@article{Lucero-Obusan_Wendelboe_Schirmer_Oda_Holodniy_2017, title={Firearm Injury Encounters in the Veterans Health Administration (VHA), 2010-2015}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7716}, DOI={10.5210/ojphi.v9i1.7716}, abstractNote={<div style="left: 72px; top: 284.606px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.11794);" data-canvas-width="66.10733333333333">Introduction</div><div style="left: 84px; top: 296.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.947749);" data-canvas-width="303.722">Firearm violence is an issue of public health concern leading to</div><div style="left: 72px; top: 309.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0321);" data-canvas-width="315.5993333333333">more than 30,000 deaths and 80,000 nonfatal injuries in the United</div><div style="left: 72px; top: 323.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01254);" data-canvas-width="74.64133333333334">States annually.</div><div style="left: 146.589px; top: 323.534px; font-size: 6.8px; font-family: serif;">1</div><div style="left: 150.049px; top: 323.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.986683);" data-canvas-width="238.23459999999992">To date, firearm-related studies among Veterans</div><div style="left: 72px; top: 336.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03069);" data-canvas-width="265.4549999999998">have focused primarily on suicide and attempted suicide.</div><div style="left: 337.359px; top: 336.867px; font-size: 6.8px; font-family: serif; transform: scaleX(1.01061);" data-canvas-width="9.145999999999999">2-5</div><div style="left: 346.499px; top: 336.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04655);" data-canvas-width="41.09466666666666">Herein,</div><div style="left: 72px; top: 349.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00612);" data-canvas-width="312.01346666666666">we examine firearm violence among VHA enrollees for all manners/</div><div style="left: 72px; top: 363.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01438);" data-canvas-width="315.3715333333333">intents, including assault, unintentional, self-inflicted, undetermined</div><div style="left: 72px; top: 376.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01779);" data-canvas-width="315.26160000000016">and other firearm-related injury encounters in both the inpatient and</div><div style="left: 72px; top: 389.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00236);" data-canvas-width="85.63466666666667">outpatient settings.</div><div style="left: 72px; top: 415.273px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.07312);" data-canvas-width="46.59133333333333">Methods</div><div style="left: 84px; top: 427.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03176);" data-canvas-width="300.2585333333333">Inpatient and Outpatient encounters with one or more ICD-</div><div style="left: 72px; top: 440.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.08246);" data-canvas-width="319.03673333333336">9-CM firearm external-cause-of-injury codes (E-codes) from</div><div style="left: 72px; top: 453.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02261);" data-canvas-width="317.2483333333332">1/1/2010-9/30/2015 were extracted from the VHA’s Praedico™</div><div style="left: 72px; top: 467.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02985);" data-canvas-width="315.7013333333332">Public Health Surveillance System, including demographics, era of</div><div style="left: 72px; top: 480.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0061);" data-canvas-width="314.9091333333334">service/eligibility, encounter type, and deaths. Firearm E-codes were</div><div style="left: 72px; top: 493.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04192);" data-canvas-width="315.63219999999995">classified for manner/intent based on the CDC’s Web-based Injury</div><div style="left: 72px; top: 507.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02896);" data-canvas-width="308.61800000000005">Statistics Query and Reporting System (WISQARS™) matrix.</div><div style="left: 380.6px; top: 507.534px; font-size: 6.8px; font-family: serif;">6</div><div style="left: 72px; top: 520.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02517);" data-canvas-width="315.6684666666665">Outpatient/emergency department (ED) data were exclusively from</div><div style="left: 72px; top: 533.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.988023);" data-canvas-width="316.56266666666664">VHA facilities (a single pediatric patient seen as a humanitarian</div><div style="left: 72px; top: 547.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03479);" data-canvas-width="315.64693333333304">emergency was excluded from the dataset). Inpatient data included</div><div style="left: 72px; top: 560.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01832);" data-canvas-width="315.4089333333334">VHA facilities and some records received from non-VHA facilities.</div><div style="left: 72px; top: 573.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01968);" data-canvas-width="317.15313333333313">VHA rate of hospitalization for firearm-related admissions was</div><div style="left: 72px; top: 587.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03824);" data-canvas-width="315.6084000000001">calculated using the total VHA acute-care admissions for the same</div><div style="left: 72px; top: 600.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00644);" data-canvas-width="143.85400000000004">time period as the denominator.