FATAL FIREARM-RELATED INJURY SURVEILLANCE IN MARYLAND

Context: Maryland began a statewide firearm-related injury surveillanc e system in 1995. The system now focuses on firearm-related deaths; a system to monitor nonfatal injuries is being developed. The system is passive; it accesses, integrates, and analyzes data collected by il Ma ryland's Office of the Chief Medical Examiner, Maryland State Police, and Division of Health Statistics. Objective: To evaluate the surveill ance system's ability to ascertain cases in the absence of a standard for the true number of cases; Design: Link records of the same firearm -related death captured by the surveillance system's multiple data sou rces, comparing the rate of false positives and false negatives, and a ssessing errors in linkage variables. Setting: Maryland, 1991-1994. Pa rticipants: All deaths occurring in the state of Maryland as a result of a firearm-related injury. Main Outcome Measures: Sensitivity and po sitive-predictive value. Results: The system is extremely sensitive, d etecting 99.61% of cases, and it has a very high positive predictive v alue, with 99.87% of the cases identified from medical examiner's offi ce data being confirmed as actual cases. Conclusions: Maryland's datab ase of information from the medical examiner's office is highly accura te far ascertaining firearm-related deaths that occur in the state. A unique identifier common across data sources would ease record linkage efforts, and improve the system's ability to monitor firearm-related deaths.