Firearm-Related Injuries at a Level-1 Trauma Center in Oregon: A Validity Study of Firearm Injury Intent Coding

Presenter Biography

Gina Stahla is an MPH student in Epidemiology at the OHSU School of Public Health.

Institution

OHSU

Program/Major

Epidemiology

Degree

MPH

Presentation Type

Presentation

Start Date

4-4-2023 12:30 PM

End Date

4-4-2023 12:45 PM

Persistent Identifier

https://archives.pdx.edu/ds/psu/40229

Keywords

injury, firearm-related injury, gun-related injury, injury epidemiology, ICD codes, intent coding

Abstract

Firearm-related injuries are a persistent and substantial public health problem in the US. More than 45,000 people died due to firearm injuries in 20201, and estimates suggest that for every death, two others suffer nonfatal injuries2 - meaning that more than 135,000 people suffer fatal or nonfatal firearm-related injuries every year in the US3. In order to inform prevention efforts, it is vital to understand the mechanisms and intent of these injuries. While we have a good sense of circumstances surrounding fatal firearm injuries, sources of data for nonfatal injuries are lacking. The purpose of this study is to describe firearm-related injuries managed in the OHSU ED from 2009-2022. Data were identified by ICD-9 and ICD-10 codes, and pertinent information was extracted from the electronic health record. Results indicated that of 1,887 participants, more than 90% had ICD codes pertaining to unintentional injury. After manual chart review of 222 charts from patients managed in the ED from 2018-2019, it was determined that 25% suffered unintentional injuries. A validity study was completed to examine concordance of intent assigned from ICD codes and chart reviews. The level of discordance indicates that ICD codes have low validity when used to determine intent of injury, indicating that they may be an unreliable source for this information. The extent to which systematic misclassification of intent has clouded our understanding of nonfatal firearm injury warrants further review.

1) Centers for Disease Control and Prevention. WISQARS, Fatal Injury Reports, National, Regional and State, 1981-2020. Accessed March 10, 2023 at https://www.cdc.gov/injury/wisqars/fatal.html.

2) Kaufman EJ, Wiebe DJ, Xiong RA, Morrison CN, Seamon MJ, Delgado MK. Epidemiologic Trends in Fatal and Nonfatal Firearm Injuries in the US, 2009-2017. JAMA Internal Medicine. 2021;181(2):237-244.

3) DeFrancesco S, Bhakta Y, Baker-Robinson W, Krushnic D, Chisholm L, Wright D, Coleman J, Tanaka Y, Couch A, Carlson K. Firearm injury emergency department visits in Oregon, 2018-2021. Accessed October 22, 2022. Available at: https://www.ohsu.edu/about/gun-violence-public-health-issue.

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Apr 4th, 12:30 PM Apr 4th, 12:45 PM

Firearm-Related Injuries at a Level-1 Trauma Center in Oregon: A Validity Study of Firearm Injury Intent Coding

Firearm-related injuries are a persistent and substantial public health problem in the US. More than 45,000 people died due to firearm injuries in 20201, and estimates suggest that for every death, two others suffer nonfatal injuries2 - meaning that more than 135,000 people suffer fatal or nonfatal firearm-related injuries every year in the US3. In order to inform prevention efforts, it is vital to understand the mechanisms and intent of these injuries. While we have a good sense of circumstances surrounding fatal firearm injuries, sources of data for nonfatal injuries are lacking. The purpose of this study is to describe firearm-related injuries managed in the OHSU ED from 2009-2022. Data were identified by ICD-9 and ICD-10 codes, and pertinent information was extracted from the electronic health record. Results indicated that of 1,887 participants, more than 90% had ICD codes pertaining to unintentional injury. After manual chart review of 222 charts from patients managed in the ED from 2018-2019, it was determined that 25% suffered unintentional injuries. A validity study was completed to examine concordance of intent assigned from ICD codes and chart reviews. The level of discordance indicates that ICD codes have low validity when used to determine intent of injury, indicating that they may be an unreliable source for this information. The extent to which systematic misclassification of intent has clouded our understanding of nonfatal firearm injury warrants further review.

1) Centers for Disease Control and Prevention. WISQARS, Fatal Injury Reports, National, Regional and State, 1981-2020. Accessed March 10, 2023 at https://www.cdc.gov/injury/wisqars/fatal.html.

2) Kaufman EJ, Wiebe DJ, Xiong RA, Morrison CN, Seamon MJ, Delgado MK. Epidemiologic Trends in Fatal and Nonfatal Firearm Injuries in the US, 2009-2017. JAMA Internal Medicine. 2021;181(2):237-244.

3) DeFrancesco S, Bhakta Y, Baker-Robinson W, Krushnic D, Chisholm L, Wright D, Coleman J, Tanaka Y, Couch A, Carlson K. Firearm injury emergency department visits in Oregon, 2018-2021. Accessed October 22, 2022. Available at: https://www.ohsu.edu/about/gun-violence-public-health-issue.