EMS injury cause codes more accurate than emergency department visit ICD-10-CM codes for firearm injury intent in North Carolina

Abstract

AbstractBackgroundThe 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. Each record was manually reviewed to determine shooter and intent, and the corresponding manual classifications were compared to the injury cause codes entered in the EMS data and to ED visit records, where linkage was possible.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 classification were comparable. However, for the 3401 EMS encounters that could be linked to an ED visit record, only 18.3% (n = 355) of the 1945 assaults and 22.2% (n = 38) of the 171 intentional self-harm suicide encounters we identified in the EMS records were identified as assault firearm injures in the ED visit data. This demonstrates a marked difference in the intent coding between 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. The results also suggest the importance of developing better guidance around intent coding for firearm injuries in the ED.