Roszko Paul J D, Ameli Jonathan, Carter Patrick M, Cunningham Rebecca M, Ranney Megan L
Epidemiol Rev. 2016;38(1):87-110. doi: 10.1093/epirev/mxv005. Epub 2016 Feb 8.
Firearm injury is a leading cause of injury-related morbidity and mortality in the United States. We sought to systematically identify and summarize existing literature on clinical firearm injury prevention screening and interventions. We conducted a systematic search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and ClinicalTrials.gov for English-language original research (published 1992-2014) on clinical screening methods, patient-level firearm interventions, or patient/provider attitudes on the same. Unrelated studies were excluded through title, abstract, and full-text review, and the remaining articles underwent data abstraction and quality scoring. Of a total of 3,260 unique titles identified, 72 were included in the final review. Fifty-three articles examined clinician attitudes/practice patterns; prior training, experience, and expectations correlated with clinicians' regularity of firearm screening. Twelve articles assessed patient interventions, of which 6 were randomized controlled trials. Seven articles described patient attitudes; all were of low methodological quality. According to these articles, providers rarely screen or counsel their patients-even high-risk patients-about firearm safety. Health-care-based interventions may increase rates of safe storage of firearms for pediatric patients, suicidal patients, and other high-risk groups. Some studies show that training clinicians can increase rates of effective firearm safety screening and counseling. Patients and families are, for the most part, accepting of such screening and counseling. However, the current literature is, by and large, not high quality. Rigorous, large-scale, adequately funded studies are needed.
在美国，枪支伤害是与伤害相关的发病和死亡的主要原因。我们试图系统地识别和总结关于临床枪支伤害预防筛查及干预措施的现有文献。我们对PubMed、科学网、护理及相关健康文献累积索引（CINAHL）、心理学文摘数据库（PsycInfo）和临床试验.gov进行了系统检索，以查找关于临床筛查方法、患者层面的枪支干预措施或患者/提供者对此的态度的英文原创研究（发表于1992年至2014年）。通过标题、摘要和全文审查排除不相关研究，其余文章进行数据提取和质量评分。在总共识别出的3260个独特标题中，72篇被纳入最终审查。53篇文章研究了临床医生的态度/实践模式；先前的培训、经验和期望与临床医生进行枪支筛查的规律性相关。12篇文章评估了患者干预措施，其中6篇为随机对照试验。7篇文章描述了患者态度；所有这些文章的方法学质量都很低。根据这些文章，医疗服务提供者很少对患者（即使是高危患者）进行枪支安全筛查或咨询。基于医疗保健的干预措施可能会提高儿科患者、自杀患者和其他高危群体安全存放枪支的比例。一些研究表明，培训临床医生可以提高有效的枪支安全筛查和咨询的比例。患者及其家属在很大程度上接受此类筛查和咨询。然而，目前的文献总体质量不高。需要开展严格、大规模且资金充足的研究。
