When trauma surgeon Michael L. Nance sees a child die from a life-threatening gunshot wound, he always wonders what could have been done to prevent the injury from happening.

Which opportunities — addressing mental-health issues, maybe, or having better ways to store guns — were missed?

"Something should have made a difference," said Nance, director of the Pediatric Trauma Program at Children's Hospital of Philadelphia and an investigator at the Center for Injury Research and Prevention.

A new research paper from Stanford University Hospital has found that more stringent gun laws on the state level can help prevent devastating gun-related injuries and deaths.

If a state has lax gun laws, the researchers found, deaths among children and teenagers are twice as common than in states with strict gun laws.

"If you put more regulations on firearms, it does make a difference," said Stephanie Chao, assistant professor of surgery at Stanford University School of Medicine and senior author of the study. "It does end up saving children's lives."

The paper, "Strict Firearms Legislation Is Associated With Lower Firearm-Related Fatalities Among Children and Teens in the United States," was presented Monday at the American Academy of Pediatrics 2018 National Conference and Exhibition in Orlando.

About 2,700 children die each year from gun-related injuries in the United States. Most of them, 62 percent, are homicides, and 31 percent are suicides, with the remaining deaths attributed to accidents or undetermined causes, according to the U.S. Centers for Disease Control and Prevention.

Children are 82 times more likely to die of gun injuries in the U.S. than in any other developed country, said Chao, who is also the medical director of trauma care at Lucile Packard Children's Hospital at Stanford.

"Sadly, there are a good number of gunshot wounds that never make it into the emergency room because guns are so incredibly lethal," Chao said.

The researchers used 2014 and 2015 data on firearms deaths of individuals from birth to age 19 from the National Vital Statistics System.

They rated the overall stringency of gun laws for all 50 states based on the Brady score, which considers policy regulations such as background checks on gun sales, reporting lost or stolen firearms, and prohibiting dangerous people from purchasing weapons. The researchers also analyzed each state's child-access prevention laws and legislation, which hold the gun owner responsible for keeping guns safely stored. They also controlled for socioeconomic and demographic factors, including unemployment rates, poverty, urbanization, alcohol dependence, tobacco and marijuana use, and high school graduation rates.

California, Connecticut, and Massachusetts were the states with the most stringent gun laws. The least restrictive states were Arizona, Alaska, and Wyoming.

Pennsylvania, which does not have child access protection laws, ranked 12th, with 3.05 deaths per 100,000 children, Chao said. New Jersey ranked fourth in strictness, with 1.55 deaths per 100,000 children, she said; Delaware ranked 10th, with 2.83 deaths per 100,000 children.

On a broad scale, everyone can agree that no children should die from gun violence, Chao said. She hopes state-level legislators will take notice of the research and act.

"There are plenty of people out there who argue more gun laws don't make a difference," she said. "I think it is important to establish that they do and move the conversation forward."

This 10-year-old girl was shot by a gang member while playing basketball outside her home in Compton, Calif., in 2010.
Barbara Davidson/Los Angeles Times
This 10-year-old girl was shot by a gang member while playing basketball outside her home in Compton, Calif., in 2010.

For Nance and other trauma physicians, the hardest conversation to have is the one with the families of the children who have died from their injuries.

"You never forget those," Nance said. The unique perspective that medical workers have from those heart-rending experiences needs to be shared more with lawmakers, he said.

Gun violence needs to be studied like any other disease, he said. "I don't see how you don't see something that is killing kids and adults as a public-health issue."

Nance believes the conversation around sensible gun legislation is changing.

"One of the groups that has really made a difference … is the March for Our Lives, which sprung up out of Parkland, Fla.," said Nance. "That group lived it and sees it as something the adults couldn't fix. Good for them, they are absolutely right: The adults couldn't fix it, although they tried."

The Stanford paper's findings, which do not prove cause and effect, are similar to many studies that show a correlation between laws and gun deaths, Nance said.

"How much do you need to know before you do something to potentially lower firearms mortality in children?" he asked.