Carolina Center for Health Informatics in the Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
PLoS One. 2024 Apr 30;19(4):e0295348. doi: 10.1371/journal.pone.0295348. eCollection 2024.
The 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.
We 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.
We 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.
This 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.
枪支伤害监测的数据及时性、准确性和完整性对于公共卫生监测工作和制定伤害预防措施至关重要。虽然急诊就诊数据可以提供有关枪支伤害的近乎实时信息，但这些数据中意图编码的准确性存在问题。我们研究了与急诊就诊数据相比，紧急医疗服务（EMS）数据是否能提供更准确的枪支伤害意图编码。
我们将枪支伤害定义应用于 NC 州全州综合征监测系统（NC DETECT）中的 EMS 遭遇数据，时间范围为 2021 年 1 月 1 日至 2022 年 12 月 31 日。我们手动审查了每个记录以确定意图，并将相应的手动分类与 EMS 数据中输入的伤害原因代码以及可以进行 EMS-ED 记录链接的 ED 就诊记录进行比较。然后，我们使用手动审查的意图分类作为金标准，在 SAS 9.4 中计算每个意图分类的敏感性、特异性、阳性和阴性预测值。
我们从 2021 年 1 月 1 日至 2022 年 12 月 31 日共确定了 9557 次符合枪支伤害定义的 EMS 遭遇。去除假阳性和重复记录后，有 8584 条记录可用于手动伤害分类。总体而言，我们的分析表明手动和 EMS 伤害原因代码分类是可比的。然而，对于 3401 次可以与 ED 就诊记录链接的 EMS 遭遇，ED ICD-10-CM 代码对攻击和故意自残遭遇的敏感性较低，分别为 18.2%（CI 16.5-19.9%）和 22.2%（CI 16-28.5%）。这表明两个数据源中的意图编码可靠性存在明显差异。
本研究说明了检查 EMS 遭遇以确定枪支伤害意图的价值，以及 ED 环境中准确意图编码的挑战。在现有的基于医院的编码指南的背景下，EMS 编码具有比 ED 编码更准确的意图编码潜力。这可能对未来的枪支伤害研究，特别是非致命性枪支伤害研究产生影响。
