Firearm injury intent by data source, count (%).

BackgroundThe timeliness, accuracy, and completeness of data for firearm injury surveillance is crucial for public health surveillance efforts and informing injury prevention measures. While emergency department (ED) visit data can provide near real-time information on firearms injuries, there are concerns surrounding the accuracy of intent coding in these data. We examined whether emergency medical service (EMS) data provide more accurate firearm injury intent coding in comparison to ED data.MethodsWe applied a firearm injury definition to EMS encounter data in NC’s statewide syndromic surveillance system (NC DETECT), from January 1, 2021, through December 31, 2022. We manually reviewed each record to determine intent, and the corresponding manual classifications were compared to the injury cause codes entered in the EMS data and to ED visit records where EMS-ED record linkage was possible. We then calculated the sensitivity, specificity, positive and negative predictive values for each intent classification in SAS 9.4 using the manually reviewed intent classifications as the gold standard.ResultsWe identified 9557 EMS encounters from January 1, 2021, through December 31, 2022 meeting our firearm injury definition. After removing false positives and duplicates, 8584 records were available for manual injury classification. Overall, our analysis demonstrated that manual and EMS injury cause code classifications were comparable. However, for the 3401 EMS encounters that could be linked to an ED visit record, sensitivity of the ED ICD-10-CM codes was low for assault and intentional self-harm encounters at 18.2% (CI 16.5–19.9%) and 22.2% (CI 16–28.5%), respectively. This demonstrates a marked difference in the reliability of the intent coding in the two data sources.ConclusionsThis study illustrates both the value of examining EMS encounters for firearm injury intent, and the challenges of accurate intent coding in the ED setting. EMS coding has the potential for more accurate intent coding than ED coding within the context of existing hospital-based coding guidance. This may have implications for future firearm injury research, especially for nonfatal firearm injuries.

背景：火器伤害监测数据的时效性、准确性和完整性对于公共卫生监测工作以及制定伤害预防措施至关重要。虽然急诊科（ED）就诊数据可以提供近乎实时的火器伤害信息，但这些数据中意图编码的准确性存在担忧。本研究旨在探讨紧急医疗服务（EMS）数据相较于ED数据在火器伤害意图编码方面的准确性。方法：本研究将火器伤害定义应用于北卡罗来纳州全州症候群监测系统（NC DETECT）中的EMS接触数据，时间范围为2021年1月1日至2022年12月31日。我们逐一审查每条记录以确定意图，并将相应的手工分类与EMS数据中输入的伤害原因代码以及可能的EMS-ED记录关联的ED就诊记录中的伤害原因代码进行比对。随后，在SAS 9.4中，我们使用手工审查的意图分类作为金标准，计算了每个意图分类的灵敏度、特异度、阳性预测值和阴性预测值。结果：从2021年1月1日至2022年12月31日，我们确定了9557条符合火器伤害定义的EMS接触记录。在去除假阳性和重复记录后，8584条记录可用于手工伤害分类。总体而言，我们的分析表明手工分类与EMS伤害原因代码分类具有可比性。然而，对于3401条能够与ED就诊记录关联的EMS接触记录，ED的ICD-10-CM代码在攻击和故意自伤遭遇中的灵敏度较低，分别为18.2%（置信区间16.5–19.9%）和22.2%（置信区间16–28.5%），这显示了两种数据源在意图编码可靠性方面的显著差异。结论：本研究既展示了审查EMS接触记录以确定火器伤害意图的价值，也揭示了在ED环境中准确编码意图的挑战。在现有的基于医院的编码指导原则下，EMS编码可能比ED编码具有更高的准确性。这可能会对未来火器伤害研究产生重要影响，尤其是对非致命火器伤害的研究。