title: Are "accidental" gun deaths as rare as they seem? A comparison of medical examiner manner of death coding with an intent-based classification approach.
abstract: OBJECTIVE
  Unintentional firearm death is often considered a nearly negligible proportion of overall gun death. These rates are based on medical examiner (ME) and coroner death classifications, which affect derived epidemiologic data and subsequent prevention measures. The aim of this study was to compare the proportion of pediatric unintentional gun deaths in Miami-Dade County based on manner of death coding by the ME with an intent-based classification of child gun deaths.
  
  
  METHODS
  ME and police records for all pediatric firearm fatalities in Miami-Dade County from 1994 to 1998 were reviewed. The ME's assignment of manner of death as homicide, suicide, or accident was compared with an intent-based classification of intentional homicide, intentional suicide, and unintentional firearm death based on expressed or implied evidence of intent to harm.
  
  
  RESULTS
  There were 123 pediatric firearm deaths in Miami-Dade County from 1994 to 1998. A significant difference between ME coding and the intent-based classification was found for homicide (94 vs 78) but not for suicide. A significant difference was also found between the ME's coding for "accident" and the investigator's classification of "unintentional" firearm death (4 vs 26).
  
  
  CONCLUSIONS
  The incidence of unintentional pediatric firearm deaths is significantly underreported by the Miami-Dade County ME when the classification of "accidental" firearm death is used. Reviewing the manner of death classification criteria or establishing an intent code on official death documentation is recommended. Furthermore, clinicians should be aware that the true incidence of unintentional gun death may be higher than that reported as accidental.
authors.affiliation: Department of Pediatrics, University of Miami School of Medicine, Miami, Florida 33101, USA. jschaech@med.miami.edu
authors.forename: Judy
authors.initials: J
authors.lastname: Schaechter
authors.forename: Isis
authors.initials: I
authors.lastname: Duran
authors.forename: Jacqueline
authors.initials: J
authors.lastname: De Marchena
authors.forename: Glendene
authors.initials: G
authors.lastname: Lemard
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Villar
mesh_terms: D000059:Accidents / Q000145:classification* / Q000401:mortality* / Q000706:statistics & numerical data; D000293:Adolescent; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D003334:Coroners and Medical Examiners / Q000145:classification / Q000706:statistics & numerical data; D003644:Death Certificates / Q000331:legislation & jurisprudence; D005260:Female; D005389:Firearms / Q000706:statistics & numerical data*; D005431:Florida / Q000453:epidemiology; D005554:Forensic Medicine; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016495:Police; D012189:Retrospective Studies; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000401:mortality*