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Applying the antecedent, behaviour, and consequence taxonomy to unintentional firearm injury as determined by a collaborative firearm injury database
  1. William B Risinger1,
  2. Alexis K Nickols2,
  3. Alexis N Harris1,
  4. Matthew V Benns1,
  5. Nicholas A Nash1,
  6. Matthew C Bozeman1,
  7. Samuel J Pera1,
  8. Jamie C Coleman1,
  9. Glen A Franklin1,
  10. Jason W Smith1,
  11. Brian G Harbrecht1,
  12. Keith R Miller1
  1. 1 Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
  2. 2 Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
  1. Correspondence to Dr Keith R Miller, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA; keith.miller{at}


Background Unintentional firearm injury (UFI) remains a significant problem in the USA with respect to preventable injury and death. The antecedent, behaviour and consequence (ABC) taxonomy has been used by law enforcement agencies to evaluate unintentional firearm discharge. Using an adapted ABC taxonomy, we sought to categorise civilian UFI in our community to identify modifiable behaviours.

Methods Using a collaborative firearm injury database (containing both a university-based level 1 trauma registry and a metropolitan law enforcement database), all UFIs from August 2008 through December 2021 were identified. Perceived threat (antecedent), behaviour and injured party (consequence) were identified for each incident.

Results During the study period, 937 incidents of UFI were identified with 64.2% of incidents occurring during routine firearm tasks. 30.4% of UFI occurred during neglectful firearm behaviour such as inappropriate storage. Most injuries occurred under situations of low perceived threat. UFI involving children was most often due to inappropriate storage of weapons, while cleaning a firearm was the most common behaviour in adults. Overall, 16.5% of UFI involved injury to persons other than the one handling the weapon and approximately 1.3% of UFI resulted in mortality.

Conclusions The majority of UFI occurred during routine and expected firearm tasks such as firearm cleaning. Prevention programmes should not overlook these modifiable behaviours in an effort to reduce UFIs, complications and deaths.

  • Firearm
  • Violence
  • Policy

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors Study design (KRM, WBR, AKN), data collection/analysis (KRM, WBR, AKN, ANH), data interpretation (all authors), manuscript drafting (WBR, KRM, AKN, ANH), critical revisions (KRM, WBR, AKN, MVB, NAN, MCB, SJP, JCC, GAF, JWS, BGH). KRM is the guarantor for this study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.