Epidemiology and clinical aspects of stray bullet shootings in the United States.

BACKGROUND Stray bullet shootings contribute to a sense of risk in affected communities but have rarely been studied. We describe the epidemiology and clinical aspects of stray bullet shootings in the United States. METHODS We defined a case as a shooting event involving death or injury to a person and meeting criteria for a stray bullet mechanism of injury. From March 1, 2008, to February 28, 2009, we conducted real-time surveillance using two automated Internet news searches for the term "stray bullet." Secondary searches were performed to identify new cases and additional news reports. RESULTS We reviewed 1,996 non duplicate news reports for 501 shooting events, of which 284 (56.7%) met our case criteria. There were 317 persons injured by stray bullets, of whom 65 (20.5%) died. Most cases (59.2%) involved interpersonal violence. When compared with persons killed or injured in firearm-related assaults or unintentional shootings generally in the United States in 2007, those killed or injured by stray bullets were more likely to be female (44.8% and 10.7%, respectively; odds ratio, 7.4; 95% confidence interval, 5.9-9.3) and outside the age range 15 years to 34 years (55.5% and 27.0%, respectively; odds ratio, 5.6; 95% confidence interval, 4.3-7.3). Most stray bullet victims (81.4%) were apparently unaware of the events leading to the gunfire that caused their injuries. Shooters were predominantly male (95.9%); 62.0% were aged 15 years to 34 years. Eighteen deaths (27.7%) occurred at the scene of the shooting and 55 (84.6%) on the day of the shooting. The case-fatality ratio for stray bullet shootings was somewhat higher than that for firearm-related assaults or unintentional shootings in the United States in 2007. CONCLUSION Stray bullet shootings are epidemiologically distinct from other firearm-related injury events. It is likely that not all stray bullet shootings were identified, there may have been differential reporting related to severity of outcome, and missing data were common. LEVEL OF EVIDENCE Epidemiological study, level III.