The Wisconsin Firearm-Related Injury Surveillance System

The emerging infrastructure of US firearms injury data

For every fatal shooting in the United States, detailed information from reports of coroners or medical examiners, police departments, and other sources is recorded in the National Violent Death Reporting System. There is no such system in place for nonfatal shootings, which far outnumber fatalities. Hospital data systems are in place that could, with some improvements, provide access to reliable local, state and national estimates of firearm injuries. Such estimates are possible because most firearms injuries are treated in hospitals, and hospitals routinely assign "external cause of injury" codes to all injury encounters. Federal health agencies supervise a number of data systems that centralize hospital data. Challenges currently being addressed are public access, timeliness, and accuracy of coding of intent. (Hospitals misclassify many firearm assaults as accidents.) Law enforcement agencies provide detailed data on shootings in criminal circumstances, including shootings that are not treated in a hospital. The FBI's Uniform Crime Reports (UCR) system aggregates data from agencies. The FBI instituted a radical reform of this system beginning in 2021, resulting in a sharp agency participation drop that prevents valid national estimates. The reform requires agencies to report incident-level data instead of summary counts, which is all that was required for the previous 90 years. There are ongoing efforts to increase participation in the new system and restore its former status as the leading source of national crime estimates. In the meantime, data on nonfatal gunshot cases are available from a number of police departments. We discuss additional reforms needed to generate timely, accurate, publicly accessible data from hospitals and police.

The Case for Enhanced Data Collection of Gun Type

BACKGROUND

National surveillance systems have differentiated long guns into rifles and shotguns but fail to do so for handgun type. We sought to determine whether specific gun type data could be collected and whether knowledge of specific gun types (rifle, shotgun, pistol, revolver) could be used to distinguish gun homicide victims with respect to important injury parameters such as number of wounds.

METHODS

Data on gun fatalities over a 5-year period in three communities were abstracted from medical examiner/coroner, police, and crime laboratory records.

RESULTS

Gun type was obtained for 92% of 490 guns linked to 405 gun homicides. Handguns were associated with more wounds per gun than long guns (p = 0.001) and more entry wounds per gun than long guns (p = 0.002). Among handguns, pistols were associated with more wounds per gun (p < 0.001) and entry wounds per gun (p = 0.001) than revolvers. These same associations were not found among specific long gun types (i.e., rifles and shotguns).

CONCLUSION

Our findings demonstrate that information about gun type can be obtained and that significant differences exist in wounds per gun between long guns and handguns and between pistols and revolvers. Classification of long guns into rifles and shotguns and handguns into pistols and revolvers should be included in local, regional, and national data collection systems.

Effective Trauma Center Partnerships to Address Firearm Injury: A New Paradigm

BACKGROUND

Firearm violence is the second leading cause of injury-related death. This study examined the use of local trauma centers as lead organizations in their communities to address firearm injury.

METHODS

Three trauma centers in cities with populations less than 100,000 were linked with a university-based firearm injury research center. A trauma surgeon director and coordinator partnered with communities, recruited and directed advisory boards, established a local firearm injury surveillance system, and informed communities using community-specific profiles. Primary process and outcome measures included completeness of data, development of community-specific profiles, number of data-driven consumer media pieces, number of meetings to inform policy makers, and an analysis of problems encountered.

RESULTS

Local trauma centers in smaller communities implemented a firearm injury surveillance system, produced community-specific injury profiles, and engaged community leaders and policy makers to address firearm injury. Community-specific profiles demonstrated consistent firearm suicide rates (6.58-6.82 per 100,000) but variation in firearm homicide rates (1.08-12.5 per 100,000) across sites. There were 63 data-driven media pieces and 18 forums to inform community leaders and policy makers. Completeness of data elements ranged from 57.1% to 100%. Problems experienced were disconnected data sources, multiple data owners, potential for political fallout, limited trauma center data, skills sets of medical professionals, and sustainability.

CONCLUSION

Trauma centers, when provided resources and support, with the model described, can function as lead organizations in partnering with the community to acquire and use community-specific data for local firearm injury prevention.

Sensitivity and predictive value positive measurements for public health surveillance systems

Two important measurements for the evaluation of a public health surveillance system are sensitivity and predictive value positive (PVP). The computation of sensitivity and PVP for a public health surveillance system, however, can be complicated by the absence of an appropriate gold standard. In addition, there are few references for the computation of sensitivity and PVP for a surveillance system. To determine how these attributes of evaluation have been reported in epidemiologic literature, I review papers that report sensitivity and PVP for public health surveillance systems. Of the 31 papers that met selection criteria, 21 (68%) included either a reference for the computation or a definition of the attributes, whereas 18 (58%) reported both attributes. All 31 papers reported sensitivity, and among the 31 papers, 24 (77%) reported more than one sensitivity measurement. Among the 18 papers that reported at least PVP, 13 (72%) reported more than one PVP measurement. This review provides guidance in computing sensitivity and PVP for a public health surveillance system.

Why firearm injury surveillance?

With the current progress of state firearm injury surveillance systems reported in this issue of the Journal, questions about the logical progression of these efforts are being raised. This article reviews the current state of firearm injury data, discusses the importance of firearm injury surveillance, and offers suggestions for maximizing the potential of future efforts in this area.