Citation

Barber C, Goralnick E, Miller M. JAMA Intern. Med. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, American Medical Association)

DOI

10.1001/jamainternmed.2021.0382

PMID

unavailable

Abstract

To the Editor Kaufman et al1 recently reported that more than half of the nonfatal firearm injuries treated in US emergency departments were unintentional (accidents). We believe the study overestimated the number of accidents causing nonfatal firearm injuries and underestimated the number of assaults. The problem lies not with the authors' calculations but with their data source, the Nationwide Emergency Department Sample (NEDS), and more specifically with the coded data that hospitals submit to NEDS. The International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis coding system that hospitals use for billing purposes has historically skewed toward classifying injuries as accidents. This tendency became policy in 2015 when US hospitals adopted the new International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding system, the manual for which states that if intent "is unknown or unspecified, code the intent as accidental."

Language: en