Firearm-related injury surveillance in Colorado.

CONTEXT: The Colorado Department of Public Health and Environment uses existing data sources to identify and assess firearm-related deaths and injuries statewide. OBJECTIVE: Implementation and evaluation of a surveillance system for fatal and hospitalized nonfatal firearm-related injuries. DESIGN: Electronic death certificate and hospital discharge data are used to identify firearm-related deaths and injuries. Cases are confirmed and supplemental information is obtained from the Colorado Uniform Crime Report/Supplemental Homicide Report, police investigations, medical records, and newspaper accounts. Electronic data sets are created containing the information manually abstracted from these sources. SETTING: Statewide. PARTICIPANTS: Vital records, Colorado Hospital Association, medical records, Colorado Division of Criminal Justice, police departments. MAIN OUTCOME MEASURES: Surveillance system simplicity, flexibility, sensitivity, and predictive value positive. RESULTS: System-identified cases were compared with deaths and injuries identified from external sources such as hospital trauma registries, emergency department logs, and paramedic trip reports. The surveillance system is flexible, acceptable to reporting agencies, and sensitive, detecting 69% to 77% of firearm-related hospitalizations identified from external sources. The system's predictive value positive is high, with 89% of the potential cases confirmed as actual cases. Although simple in design, the surveillance system requires significant staff time to abstract information and because existing data sources are used, timeliness of the data is often delayed. Additionally, minor injuries (those requiring less than 24 hours or no hospitalization) are not detected. CONCLUSIONS: Despite these limitations, the surveillance system is a valuable resources for information about firearm-related deaths and injuries, and represents an important first step in reducing the number and severity of firearm-related injuries in Colorado.