Use of Firearms in Terrorist Attacks

Abstract

in sensitivity analyses extending the incubation period to 72 hours (OR, 2.8; 95% CI, 1.2-6.3). Trends in other areas did not reach statistical significance, and the effect was not significant in an adjusted hospitalwide analysis. Subsequent investigation revealed that cleaning practices for the scanner table of the CT-ED had not yet been updated to match the standardized methods applied in other radiology suites. Discussion | In a large university hospital, passing through the CT-ED within 24 hours after a patient with C difficile had been there was associated with increased risk of developing CDI. Our novel analytic methods identified a previously undiscovered opportunity for real-world practice change. We continue to monitor the success of improved cleaning practices implemented as a result of this study. Leveraging EHR data for spatial and temporal analytics may be a widely applicable strategy for infection control and quality improvement at other institutions and for other infectious diseases. Francisco, for their input and collaboration on this manuscript. We also thank the Quality Improvement Executive Committee and the Department of Hospital Epidemiology and Infection Control (HEIC) at our institution for their collaboration on improving infection control practices in our hospital based on the findings of this study. They received no compensation for their contributions beyond that of their employment. 1. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372(9):825-834. 2. Brown K, Valenta K, Fisman D, Simor A, Daneman N. Hospital ward antibiotic prescribing and the risks of Clostridium difficile infection. JAMA Intern Med. Although firearms are used in only a small proportion of terrorist attacks, these highly publicized events shed light on access to weapons and mass shootings. The sociopolitical and cultural context surrounding firearms, including the proportion of individuals owning guns, varies between countries. 1 The United States has a higher rate of firearms deaths than other high-income countries. 2,3 We compared the proportion of terrorist attacks committed with firearms in the United States with the proportion in other high-income countries. We also compared the lethality of attacks with firearms to those by other means. Methods | We queried The Global Terrorism Database from 2002 to 2016. 4 Maintained by the National Consortium for the Study of Terrorism and Responses to Terrorism at the University of Maryland, this database incorporates a methodology that includes both machine learning and manual review to abstract high-quality information from more than 1 million daily media reports published worldwide in over 80 languages. The database defines a terrorist attack as the "use of illegal force and violence by a non-state actor to attain a political, economic, religious , or social goal through fear, coercion, or intimidation." 4 For each attack, the location, type, and number of fatalities are collected. The database categorizes weapons as biological, chemical, explosive, fake weapons, firearms, incendiary (eg, arson), melee, sabotage equipment, vehicle (nonexplosive), other, and unknown. To avoid calculating proportions in countries with few data points, we calculated the proportion of attacks involving firearms among countries in the top 75th percentile (10 attacks or more) over the study period. The number of fatalities per attack was calculated by weapon type. Of the 23 countries with at least Letters