Firearm-related injury
2025 Case Definition

Background

A firearm-related injury is a gunshot wound or penetrating injury from a weapon that uses a powder charge to fire a projectile (e.g., bullet). This includes handguns, rifles, shotguns and ghost guns. Injuries from air-powered guns, BB guns, or pellet guns, are not considered firearm injuries because they do not use a powder charge to fire a projectile. Firearm injuries vary by intent: self-inflicted, unintentional, assault, legal intervention, terrorism, or undetermined intent. Firearm-related injuries are a major public health issue. In 2022, over 48,000 firearm-related deaths occurred in the U.S., and more than twice as many people suffered nonfatal injuries as those who died that year. Most medically-treated firearm injuries result from assaults, and nearly two in ten from unintentional injuries. Self-inflicted injuries are less common in emergency departments, as most suicide attempts using firearms are fatal. Firearm injuries are a leading cause of death for those aged 1-44, and the leading cause for children and teens aged 1-19.

The Council of State and Territorial Epidemiologists (CSTE) approved position statement introduces a standardized public health case definition for firearm-related injury (both fatal and nonfatal). Public health departments can use this definition to estimate injury prevalence, identify risk factors, monitor injury outcomes, respond to patterns, improve resource allocation, implement targeted prevention, and track the effectiveness of prevention efforts. This information should be used solely for public health purposes.

Clinical Criteria

• A person who presented for medical care for a firearm-related injury.

Criteria to Distinguish a New Case from an Existing Case

For public health surveillance purposes, enumeration should begin for firearm-related injuries that occur on or after the surveillance period begins within each jurisdiction. A new case of a firearm-related injury should be enumerated when:

• A person was not previously enumerated as a case during the defined surveillance period,
  OR
• A person was previously enumerated as a case, during the defined surveillance period, with a nonfatal firearm-related injury but later experiences a separate or unrelated firearm-related injury (nonfatal or fatal) during another individual incident.

Note: The beginning date of the surveillance period is defined by the jurisdiction based on their needs. If a person was already counted as a case of firearm-related injury, that person should not be counted as a new case for that same firearm-related injury if they received medical care during a subsequent encounter (i.e., aftercare or follow-up visits following original treatment of a firearm injury, such as wound care, infection, or removal of sutures) or for sequalae (i.e., complications or conditions following original treatment of a firearm injury, such as chronic pain following a firearm injury or scar formation). Additionally, patient transfers within the facility or to a different health care facility for treatment of the same firearm-related injury should not be enumerated as new cases of firearm-related injury.

Confirmed

• Meets clinical criteria, OR
• Meets vital record or coroner or medical examiner record criteria,* OR
• Meets healthcare record criteria,* OR
• Meets EMS record criteria.*

* See "Other Criteria" for further information

Vital Record or Coroner or Medical Examiner Record Criteria

• A person whose death certificate lists a firearm-related injury as a cause of death or significant condition contributing to death,
  OR
• A person whose coroner or medical examiner record indicates a firearm-related injury as a cause of death or significant condition contributing to death,
  OR
• A person whose record in a jurisdiction’s Violent Death Reporting System indicates a firearm-related injury as a cause of death or significant condition contributing to death.

Healthcare Record Criteria

• A person whose healthcare record contains any diagnosis code, external cause of injury code, or any mention of a firearm-related injury.

EMS Record Criteria

• A person whose EMS record includes any mention of a firearm-related injury.