• B Wiersema, C Loftin, R C Mullen, E M Daub, M A Sheppard, J E Smialek, and D McDowall.
• Department of Criminology and Criminal Justice, University of Maryland, College Park 20742-8235, USA.
• Am J Prev Med. 1998 Oct 1;15(3 Suppl):46-56.

ContextMaryland began a statewide firearm-related injury surveillance system in 1995. The system now focuses on firearm-related deaths; a system to monitor nonfatal injuries is being developed. The system is passive; it accesses, integrates, and analyzes data collected by Maryland's Office of the Chief Medical Examiner, Maryland State Police, and Division of Health Statistics.ObjectiveTo evaluate the surveillance system's ability to ascertain cases in the absence of a standard for the true number of cases.DesignLink records of the same firearm-related death captured by the surveillance system's multiple data sources, comparing the rate of false positives and false negatives, and assessing errors in linkage variables.SettingMaryland, 1991-1994.ParticipantsAll deaths occurring in the state of Maryland as a result of a firearm-related injury.Main Outcome MeasuresSensitivity and positive predictive value.ResultsThe system is extremely sensitive, detecting 99.61% of cases, and it has a very high positive predictive value, with 99.87% of the cases identified from medical examiner's office data being confirmed as actual cases.ConclusionsMaryland's database of information from the medical examiner's office is highly accurate for ascertaining firearm-related deaths that occur in the state. A unique identifier common across data sources would ease record linkage efforts, and improve the system's ability to monitor firearm-related deaths.

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