Missouri firearm-related injury surveillance system

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.