</div><div style="left: 72px; top: 625.94px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.08488);" data-canvas-width="40.93600000000001">Results</div><div style="left: 84px; top: 637.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03564);" data-canvas-width="303.56220000000013">During the time frame examined, 5,205 unique individuals were</div><div style="left: 72px; top: 651.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.964777);" data-canvas-width="311.84800000000007">seen with a firearm E-code. Of these, 4,221 were seen in the outpatient/</div><div style="left: 72px; top: 664.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02044);" data-canvas-width="315.214">ED setting only, 597 in the inpatient setting only, and the remaining</div><div style="left: 72px; top: 677.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01672);" data-canvas-width="315.3194000000001">387 had encounters in both the outpatient/ED and inpatient settings.</div><div style="left: 72px; top: 691.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02058);" data-canvas-width="315.36019999999996">VHA firearm admission rate was 1.63 per 10,000 VHA admissions,</div><div style="left: 72px; top: 704.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.972228);" data-canvas-width="242.2953333333333">compared to a national rate of 1.96 per 10,000 in 2010.</div><div style="left: 314.315px; top: 704.867px; font-size: 6.8px; font-family: serif;">7</div><div style="left: 317.682px; top: 704.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.977506);" data-canvas-width="68.66980000000001">Table 1 shows</div><div style="left: 72px; top: 717.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.987437);" data-canvas-width="314.53173333333336">the breakdown of encounters by manner/intent. Unintentional was the</div><div style="left: 72px; top: 731.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.973643);" data-canvas-width="314.37306666666643">most common firearm injury manner/intent. Overall, the median age at</div><div style="left: 72px; top: 744.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.961732);" data-canvas-width="314.2778666666665">initial encounter was 54 (range 19-100 years), and 96% were male. The</div><div style="left: 72px; top: 757.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00713);" data-canvas-width="314.9284">highest percentage served in the Persian Gulf War Era (2,136, 41%),</div><div style="left: 72px; top: 771.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02547);" data-canvas-width="315.41799999999995">followed by Vietnam Era (1,816, 35%) and Post-Vietnam Era (716,</div><div style="left: 72px; top: 784.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.980342);" data-canvas-width="314.47733333333315">14%). The greatest number of patients with a firearm-coded encounter</div><div style="left: 72px; top: 797.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.99071);" data-canvas-width="314.5339999999999">resided in Texas (453), California (349), Florida (326), Arizona (214)</div><div style="left: 72px; top: 811.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00111);" data-canvas-width="72.08">and Ohio (212).</div><div style="left: 72px; top: 836.606px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.10259);" data-canvas-width="68.01133333333334">Conclusions</div><div style="left: 84px; top: 848.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.986169);" data-canvas-width="304.26599999999996">Unintentional injuries were the most common form of firearm</div><div style="left: 72px; top: 861.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0953);" data-canvas-width="319.06166666666644">injury among VHA enrollees, representing over half of all</div><div style="left: 72px; top: 875.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.962516);" data-canvas-width="315.7693333333333">outpatient/ED firearm encounters and more than twice the number</div><div style="left: 72px; top: 888.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03261);" data-canvas-width="315.5993333333335">of firearm hospitalizations compared with any other manner/intent.</div><div style="left: 72px; top: 901.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.969443);" data-canvas-width="316.1353999999999">Limitations include that not all U.S. Veterans are VHA enrollees;</div><div style="left: 72px; top: 915.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00649);" data-canvas-width="314.86379999999997">miscoding and misclassification of firearm-related injuries may have</div><div style="left: 72px; top: 928.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.991393);" data-canvas-width="316.56833333333316">occurred; and data from non-VHA outpatient/ED encounters and</div><div style="left: 72px; top: 941.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0058);" data-canvas-width="314.9839333333333">some non-VHA hospitalizations are not available to our surveillance</div><div style="left: 72px; top: 955.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00329);" data-canvas-width="314.8989333333333">system for analysis. Additional study is needed to further understand</div><div style="left: 408px; top: 283.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.995221);" data-canvas-width="316.3643333333333">the epidemiology of firearm-related injuries among Veterans and</div>inform VHA leadership and providers}, number={1}, journal={Online Journal of Public Health Informatics}, author={Lucero-Obusan, Cynthia and Wendelboe, Aaron and Schirmer, Patricia and Oda, Gina and Holodniy, Mark}, year={2017}, month={May} }