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Prevention of firearm injuries with gun safety devices and safe storage

An Eastern Association for the Surgery of Trauma Systematic Review

Violano, Pina PhD; Bonne, Stephanie MD; Duncan, Thomas DO; Pappas, Peter MD; Christmas, A. Britton MD; Dennis, Andrew DO; Goldberg, Stephanie MD; Greene, Wendy MD; Hirsh, Michael MD; Shillinglaw, William DO; Robinson, Bryce MD; Crandall, Marie MD

Journal of Trauma and Acute Care Surgery: June 2018 - Volume 84 - Issue 6 - p 1003–1011
doi: 10.1097/TA.0000000000001879

BACKGROUND Over 50,000 homicides and suicides occur each year. An estimated half of all US households are believed to have a firearm present, making them one of the most ubiquitous consumer products. Our goal was to determine if the manner of storage of a firearm in a home could potentially make a difference in the outcomes of intentional and unintentional injuries involving a firearm; specifically addressing the use of gun safes and devices that block/disable firearm function (trigger locks, cable locks, etc.).

METHODS A comprehensive review of the literature was performed. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the breadth and quality of the data specific to our Population, Intervention, Comparator, Outcomes (PICO) questions.

RESULTS A total of 176 studies were initially identified, then, 120 more added after a subsequent literature review, with 97 removed as duplicates. One hundred ninety-one case reports, case series, and reviews were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of two studies which merited inclusion for PICO 1, should gun locks be used to prevent firearm injuries and six studies which merited inclusion for PICO 2, should safe storage for guns be used to prevent firearm injuries.

CONCLUSION PICO 1: We conditionally recommend that gun locks be used to prevent unintentional firearm injury. PICO 2: Because of the large effect size and the reasonable quality of available evidence with safe storage of firearms, we recommend safe storage prevent firearm-related injuries.

LEVEL OF EVIDENCE Systematic review, level III.

From the Injury Prevention Center, Yale-New Haven Hospital (P.V.), New Haven, Connecticut; Division of Trauma/Surgical Critical Care, Rutgers New Jersey Medical School (S.B.), Newark, New Jersey; Department of Trauma Services, Ventura County Medical Center (T.D.), Ventura, California; Department of Surgery, University of Central Florida College of Medicine (P.P.), Orlando, Florida; Department of Surgery, Carolinas Health Care (A.B.C), Charlotte, North Carolina; Department of Trauma, Cook County Hospital (A.D.), Chicago, Illinois; Division of Acute Care Surgical Services, Virginia Commonwealth University (S.G.), Richmond, Virginia; Acute and Critical Care Surgery, Emory University School of Medicine (W.G.), Atlanta, Georgia; Pediatric Surgery and Trauma, University of Massachusetts (M.H.), Boston, Massachusetts; Mission Trauma Services, Mission Hospitals Asheville (W.S.), Asheville, North Carolina; and Trauma, Burn, & Critical Care, University of Washington Harborview Medical Center (B.R.), Seattle, Washington.

Submitted: January 22, 2018, Revised: February 27, 2018, Accepted: March 1, 2018, Published online: March 8, 2018.

Address for reprints: Marie Crandall, MD, University of Florida College of Medicine Jacksonville, 655 W. 8th Street, Jacksonville, FL 32209; email:

© 2018 Lippincott Williams & Wilkins, Inc.