Objective: 1. To improve our understanding of the processes leading to injury by determining whether or not the injuries were inflicted and by more specifically assessing the degree of intentionality. 2. To compare the determination of intent using this paradigm with currently used methods.

Methods: We developed a new paradigm for intentionality which characterizes the ACT OF INFLICTING injury (self-inflicted, inflicted by other, not inflicted) and the MOTIVE for inflicting injury. Intentional or unintentional MOTIVES are determined separately for the ACT of injury and the injury OUTCOME. We reviewed 495 emergency department cases with injuries in 10-19 year olds from 7 DC hospitals in a surveillance study. Three investigators independently classified all cases using the new paradigm and three others used currently used definitions of intent (intentional, unintentional, other). Interrater reliability was measured.

Results: In the new paradigm, more injuries involved intentional motives for the ACT compared to current classification. For example, 84% of sports injuries were coded as unintentional acts compared to 94% using current methods. Overall, when trained investigators coded intent, on average 32% were intentional, 65% unintentional, 3% undetermined. Using the new paradigm, 36% were thought to be intended ACTS, 60% unintended acts, and 4% undetermined. 29% were thought to involve intentional motive for OUTCOME, 66% unintentional, and 5% undetermined. 18% were inflicted by self, 47% inflicted by other, 33% not inflicted, and 3% undetermined. Using current coding definitions there was 94% agreement between paired raters with an average Kappa of.88. In the new paradigm questions on intentionality of act, intentionality of outcome, and infliction of act, the agreement was 88, 89, 84% with Kappas of.75,.77,.67 respectively.

Conclusions: This paradigm which expands the definition of intentionality in injury provides improved understanding of the causal sequence of injury and has important implications for research and intervention. Centers for Disease Control and Prevention