Missouri firearm-related injury surveillance system

Abstract

Context The Missouri Department of Health collects hospital inpatient and emergency room records statewide. With mortality data, they make up a population-based surveillance system of firearm-related injuries. Much information is not captured by these data, however. Objective During a three-year project we attempted to develop a timely, representative, and sensitive surveillance system of firearms-related injuries and their circumstances. Design The surveillance system consisted of Missouri's hospital and mortality records linked to police records of firearm incidents. Setting Lack of standardization of police department data precluded a statewide surveillance system; therefore, we concentrated on the two largest urban areas, St. Louis and Kansas City. Participants Firearm-related injuries occurring during crimes in the surveillance area in 1994 were recorded. Wounds inflicted unintentionally or during suicide attempts were excluded. Main outcome measures We evaluated the system according to its simplicity, flexibility, acceptability, sensitivity, predictive value positive, representativeness, and timeliness. Results The surveillance system was neither timely nor simple. Though estimated to represent 95% of the desired cases, information about the firearms and the circumstances was relatively scant. Conclusions Police records as they now exist cannot be included in a statewide firearms surveillance system. The cost/benefit ratio does not justify even a regional surveillance system. Standardization of police records would be helpful, but some information will always be lacking unless the perpetrator is arrested.