We were interested in the paper by Srinivasan et al 1 as it brings into focus the differences in the epidemiology of firearm injuries in children and young people between the USA and the UK and the importance that gun control has had in child and adolescent safety here. Through the Child Death Review in Wales, we have previously reviewed deaths from firearm injuries in the UK. This followed the death in Wales of a young person by his own hand using a shotgun. This prompted us to examine the problem of firearm deaths to children and young persons in Great Britain. 2 We hoped to search for common themes that underpin the causes of childhood firearm deaths and investigate the scope for prevention.In the paper from America, 1 the incidence of fatal firearm injuries attending emergency rooms was 0.4/100 000 (CI −02 to 1.0) with a non-fatal rate of 23.5 (CI 14.1 to 32.9). The fatal rate quoted is for children presenting dead or dying to emergency departments, and the overall rate of firearm injuries deaths is much larger (3.2/100 000 children 3 ) in 2010. Of the injuries in emergency room study, 64% were unintentional. Some of these unintentional shootings may occur when children are unsupervised in a home, find a loaded gun and accidentally fire it. There are also youth suicides.In our study between 2005 and 2010, 41 children were killed by firearms: 1 in Scotland, 4 in Wales and 36 in England. Looking at England and Wales, the incidence in children 0-18 years is 0.057/ 100 000/year. The age range was 18 months to 17 years, with a majority (32) aged 15-17 years. There were 8 accidental deaths, 6 suicides and 27 murders. Eight deaths involved air rifles. Notably of the murders, 24 children were of Afro-Caribbean origin and 4 were female. There was a geographical variation, with 16 murders occurring in London and 6 in Manchester. Nineteen cases of murder were linked to criminal gangs.

MVCs are a leading cause of death and disability for teenagers. In Wales, a child death review process has been established to carry out thematic reviews of deaths; this approach is believed to highlight opportunities for prevention that individual case review could not. Cases were 13-year-old to 17-year-old Welsh residents who died as car drivers or passengers between 1 January 2006 and 31 December 2010. An expert panel was convened to review these cases. 28 MVCs occurred and 34 13-17 year olds died; 24 males, 10 females. 51 vehicles were involved; 23 driven by 17-year-old to 19-year-old males. 19 of the 28 MVCs occurred between 21:00 and 05:00. The risk factors identified were consistent with global research on MVC deaths and injuries to teenagers. However, there is a lack of effective interventions to tackle these in the UK. It is recommended that the implementation of Graduated Driver Licensing is considered.

No abstract