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Kaufman EJ, Karp DN, Delgado MK. US Emergency Department Encounters for Law Enforcement–Associated Injury, 2006-2012. JAMA Surg. 2017;152(6):603–605. doi:10.1001/jamasurg.2017.0574
Deaths of civilians in contact with police have recently gained national public and policy attention. While journalists track police-involved deaths,1 epidemiologic data are incomplete,2,3 and trends in nonfatal injuries, which far outnumber deaths, are poorly understood. The International Classification of Diseases, Ninth Revision, Clinical Modification, includes external cause-of-injury codes identifying injuries owing to contact with law enforcement (E970-E978). Using these codes, prior studies have identified 715 118 nonfatal injuries, 3958 hospitalizations, and 3156 deaths between 2003 and 2011 from US Centers for Disease Control and Prevention data and the Nationwide Inpatient Sample,4 and 55 400 fatal and nonfatal injuries in 2012 from the Vital Statistics mortality census, Nationwide Inpatient and Emergency Department Samples, and journalists’ reports.5 In this study, we used a nationally representative database to determine whether the incidence of emergency department (ED) visits for injures by law enforcement increased relative to total ED visits from 2006 to 2012. We assessed demographic and clinical characteristics of visits for law enforcement–associated injury.
The Nationwide Emergency Department Sample is a nationally representative sample of ED visits, both discharges and hospital admissions, including approximately 20% of US ED visits.6 We identified visits with an injury diagnosis and an E-code indicating legal intervention. We used the Nationwide Emergency Department Sample sampling strata and discharge weights to produce nationally representative estimates. We normalized counts to total ED visits and used the nonparametric test of trend to assess for trend over time. A P value of less than .05 was considered significant. All tests were 2-sided.
This study used a database that contained no individually identifiable information. Therefore, no patient consent was obtained, and the study met criteria to be exempt from review by the University of Pennsylvania Perelman School of Medicine institutional review board.
From 2006 to 2012, there were 355 677 ED visits for legal intervention injuries, and frequencies did not increase over time (linear trend −0.1; 95% CI, −0.9 to 0.6 per 100 000 ED visits; P = .61 for trend) (Figure). Just 0.3% of these visits (n = 1202) resulted in death. More than 80% of patients were men (n = 306 210), and the mean (SD) age of patients was 32.4 (0.1) years (Table). Most lived in zip codes with median household income less than the national average, and 81% lived in urban areas (n = 280 277). Legal intervention injuries were more common in the South and West and less common in the Northeast and Midwest. Most legal intervention injuries resulted from being struck, with gunshot and stab wounds accounting for fewer than 7%. Most injuries were minor (Injury Severity Score <9). Medically identified substance abuse was common in patients injured by police (9.7% [n = 34 343] for alcohol and 5.9% [n = 20 904] for other substances) as was mental illness (20.0%; n = 71 126).
Using a nationally representative data set, we identified approximately 51 000 ED visits per year for patients injured by law enforcement in the United States. While public attention has surged in recent years, we found these frequencies to be stable over 7 years, indicating that this has been a longer-term phenomenon. This analysis adds to existing literature by establishing frequencies of nonfatal injuries, which are most of the injuries,3 by assessing trends over time,5 and by including all ED visits, rather than the small proportion admitted to the hospital.4 While it is impossible to classify how many of these injuries are avoidable, these data can serve as a baseline to evaluate the outcomes of national and regional efforts to reduce law enforcement–related injury.
Inaccurate or incomplete coding is an inherent limitation of our study. Some patients have no cause of injury coded. There are no International Classification of Diseases, Ninth Revision, Clinical Modification codes for legal intervention injuries by fall or dog bite,5 although these may have been captured under E977, “legal intervention by unspecified means.” The Nationwide Emergency Department Sample does not include patient race/ethnicity or a geographic indicator finer than region. We cannot determine whether injuries occurred in custody or account for out-of-hospital deaths or readmissions.6 Existing databases, such as the Nationwide Emergency Department Sample, can be used for ongoing epidemiologic surveillance of this phenomenon. However, further study is needed to determine how new data collection efforts in the ED can add to the speed and accuracy of administrative data sources to support collaborative injury prevention efforts among clinicians, communities, law enforcement agencies, and policy makers.
Corresponding Author: Elinore J. Kaufman, MD, MSHP, Department of Surgery, New York–Presbyterian Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 (email@example.com).
Accepted for Publication: January 20, 2017.
Published Online: April 19, 2017. doi:10.1001/jamasurg.2017.0574
Author Contributions: Dr Kaufman had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Kaufman, Delgado.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Kaufman, Karp.
Critical revision of the manuscript for important intellectual content: Kaufman, Delgado.
Statistical analysis: Kaufman, Delgado.
Obtained funding: Delgado.
Administrative, technical, or material support: Karp.
Conflict of Interest Disclosures: None reported.
Funding/Support: Dr Delgado was supported by grant K12HL109009 from the National Heart, Lung, and Blood Institute.
Role of the Funder/Sponsor: The funder had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.