Inaccuracies In Registry Data Regarding Shooting Intent For Pediatric Firearm Injuries
*Bindi Naik-Mathuria1, Elisa Benavides2, Marie Kasbaum2, *Trey Babino1, Aden Feustel2, Rosemary Demet2, Lisa Pompeii2
1Texas Children's Hospital, Houston, TX;2Baylor College of Medicine, Houston, TX
Background: Pediatric firearm injuries are a leading cause of death and an accurate understanding of the scope of the problem is important to guide policy and prevention efforts. We hypothesized that registry data that is submitted to NTDB may have inaccuracies, specifically pertaining to unintentional shootings. Method: Retrospective chart review from a level I pediatric trauma center between 2018-2020. Shooting intent obtained from registry data was compared to manual review of notes in the medical charts. Each chart was reviewed by minimum two abstractors. Results: Of 83 patients, median age was 14 years (IQR 4-16), 84% were male and 54% were Black. Registry shooting intent based on ICD-10-CM E-codes were: Assault (46%), Unintentional (36%), Intentional self-harm (6%), Undetermined (7%) and Other (2%). Chart review intent categories were: Homicide (1%), Intentional discharge (43%), Negligent discharge (28%), Suicide (2%), Bystander (stray bullet) (23%), and Unclear (17%). Overall, 40% of intents did not match; excluding bystander (not in registry), there was still 20% mismatch. More than a third (35%) of the Unintentional registry category was miscoded; 33% were Intentional, 25% Bystander, and 33% were Unclear per chart review. Bystander shootings were most commonly coded as Assault (71%) or Unintentional (18%) in the registry. Conclusion: Registry data can be inaccurate, particularly when it comes to shooting intent, which can affect data used to guide policy and prevention. Accidental (negligent) discharge may be less prevalent than reported and should be separated from bystander shootings, which are also unintentional. Adding a bystander E-code should be considered.
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