Evaluation of the emergency department logbook for population-based surveillance of firearm-related injury

Study objective: To evaluate existing emergency department logbooks as a source of population-based data on firearm-related injuries. Methods: We examined the logbooks of the 24 acute care and specialty-hospital EDs in Allegheny County, Pennsylvania, to determine the number and type of data variables each contained and the completeness of reporting of each variable for selected firearm-related cases. The amount of missing data for certain variables was determined and the cause for the missing data described. Results: Logbooks from 18 of the 24 eligible hospitals were reviewed. We identified 785 cases of firearm-related injury recorded between January 1, 1992, and December 31, 1993. Of the variables we selected for analysis, only date (100%), chief complaint or diagnosis (100%), name (98%), and time of admission (97%) were consistently documented. In 37% of cases the patient's county of residence could not be determined. Similarly incomplete data were found for body part injured (31%), race (28%), age (26%), sex (22%), and mode of arrival (21%). The factor most responsible for the high percentage of incomplete data was the considerable variation in the data elements contained in the different hospitals' logbooks. Conclusion: Missing data resulting from inconsistencies in the variables contained in different EDs' logbooks and errors of omission prevent ED logbooks, in their current state, from providing population-based data for surveillance of firearm-related injury. Standardization of such variables in ED logbooks would yield a more useful source of information for injury and disease surveillance. In lieu of standardized logbooks, multiple sources of data are necessary to establish a more comprehensive and useful system of surveillance of firearm-related injury.