Gunshot Injuries - Kansas Department of Health and Environment

Responding to an ask on the ISDS forums (https://www.healthsurveillance.org/forums/posts.aspx?group=190904&topic=...), KDHE made a first attempt at a Gunshot Injury query for Kansas syndromic data. There are a lot of other versions of GSW queries in this forum post. I recommend looking over the thread.

It's important to note that the NSSP ESSENCE Firearm subsyndrome has some innacuracies. The abbreviation "GSW" gets parsed to "GUNSHOT WOUND" by the Chief Complaint Processor. Currently the firearm subsyndrome looks for the term "GUN" but the term "GUNSHOT" doesn't register for the term "GUN." So in other words, ESSENCE is parsing GSW, but not into a form that the firearm syndrome can pick up.

This work started with a query shared by Amanda Morse, Washington State Department of Health. Her full post can be found in that same forum link above.
This query looks for the following key terms: GSW, GUN SHOT, GUNSHOT, FIREARM, RIFLE, PISTOL, OR REVOLVER - ANDNOT NAIL GUN, REMOVE GUN, NO GUN, PAINT, OR AIR SOFT
And also looks for the following ICD10 codes: W33[0-1], W34.0[09], W34.1[09], W32.[01], X93.XX, X94.[0-9], X95.[8-9], X72.XX, X73.[0-9], X74[8-9], Y22.XX, Y23[0-9], or Y24[8-9]

Kansas chose to add the key term "Bullet" and then did a review of gun-related injury SNOMED codes. The initial search returned around 170 SNOMED Codes. Running all of these on all historic Kansas production data only returned 39 ED visits. Of these 39 visits, only the following 4 SNOMED codes were captured:
 

Code

Freq

Description

283545005

33

Gunshot wound (disorder)

217903007

4

Accident caused by air rifle (event)

242869008

1

Assault by firearms (event)

269796009

1

Shotgun accident (event)

 

After these additions, the query language was (,^GSW^,or,^gun shot^,or,^gunshot^,or,^firearm^,or,^rifle^,or,^pistol^,or,^revolver^,or,^bullet^,or,^[;/ ]W33[01]^,or,^[;/ ]W340[09]^,or,^[;/ ]W341[09]^,or,^[;/ ]W32[01]^,or,^[;/ ]X93XX^,or,^[;/ ]X94[0-9]^,or,^[;/ ]X95[89]^,or,^[;/ ]X72XX^,or,^[;/ ]X73[0-9]^,or,^[;/ ]X74[89]^,or,^[;/ ]Y22XX^,or,^[;/ ]Y23[0-9]^,or,^[;/ ]Y24[89]^,or,^[;/ ]W33.[01]^,or,^[;/ ]W34.0[09]^,or,^[;/ ]W34.1[09]^,or,^[;/ ]W32.[01]^,or,^[;/ ]X93.XX^,or,^[;/ ]X94.[0-9]^,or,^[;/ ]X95.[89]^,or,^[;/ ]X72.XX^,or,^[;/ ]X73.[0-9]^,or,^[;/ ]X74.[89]^,or,^[;/ ]Y22.XX^,or,^[;/ ]Y23.[0-9]^,or,^[;/ ]Y24.[89]^,or,^[;/ ]283545005^,or,^[;/ ]217903007^,or,^[;/ ]242869008^,or,^[;/ ]269796009^,),andnot,(,^nail gun^,or,^remove gun^,or,^no gun^,or,^paint^,or,^air soft^,)

This was run on the ChiefComplaint, Triage Notes Orig, SubSyndrome Free Text, Admit Reason Combo, Clinical Impression, Chief Complaint History, and Discharge Diagnosis History. I would recommend you run this on at least one ChiefComplaint Field, Discharge Diagnosis Field, and SubSyndrome Free Text to leverage the processing power of ESSENCE.

Over the 90 day period of Kansas production data, 383 visits were returned. After reviewing by hand 233 of these were deemed likely true firearm injuries - not the best false positive rate. Most of the false positives were suicide and mental health-related with guns included in either an action or plan, but without an actua injury event. Following that, there was a sizeable number of people hit by guns (including assaults), dropping guns on their feet, and then historical GSWs that patients included in their medical history or complaints to the doctor.

Surveillance System: 
ESSENCE (NSSP)
Syndrome Definition: 

(,^GSW^,or,^gun shot^,or,^gunshot^,or,^firearm^,or,^rifle^,or,^pistol^,or,^revolver^,or,^bullet^,or,^[;/ ]W33[01]^,or,^[;/ ]W340[09]^,or,^[;/ ]W341[09]^,or,^[;/ ]W32[01]^,or,^[;/ ]X93XX^,or,^[;/ ]X94[0-9]^,or,^[;/ ]X95[89]^,or,^[;/ ]X72XX^,or,^[;/ ]X73[0-9]^,or,^[;/ ]X74[89]^,or,^[;/ ]Y22XX^,or,^[;/ ]Y23[0-9]^,or,^[;/ ]Y24[89]^,or,^[;/ ]W33.[01]^,or,^[;/ ]W34.0[09]^,or,^[;/ ]W34.1[09]^,or,^[;/ ]W32.[01]^,or,^[;/ ]X93.XX^,or,^[;/ ]X94.[0-9]^,or,^[;/ ]X95.[89]^,or,^[;/ ]X72.XX^,or,^[;/ ]X73.[0-9]^,or,^[;/ ]X74.[89]^,or,^[;/ ]Y22.XX^,or,^[;/ ]Y23.[0-9]^,or,^[;/ ]Y24.[89]^,or,^[;/ ]283545005^,or,^[;/ ]217903007^,or,^[;/ ]242869008^,or,^[;/ ]269796009^,),andnot,(,^nail gun^,or,^remove gun^,or,^no gun^,or,^paint^,or,^air soft^,)

Attached Syntax Platform: 
ESSENCE
Author: 
Submitting Author Organization: 
Kansas Department of Health and Environment
Submitting Author Email: 
Zachary.stein@icf.com
Syndrome Category: 

November 19, 2018

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