National Violent Death Reporting System Coding Manual Version 4 National Center for Injury Prevention and Control Centers for Disease Control and Prevention 2010 The National Violent Death Reporting System (NVDRS) Coding Manual was developed through an extensive consultation process. It is published by the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention. Use of trade names is for identification purposes only and does not constitute endorsement by the Department of Health and Human Services. This document and subsequent revisions can be found at the National Center for Injury Prevention and Control web site: http://www.cdc.gov/injury Suggested citation: Centers for Disease Control and Prevention. National Violent Death Reporting System (NVDRS) Coding Manual Revised [Online] 2010 National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available from: URL: www.cdc.gov/injury ii National Violent Death Reporting System Coding Manual Team The creation of the National Violent Death Reporting System (NVDRS) coding manual has been a collaborative process involving Centers for Disease Control and Prevention (CDC), the National Violent Injury Statistics System (NVISS) and contracted software developers. CDC has taken the lead on developing the case definition, table structure, the document- based architecture of the system, and several new data elements. NVISS supplied most of the data elements and definitions based on an earlier pilot for the NVDRS. The NVDRS data elements are drawn in part from the NVISS, a pilot for the system. The NVISS Child Fatality Module Team additionally developed the Child Fatality data elements for NVDRS. NVISS was developed in 1999 with the financial support of six private foundations. Without the vision and financial support of these foundations, the early work to develop the national system would not have been possible. These foundations include the Atlantic Philanthropies, the Center on Crime, Communities and Culture of the Open Society Institute, the Joyce Foundation, the John D. and Catherine T. MacArthur Foundation, the David and Lucile Packard Foundation, and the Annie E. Casey Foundation. This project is a reflection of the expertise of all the developmental partners, participating state health departments, state and local coroner/medical examiner offices and state and local law enforcement agencies. This revised version of the coding manual incorporates updates to the system and input from states and others who have been using the system since its creation. iii Table of Contents Topic Section Page Introduction 1 Definitions 5 Entering a Case/Data Structure 15 Data Elements Key 23 Incident Variables 1 1-1 Document Variables 2 2-1 Person’s Identity 3 3-1 Death Certificate Main Elements 4 4-1 Abstractor-Assigned Type of Death 5 5-1 Coroner/Medical Examiner Main Elements 6 6-1 Victim Weapon and Suspect Variables 7 7-1 Suicide, Homicide, and Undetermined Circumstances 8 8-1 Unintentional Firearm Injury Circumstances 9 9-1 Police Report Main Elements 10 10-1 Supplementary Homicide Report 11 11-1 Hospital Information 12 12-1 Child Fatality Review 13 13-1 Intimate Partner Violence Module 14 14-1 Abstractor-Assigned Weapon Type 15 15-1 Weapon Detail 16 16-1 Weapon Trace Information 17 17-1 Validation Rules 18 18-1 Index of Variable Labels I I-1 Introduction Purpose of the Coding Manual The NVDRS Coding Manual is a reference document to be used for defining cases, entering data, and checking data once they are entered. It contains information about all data elements and the way the data are structured. It should be kept at hand when doing data entry or checking, both in the office and in the field. A copy of this manual is installed with the NVDRS software as an Adobe Acrobat (.pdf ) file. It is available for download at www.cdc.gov/injury. Other material related to setting up a state violent death reporting system can be found in the NVDRS Implementation Manual. Background on NVDRS Violence against others or oneself is a major public health problem in the United States, claiming over 50,000 lives each year. It is a particular problem for the young: homicide was the second and suicide was the third leading cause of death for Americans 1 to 34 years of age in 2007. Given the importance of the problem, it is noteworthy that prior to the development of NVDRS there was no national surveillance system for fatalities due to violence in the United States. In contrast, the federal government has supported extensive data collection efforts for the past three decades on other leading causes of death. For example, the National Highway Traffic Safety Administration records the critical details of fatal motor vehicle crashes, which result in more than 40,000 deaths among U.S. residents annually. That system, called the Fatality Analysis Reporting System (FARS), has existed since 1975. The result of that investment has been a better understanding of the risk factors for motor vehicle deaths — information that has helped to target safety improvements that have led to a significant decline in motor vehicle fatalities since the 1970s. Public health leaders and others are aware of the long-standing gap in information about violence, and have been pressing the need for a national surveillance system for violent deaths since 1989. In 1999, the Institute of Medicine recommended that CDC develop a fatal intentional injury surveillance system modeled after FARS. That same year, six private foundations pooled their funds to demonstrate that data collection about violent deaths was feasible and useful. They supported the National Violent Injury Statistics System (NVISS). NVISS was administered by the Harvard Injury Control Research Center and included 12 participating universities, health departments, and medical centers. In 2000, dozens of medical associations, suicide prevention groups, child protection advocates, and family violence prevention organizations joined a coalition whose purpose was to secure federal funding to extend NVISS-like surveillance nationwide. Congress approved $1.5 million to start the new system, called the National Violent Death Reporting System (NVDRS), in fiscal year 2002. The first cooperative agreements were established with six state health departments in September 2002, including: Maryland, Massachusetts, New Jersey, Oregon, South Carolina and Virginia. Funding for additional states was made available in fiscal year 2003 and another seven states implemented NVDRS (Alaska, 1 Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin). Further funding became available in 2004, and Kentucky, New Mexico, Utah and four counties in California began data collection in 2005. The most recent expansion of the program began in 2009, with the states of Michigan and Ohio joining NVDRS and collecting data from the start of 2010. California data is available only from 2005 to 2008. Vision Assist in the prevention of violent deaths in the U.S. through the provision of systematically and routinely collected, accurate, timely, and comprehensive data for prevention program development. Goals 1. Collect and analyze timely, high-quality data for monitoring the magnitude and characteristics of violent deaths at the national, state, and local levels. 2. Ensure that violent death data are routinely and expeditiously disseminated to public health officials, law enforcement officials, policy makers and the public, in accordance with data re-release plans. 3. Track and facilitate the use of NVDRS data for researching, developing, implementing and evaluating strategies, programs and policies designed to prevent violent deaths and injuries at the national, state and local levels. 4. Build and strengthen partnerships with organizations and communities at the national, state, and local levels to ensure that data collected are used to prevent violent deaths and injuries. 5. Identify creative strategies for expanding and sustaining NVDRS in all 50 states, the District of Columbia (DC) and U.S. territories. NVDRS Methodology NVDRS is a population based active surveillance system that provides a census of violent deaths that occur among both residents and nonresidents of funded U.S. states. There is no sampling involved, and thus all violent deaths are included. The system defines a death due to violence as “a death resulting from the intentional use of physical force or power against oneself, another person, or against a group or community,” which is the World Health Organization (WHO) definition of violence. The case definition includes suicides, homicides, deaths from legal intervention (a subtype of homicide), deaths of undetermined intent, and unintentional firearm fatalities. Deaths of undetermined intent are included because this category includes deaths with some evidence of intent, but without enough to definitively classify the death as purposeful. Unintentional firearm injury deaths, are included because the category is likely to include some deaths that are in fact intentional or of undetermined intent. Legal executions, which are considered part of deaths from legal 2 intervention, are excluded from NVDRS as they are beyond the scope of public health. Deaths due to acts of war are also excluded. The system is coordinated and funded at the federal level and depends on separate data collection efforts in each funded state managed by the state health departments. Unlike most public health surveillance systems