsychiatry. 2005;75(3):356-368
PubMed   |  Link to Article
Wolfer TA. Coping with chronic community violence: the variety and implications of women's efforts.  Violence Vict. 2000;15(3):283-301
PubMed
Centers for Disease Control and Prevention (CDC).  New Year's Eve injuries caused by celebratory gunfire: Puerto Rico, 2003.  MMWR Morb Mortal Wkly Rep. 2004;53(50):1174-1175
PubMed
 WISQARS (Web-based Injury Statistics Query and Reporting System). Centers for Disease Control and Prevention. http://www.cdc.gov/injury/wisqars/index.html. Accessed November 14, 2010
Sorenson SB, Manz JGP, Berk RA. News media coverage and the epidemiology of homicide.  Am J Public Health. 1998;88(10):1510-1514
PubMed   |  Link to Article

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