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A comparison of two surveillance systems for deaths related to violent injury
  1. R D Comstock1,
  2. S Mallonee2,
  3. F Jordan3
  1. 1Oklahoma State Department of Health, Injury Prevention Service, Oklahoma City, Oklahoma and Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Applied Public Health Training, Atlanta, Georgia, USA
  2. 2Oklahoma State Department of Health, Injury Prevention Service, Oklahoma City, Oklahoma, USA
  3. 3Office of the Chief Medical Examiner, Oklahoma City, Oklahoma, USA
  1. Correspondence to:
 Dr R Dawn Comstock
 Children’s Center for Injury Research and Policy, Ohio State University, College of Medicine, Department of Pediatrics, 700 Children’s Drive, Columbus, OH 43205, USA;


Objective: To compare violent injury death reporting by the statewide Medical Examiner and Vital Statistics Office surveillance systems in Oklahoma.

Methods: Using a standard study definition for violent injury death, the sensitivity and predictive value positive (PVP) of the Medical Examiner and Vital Statistics violent injury death reporting systems in Oklahoma in 2001 were evaluated.

Results: Altogether 776 violent injury deaths were identified (violent injury death rate: 22.4 per 100 000 population) including 519 (66.9%) suicides, 248 (32.0%) homicides, and nine (1.2%) unintentional firearm deaths. The Medical Examiner system over-reported homicides and the Vital Statistics system under-reported homicides and suicides and over-reported unintentional firearm injury deaths. When compared with the standard, the Medical Examiner and Vital Statistics systems had sensitivities of 99.2% and 90.7% (respectively) and PVPs of 95.0% and 99.1% for homicide, sensitivities of 99.2% and 93.1% and PVPs of 100% and 99.0% for suicide, and sensitivities of 100% and 100% and PVPs of 100% and 31.0% for unintentional firearm deaths.

Conclusions: Both the Vital Statistics and Medical Examiner systems contain valuable data and when combined can work synergistically to provide violent injury death information while also serving as quality control checks for each other. Preventable errors within both systems can be reduced by increasing training, addressing sources of human error, and expanding computer quality assurance programming. A standardized nationwide Medical Examiners’ coding system and a national violent death reporting system that merges multiple public health and criminal justice datasets would enhance violent injury surveillance and prevention efforts.

  • CME-1, official Medical Examiner report
  • ICD-10, International Classification of Diseases, 10th revision
  • NVSS, National Vital Statistics System
  • OSDH, Oklahoma State Department of Health
  • PVP, predictive value positive

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