BACKGROUND: Prevention of firearm injury requires an understanding of circumstances, including intent to harm. Deliberate firearm injury, such as homicide or suicide, suggests different interventions than unintentional injury. Current death classifications may misguide prevention workers. Our county Medical Examiner (ME) defines homicide as being shot by another person and suicide as being shot by oneself, regardless of intent. The Centers for Disease Control (CDC) defines unintentional firearm death as that which occurs when the person firing the gun does not intend harm.
METHODS: We examined ME and police records for all pediatric (<18 years) firearm fatalities in a large urban county from 1994-1998. Using the CDC definition, we re-classified deaths as homicide, suicide or unintentional. Examples of the later include when the gun was dropped, handled by a toddler, engaged in play or other non-malevolent activity. Russian roulette deaths were not included.
RESULTS: Over the five-year period studied, the ME reported 123 pediatric deaths. A significant difference between ME coding and reclassification was found for homicide (94 vs. 78; p=0.026), though not for suicide (25 vs. 18; p=0.24). A markedly significant difference was found between the ME coding for “accident” and the reclassification of “unintentional death” (4 vs. 24; p<0.0001).
CONCLUSIONS: In one large urban county the incidence of unintentional pediatric firearm deaths is significantly higher than currently reported. Revising the system of death classification by the Medical Examiner may improve the accuracy of future injury statistics and thereby better inform local prevention strategies.
Learning Objectives: At the conclusion of the session, the learner in this session will be able to: 1. Identify inconsistencies in Medical Examiner coding of firearm-related cause of death. 2. Recognize that literal definitions of homicide, suicide and accident may be inadequate when applied to firearm deaths caused by children different developmental stages. 3. Discuss how Medical Examiner death codes play an important role in prevention planning.
Keywords: Firearms, Coding
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
The 129th Annual Meeting of APHA