Out-of-hospital violence injury surveillance: quality of data collection

The recognized need to improve data collection for violence prevention may be met, in part, by using out-of-hospital data for injury surveillance. The purpose of the Prehospital Violence Injury Surveillance project was to examine the extent to which paramedics can adequately collect information about injuries, particularly intentional injuries, at emergency scenes.

Paramedics in a large Midwestern metropolitan area were trained to assess violence-related events and collect relevant data using a modified ambulance run report form. Data collected from 8 violence-related training scenarios and from 13 ride-along observations were analyzed to estimate paramedic interrater reliability using the kappa statistic. Data from 7,363 run report forms, filed during a 3-month study period, were abstracted and analyzed for completeness and quality.

Paramedics demonstrated fair to good, and sometimes excellent, interrater agreement when documenting the training scenarios. Paramedics revealed barriers to collecting violence-related out-of-hospital data. The paramedics and the observer disagreed in documenting 77% of the ride-along observations. Overall, 73% of abstracted run report forms showed documentation errors, with more than 99% of these reports containing errors of omission and 29% showing internal documentation inconsistencies. Despite the emphasis on violence-related data, documentation of domestic abuse screening was missing from more than 99% of run reports from female patients.

Significant barriers to quality out-of-hospital data collection were identified during study implementation and in abstracted run reports. These barriers included the following: lack of organizational support; characteristics of the violence-related data elements; design of the ambulance run report form; and paramedic knowledge, attitudes, and behaviors regarding data collection.