@article{Walsh_2017, title={Comparing Emergency Department Gunshot Wound Data with Mass Casualty Shooting Reports}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7611}, DOI={10.5210/ojphi.v9i1.7611}, abstractNote={<div style="left: 90px; top: 320.758px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.08129);" data-canvas-width="63.778333333333336">Objective</div><div style="left: 105px; top: 335.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.01199);" data-canvas-width="378.90591666666654">To determine whether mass casualty shooting events are captured</div><div style="left: 90px; top: 352.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00088);" data-canvas-width="183.34500000000008">via syndromic surveillance data.</div><div style="left: 90px; top: 384.091px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.11768);" data-canvas-width="82.63416666666666">Introduction</div><div style="left: 105px; top: 399.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.959629);" data-canvas-width="379.7091666666669">Shootings with multiple victims are a concern for public safety</div><div style="left: 90px; top: 415.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02874);" data-canvas-width="394.31499999999977">and public health. The precise impact of such events and the trends</div><div style="left: 90px; top: 432.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.979395);" data-canvas-width="392.7538333333333">associated with them is dependent on which events are counted. Some</div><div style="left: 90px; top: 449.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.0358);" data-canvas-width="394.5884166666663">reports only consider events with multiple deaths, typically four or</div><div style="left: 90px; top: 465.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03151);" data-canvas-width="394.57141666666666">more, while other reports also include events with multiple victims</div><div style="left: 90px; top: 482.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.989536);" data-canvas-width="138.13916666666668">and at least one death.</div><div style="left: 228.19px; top: 482.751px; font-size: 8.5px; font-family: serif;">1</div><div style="left: 232.545px; top: 482.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.989221);" data-canvas-width="253.24049999999997">Underreporting is also a concern. Some</div><div style="left: 90px; top: 499.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.98113);" data-canvas-width="393.0570000000002">commonly cited databases for these events are based on media reports</div><div style="left: 90px; top: 515.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.983211);" data-canvas-width="393.153333333333">of shootings which may or may not capture the complete set of events</div><div style="left: 90px; top: 532.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00085);" data-canvas-width="275.7683333333334">that meet whatever criteria are being considered.</div><div style="left: 105px; top: 549.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.960656);" data-canvas-width="379.8111666666664">Many gunshot wounds are treated in the emergency department</div><div style="left: 90px; top: 565.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03061);" data-canvas-width="394.41416666666674">setting. Emergency department registrations routinely collected for</div><div style="left: 90px; top: 582.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.954917);" data-canvas-width="394.6833333333333">syndromic surveillance will capture all of those visits. Analysis of</div><div style="left: 90px; top: 599.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.975154);" data-canvas-width="393.03575">that data may be useful as a supplement to mass shooting databases by</div><div style="left: 90px; top: 615.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.995268);" data-canvas-width="393.3134166666666">identifying unreported events. In addition, clusters of gunshot wound</div><div style="left: 90px; top: 632.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.01972);" data-canvas-width="394.1549166666665">incidents which are not the result of a single shooting event but still</div><div style="left: 90px; top: 649.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.965779);" data-canvas-width="394.95533333333304">represent significant public safety and public health concerns may</div><div style="left: 90px; top: 665.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00869);" data-canvas-width="101.12166666666667">also be identified.</div><div style="left: 90px; top: 697.425px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.07287);" data-canvas-width="58.23916666666666">Methods</div><div style="left: 105px; top: 712.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.04444);" data-canvas-width="382.5254999999999">Emergency department registration data was collected from</div><div style="left: 90px; top: 729.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.998039);" data-canvas-width="390.0168333333334">hospitals via the EpiCenter syndromic surveillance system. Gunshot-</div><div style="left: 90px; top: 745.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.01154);" data-canvas-width="396.1878333333333">related visits were identified based on chief complaint contents</div><div style="left: 90px; top: 762.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.0012);" data-canvas-width="395.27266666666657">using EpiCenter’s regular expression-based classification system.</div><div style="left: 90px; top: 779.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.0196);" data-canvas-width="389.99558333333346">The gunshot wound classifier attempts to exclude patients with pre-</div><div style="left: 90px; top: 795.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.983065);" data-canvas-width="393.0130833333332">existing wounds and shooting incidents involving weapon classes that</div><div style="left: 90px; top: 812.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00304);" data-canvas-width="386.35333333333324">are lesser concerns for public safety, such as nail guns and toy guns.</div><div style="left: 105px; top: 829.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.962269);" data-canvas-width="379.93583333333316">Gunshot-related visits were clustered by day of registration and</div><div style="left: 90px; top: 845.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.997391);" data-canvas-width="396.09716666666696">separately by facility, by patient home zip code, and by patient</div><div style="left: 90px; top: 862.