摘要：Objectives. To investigate the validity of the apparent downward trend in the national case–fatality rate for gunshot wounds from assault. Methods. We reanalyzed the estimated annual number of nonfatal firearm injuries the National Electronic Injury Surveillance System reported from 2003 to 2012. We adjusted the estimates for discontinuities created by the substitution of 1 hospital for another in the sample and for a downward trend in the percentage of gunshot injuries classified as “unknown circumstance.” Firearm homicide data are from the Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System. Results. The unadjusted National Electronic Injury Surveillance System estimate increased by 49%, yielding a decline in the case–fatality rate from 25% to 18%. Our adjustments eliminated these trends; the case–fatality rate was 22% in both 2003 and 2012. Conclusions. With reasonable adjustments, the trend in nonfatal injuries from interpersonal firearms assault tracks the flat trend in firearms homicides, suggesting that there was no increase in firearms violence during this period. The case–fatality rate did not change, and trauma care improvements did not influence the firearms homicide trend. Recent reports in the peer-reviewed literature and lay press 1–3 have suggested what would be a very positive development: improvements in the survivability of assault-related gunshot wounds, as reflected by a decline in the case–fatality rate for firearm assault. These reports have relied on mortality data from the National Center for Health Statistics and nonfatal injury data from the National Electronic Injury Surveillance System (NEISS)-All Injury Program (AIP). The authors of these reports attribute the good news to improvements in emergency medical services and clinical care for severely injured patients. But published analyses of other aggregated clinical data show that the case–fatality rate for firearm-related injuries has remained stable or increased in recent years. 4–6 We assessed the validity of the reported estimates that the case–fatality rate for firearm-related assaults is decreasing. Our investigation focused on the NEISS.
