Inaccuracies Exist in Trauma Registry Data Regarding Shooting Intent for Pediatric Firearm Injuries

Institutional trauma registries, which contribute data to the National Trauma Data Bank, are a fundamental resource for trauma research, though may have significant deficits in data accuracy. We hypothesize that inaccuracies in shooting intent exist at institutional registries of pediatric trauma centers.

Pediatric firearm injuries (ages 0-17 years) in a single county between 2018 and 2020 were identified from three Level I trauma centers. Demographics and Ecodes were extracted from each registry and shooting intent was compared to retrospective review of the hospital records, including bystander as a category.

Of 410 pediatric firearm injuries included, the majority were male (84%), non-Hispanic Black (45%) or Hispanic White (40%), and 15-17 years old (69%). Compared to final reviewer designations, the trauma registry's assault category showed high sensitivity (88.5%), but low specificity (67%), and only 78% accuracy. The trauma registry's accidental category was less sensitive (88%) but more specific (88%), with an accuracy of 88%. The most specific and accurate intention category was intentional self-harm, which had 79% sensitivity, 99.5% specificity, and 99% accuracy. Bystander shootings were most commonly categorized as assault (75%), followed by accidental (18%).

Significant inaccuracies in coding of pediatric firearm shooting intent exist in trauma registries. Additionally, there is no Ecode for bystander shootings, which overestimates other intent categories. Our study highlights the importance of improving the accuracy of firearm injury data collection to provide a better understanding of firearm injuries at a national level to inform targeted prevention efforts specific to shooting types.

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