Also Appearing in This Issue of JAMA


Study Examines Trends in Firearm Injuries Among Children and Adolescents

“Given recent firearm-related fatalities combined with declining gun research funding, it is important to monitor firearm injuries in youths. Injury death rates are available but provide an incomplete picture of these potentially preventable injuries,” writes Angela Sauaia, M.D., Ph.D., of the University of Colorado School of Public Health, Denver and colleagues.

As reported in a Research Letter, the authors investigated the trends from 2000 to 2008 of both fatal and nonfatal firearm injuries in children and adolescents 4 to 17 years of age presenting to 2 Colorado urban trauma centers (in Denver and Aurora). The researchers compared firearm injuries with other injuries regarding patient characteristics (age, sex, race/ethnicity [white non-Latino vs. others], injury self-infliction, mortality, and intensive care requirement) and analyzed temporal trends regarding patient and injury characteristics as well as outcomes among fatal and nonfatal firearm injuries.

Overall, during this time period 6,920 youths were injured. Firearms caused the injury in 129 of these youths (1.9 percent) (2.1 percent in 2000-2002; 1.9 percent in 2003-2005; 1.6 percent in 2006-2008). Firearm-wounded patients were more likely to be adolescent males, and their injuries were more often self-inflicted compared with youths with other injuries. Sixty-five patients (50.4 percent) with firearm injuries required intensive care vs. 1,311 patients (19.3 percent) with other trauma; 17 patients (13.2 percent) with firearm injuries died vs. 116 (1.7 percent) with other trauma. Firearm injury severity significantly increased over time.

“Firearms were an important mechanism of injury in the youth in this study. Compared with other serious injuries, firearm injuries were more severe, more often required intensive care, and claimed more lives, justifying focusing on pediatric firearm injuries as a prevention priority,” the authors write. “More recent data from other areas with detail on the circumstances of the firearm injury are needed.”

(JAMA. 2013;309[16]:1683-1685. Available pre-embargo to the media at

Media Advisory: To contact Angela Sauaia, M.D., Ph.D., call David Kelly at 303-503-7990 or email


Viewpoint in This Issue of JAMA

The Clinical Learning Environment – The Foundation of Graduate Medical Education

Kevin B. Weiss, M.D., of the Accreditation Council for Graduate Medical Education (ACGME), Chicago, and colleagues write that the “next step in the evolution of resident physician training is the Next Accreditation System (NAS), which is now being implemented by the ACGME.” In this Viewpoint, the authors discuss the Clinical Learning Environment Review (CLER) program, which is the first component of the NAS to be operationalized nationally.

“Given the broad public need and mandate to improve the quality and safety of medical care in the United States, the future workforce must be trained to recognize opportunities for improvement and actively engage their health care organizations to implement systems-based improvements in patient care. Teaching hospitals and other clinical learning environments must teach quality and safety improvement and incorporate residents and fellows into formal quality and safety structures and initiatives. Through its CLER program, the ACGME seeks to engage U.S. teaching institutions in identifying and implementing the most effective quality improvement strategies that focus on the safety, quality, and value of care. By doing so, the ACGME seeks to enhance the preparation of residents and fellows to best serve their patients in an ever increasingly complex health care environment.”

(JAMA. 2013;309[16]:1687-1688. Available pre-embargo to the media at

Media Advisory: To contact Kevin B. Weiss, M.D., call Timothy Brigham at 312-755-5000 or email

Editor’s Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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