For a long time, physicians at the major trauma centers in St. Louis say they have cared for an alarming number of people with gunshot wounds — including many children.

“Some weeks we’ll operate more on gunshot wounds than we will for simple things like appendicitis,” said Dr. Pamela Choi, a surgery resident at Washington University.

That’s partly because ambulances in the St. Louis region generally direct gunshot victims to just a handful of emergency rooms. That also created a concentration of data for Choi and a team of physician researchers to study at St. Louis Children's Hospital and Cardinal Glennon. They hope to reduce firearm-related deaths and injuries among children by identifying the causes.

The numbers were “staggering,” said Dr. Martin Keller, the study’s senior author: Over five years, 398 patients under age 16 were treated for firearm injuries in two St. Louis emergency rooms. Twenty died as a result of their injuries, and many others were left with long term disabilities. Almost a third of firearm injuries were accidents — often a result of a child finding an unsecured gun in the home and shooting herself, a sibling or a friend. Those who died at the scene were not counted, and injuries by BB or pellet guns were included in the data if a patient came to the emergency room.

“They’re in the wrong place in the wrong time, or they’re doing what kids normally do, which is exploring their environment,” Keller said. “It’s innocent people doing normal things.”

Throughout the study period between 2008 and 2013, the rate of accidental shootings held relatively steady. Keller said that’s a sign pediatricians should ask parents during their children’s checkups about whether guns are in the home, and discuss the risks, just like they would caution them against smoking near a child or not using a car seat.

In fact, deaths attributed to guns now outnumber traffic-related fatalities in Missouri. In 2013, firearms took 880 lives in Missouri, while traffic deaths numbered 744.

Intentional shootings wounding young people under 16 appeared to mirror overall trends in St. Louis, and declined during the study period. (They have since spiked this year.) When researchers broke out the times of the shootings, they found that the majority occurred between 6 p.m. and midnight, generally earlier than the city-enforced curfew for juveniles.

“This suggests that initiatives focused on after-school youth programs, firearm safety education and violence prevention within the home, rather than curfew enforcement outside, may be of greater yield,” the study authors wrote.

In addition to these measures, the study recommends policies supported by the American Pediatric Surgical Association, such as background checks for all firearms transactions, limiting access to high-capacity magazines and assault-style weapons, and promoting safe storage techniques.

To Choi, the common denominator is the abundance of guns in the St. Louis area. In 2007, Missouri repealed a law requiring a permit to purchase a handgun.That correlated with a subsequent rise in firearm-related homicides.

“I think this is a problem that we can’t ignore. And I don’t think it’s something that we should accept,” Choi said.

The study has been published online and will appear in a January issue of Trauma Acute Care Surgery.

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Correction: This article has been edited to clarify that the 398 victims were treated at just two emergency rooms--St. Louis Children's Hospital and Cardinal Glennon.