MASSACHUSETTS WEAPON-RELATED INJURY SURVEILLANCE SYSTEM

Context: Surveillance data on nonfatal weapon-related injuries-particu larly those treated only in the emergency department (ED)-have been la rgely unavailable. Objective: To develop a surveillance system for fat al and nonfatal gunshot wounds and sharp instrument assaults. Design: The Massachusetts Department of Public Health (DPH) developed an ED-ba sed reporting system for weapon-related injuries. Inpatient discharges and mortality data were linked to ED data, and police data sources we re evaluated. Setting: Statewide. Participants: All 84 acute care hosp ital emergency departments. Uniform Hospital Discharge Data Set (UHDDS ), mortality, and police data were obtained from existing systems. Mai n Outcome Measures: System sensitivity, predictive value positive (PW) , representativeness, flexibility, usefulness, acceptability, and sust ainability. Results: The ED reporting system captured 82% of firearm-r elated injuries and 74% of reportable sharp instrument wounds from 199 4 to 1996. Case reporting by demographic characteristics of the victim was representative and largely complete. Reporting by characteristics of the incident (e.g., type of gun) was less reliable. Police data we re used to augment the system. From 1994 to 1996, ED-treated gunshot w ounds dropped 41%, from 662 in 1994 to 393 in 1996. Unintentional and self-inflicted gunshot wounds showed no declines. For every firearm-re lated homicide, 4.7 nonfatal firearm assaults were treated; 85% of sel f-inflicted gunshot wounds were fatal. Conclusions: The system has pro ven timely (1996 ED data were available for release in March 1997), fl exible (the reporting form has been revised several times), useful (DP H responds to 150 weapon injury data requests annually), acceptable (r eporting is voluntary and no hospital declined participation), and sus tainable (state funding is currently supporting the ED reporting syste m).