Accuracy of the National Violent Death Reporting System in Identifying Unintentional Firearm Deaths to Children by Children

Abstract

Abstract Background: In assigning manner of death (MOD) for inclusion on death certificates, medical examiners and coroners have six options: natural, accident, suicide, homicide, undetermined, and pending. Unfortunately, they do not always apply uniform criteria in assigning manner. Previous research indicates surveillance statistics based on death certificates, such as the National Vital Statistics System, grossly miscount firearm accidents. The National Violent Death Reporting System (NVDRS) has taken steps to reduce variability in manner of death coding by providing uniform criteria for assigning an “abstractor manner of death” (AMD). A previous study found good accuracy of AMD coding for firearm accidents, 2003-2006, but a more recent study reported that the NVDRS undercounted self- and other-inflicted firearm accidents in which both the victim and shooter were under age 15. Findings: We replicated the recent study’s population, identifying 924 NVDRS incidents from 2009-2018 in which both victim and shooter’s age was under 15 and AMD was homicide, suicide, unintentional or undetermined (there were no legal intervention deaths to children). We assigned a researcher-adjudicated MOD (RMD) by reviewing incident narratives, following NVDRS coding guidelines. RMD was compared with AMD and with manner recorded on the death certificate (MOD). Based on RMD as the gold standard, the sensitivity, specificity, and predictive values positive and negative of the AMD for childhood firearm accidents were, respectively 90%, 99%, 98% and 96%; 86% (24/28) of false negatives were coded by abstractors as homicides. By contrast, death certificate manner had relatively poor sensitivity of 63%. Conclusions: In our sample of 924 deaths, the abstracter manner of death generally agreed with researcher-adjudicated manner of death, though not perfectly, missing 10% of researcher-adjudicated accidents, mostly because abstractors coded accidents as homicides. A sizable minority of false negatives were accidents where the narrative explicitly noted that adult negligence contributed to a child’s unintentional shooting death. While AMD coding in NVDRS is excellent, it could be improved if NVDRS coding guidelines explicitly affirmed that prosecution for negligent manslaughter is not a counterindication to an AMD of accident, provided the firearm was not used to intentionally harm, threaten, or coerce an individual.