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.04729);" data-canvas-width="394.82924999999983">home county. The largest clusters of each type were compared via</div><div style="left: 90px; top: 879.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.985183);" data-canvas-width="393.03858333333295">manual search against media reports of shootings and against the Gun</div><div style="left: 90px; top: 895.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00443);" data-canvas-width="240.39416666666665">Violence Archive mass shooting database.</div><div style="left: 90px; top: 927.425px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.08488);" data-canvas-width="51.17">Results</div><div style="left: 105px; top: 942.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02688);" data-canvas-width="379.21049999999997">A total of 23,132 gunshot-related visits were identified from 635</div><div style="left: 90px; top: 959.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02717);" data-canvas-width="394.3631666666666">healthcare facilities from 2013 to 2015. From these, the five largest</div><div style="left: 90px; top: 975.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02679);" data-canvas-width="394.2710833333333">clusters by facility, by zip code, and by county were identified. The</div><div style="left: 90px; top: 992.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02694);" data-canvas-width="394.43116666666657">clusters included 112 gunshot wounds in total, ranging in size from</div><div style="left: 90px; top: 1009.04px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00027);" data-canvas-width="152.67416666666665">4 to 12 with a median of 7.</div><div style="left: 105px; top: 1025.71px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00304);" data-canvas-width="378.6126666666667">Of the 5 facility clusters, 5 had a corresponding media story and 2</div><div style="left: 90px; top: 1042.38px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.969875);" data-canvas-width="392.79916666666657">were located in the shooting database. Of the 5 zip code clusters, 1 had</div><div style="left: 90px; top: 1059.04px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03114);" data-canvas-width="394.4779166666668">a corresponding media story and none were located in the shooting</div><div style="left: 90px; top: 1075.71px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.990305);" data-canvas-width="393.2170833333332">database. Of the 5 county clusters, 4 had a corresponding media story</div><div style="left: 90px; top: 1092.38px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00073);" data-canvas-width="244.72916666666666">and 1 was located in the shooting database.</div><div style="left: 90px; top: 1124.09px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.10336);" data-canvas-width="85.01416666666667">Conclusions</div><div style="left: 105px; top: 1139.04px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.954149);" data-canvas-width="379.7672499999997">Multiple gunshot wound patients being treated on the same day</div><div style="left: 90px; top: 1155.71px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.999675);" data-canvas-width="393.5386666666666">were not necessarily all shot during the same incident or by the same</div><div style="left: 90px; top: 1172.38px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02156);" data-canvas-width="394.3730833333334">shooter. The information available in a syndromic surveillance feed</div><div style="left: 90px; top: 1189.04px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.963338);" data-canvas-width="395.1933333333334">does not allow for direct identification of the shooter or shooters.</div><div style="left: 90px; top: 1205.71px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.966013);" data-canvas-width="394.71308333333315">Given that limitation, a complete correspondence between clusters</div><div style="left: 510px; top: 319.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.996264);" data-canvas-width="393.2751666666666">identified in syndromic surveillance data and mass shootings was not</div><div style="left: 510px; top: 335.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.979544);" data-canvas-width="392.7155833333333">expected. The strong correlation between clusters and media coverage</div><div style="left: 510px; top: 352.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.01547);" data-canvas-width="394.0543333333334">indicates that the news is a reasonable source for shooting data. The</div><div style="left: 510px; top: 369.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02308);" data-canvas-width="394.2795833333331">smaller overlap with the mass shooting database is likely due to the</div><div style="left: 510px; top: 385.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03378);" data-canvas-width="394.30225000000024">more stringent criteria required for an incident to qualify as a mass</div><div style="left: 510px; top: 402.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.0012);" data-canvas-width="52.345833333333324">shooting.</div><div style="left: 525px; top: 419.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.954864);" data-canvas-width="380.1950833333333">It is still notable that the majority of gunshot clusters were not</div><div style="left: 510px; top: 435.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00446);" data-canvas-width="393.6803333333333">associated with any particular mass shooting incident. This serves as</div><div style="left: 510px; top: 452.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.01624);" data-canvas-width="394.0798333333333">a reminder that mass shootings represent only a small portion of the</div><div style="left: 510px; top: 469.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.959431);" data-canvas-width="395.0615833333335">total gun violence in the United States. Healthcare data represents</div><div style="left: 510px; top: 485.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03742);" data-canvas-width="394.41133333333346">a significant additional data source for understanding the complete</div><div style="left: 510px; top: 502.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00373);" data-canvas-width="289.97749999999996">impact of gun violence on public health and safety.</div><div style="left: 510px; top: 721.261px; font-size: 12.5px; font-family: serif; transform: scaleX(1.00498);" data-canvas-width="337.0874999999998">Weekly time series of gunshot-related emergency department visits</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Walsh, Andrew}, year={2017}, month={May} }