Firearms Assaults Too Often Classified as ‘Accidental’

A Northeastern University professor says a “glaring gap” in national data collected by hospitals about firearms injuries vastly underestimates the number of intentionally inflicted gunshot wounds that are sending patients to emergency rooms.

In a study published Dec. 13, Dr. Matthew Miller, professor of health sciences and epidemiology at Bouve College of Health Sciences, and colleagues report that hospital discharge data at three major trauma centers incorrectly listed firearm assaults as firearm accidents nearly 30% of the time.

Hospital discharge data “are used by many researchers to study gun injuries and is the underlying source of information for the largest ongoing U.S. surveillance system to track emergency room visits for firearms injuries,” Miller.  

The data has led to peer-reviewed publications in respected journals reporting that “firearms accidents are responsible for half of all the firearms injuries in the United States,” he says. 

“And that’s just not true. There’s a gross overestimate of firearm accidents and an underestimate of firearm assaults,” Miller says.

headshot of dr. matthew miller
Photo by Matthew Modoono/Northeastern University

For their study, published in JAMA’s open access medical journal, the researchers took a deep look at electronic medical records—including medical record narratives—involving gunshot injuries at three major trauma centers: Brigham & Women’s Hospital, Massachusetts General Hospital and the University of Washington’s Harborview Medical Center. 

They found that while 68%, or 837 of the 1,1227 firearms injury cases seen between October 2015 and December 2019 were the result of assaults, 234 of these cases, or 28%, were incorrectly coded as unintentional injuries in hospital discharge data. 

Some researchers have known for a while that the estimates of gunshots assaults reported by hospital discharge data “are way off,” Miller says. 

“What no one understood was what exactly was behind the coding problem,” he says. 

“We wondered how much of the problem might be a matter of misinterpreting incidents that should be coded as assaults but might reasonably be thought of as accidents.”

“If I were to try and shoot person A, and I hit person B, that’s an assault,” even though a medical records coder might think hitting B was not intended and thus it should be coded as an accident. 

But that did not turn out to be a common pattern. Instead, the problem ran much deeper and included erroneously coding as accidents incidents that were unambiguously assault related firearm injuries, Miller says. 

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