multiple cause of injury deaths presented using the icd-10 injury mortality diagnosis matrix...

Multiple Cause of Injury Deaths Presented Using the ICD-10

Injury Mortality Diagnosis Matrix

Margaret Warner, PhDLois A Fingerhut, MA

NCIPC Denver 2005

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

Overview

•Multiple cause of death data

• ICD revisions and modifications

•Matrices for ICD classification• External Cause of Matrix (ICD-9, ICD-9 CM, ICD-10)

• Barell Injury Diagnosis Matrix (ICD-9 CM)

• Injury Mortality Diagnosis Matrix (ICD-10)

•Present 2002 multiple cause data using ICD-10 injury diagnosis matrix

•Discuss some methodological considerations

Multiple cause data for injury deaths

Up to 20 conditions mentioned on death certificate including …

•External cause of injury•Underlying cause•*U,V,W,X,Y codes

•Injury diagnoses•S and T codes

•Other diagnoses•A,B,C…R codes

External cause

•External cause of death

•Always selected as underlying cause for injury deaths

•Mechanism (e.g. car crash, firearm)

•Intent (e.g. unintentional, suicide)

•External cause matrix •Cross classifies by mechanism &

intent

•Gaining widespread national and international use

External cause matrix-basic structure

Intent of injury

Mechanism

Unintentional

Suicide

Homicide

Undeter-mined

Other

MV-traffic

Cut

Firearm External cause codes for ICD-9 & ICD-9 CM & ICD-10

Poisoning

Struck by/

against

Suffocation

Etc…..

ICD revisions and modifications in US

• International Classification of Diseases

•Classifies ALL health conditions

•9th and 10th revisions•ICD-9 Mortality: 1979 - 1998 •ICD-10 Mortality: 1999 - present

•Clinical modifications for morbidity•ICD-9 CM currently in use in US •ICD-10 CM developed – implementation?

Barell Matrix

•Standard for presenting injury morbidity data

•Body region by nature of injury

• ICD-9 CM codes

•STIPDA recommended as method to present morbidity data

•Chartbook from NCHS on National Hospital Discharge Survey and included in annual tables

ICD-10 Injury mortality diagnosis matrix

• Over 1,200 ‘S’ or ‘T’ codes describe fatal injuries

• Summarized ….

•Body region (e.g. thorax, extremities)•43 17 5 categories

•Nature (e.g. fracture, open wounds)•19 16 categories

Nature of injury Fractures Dislocations Internal Open Amputation Blood wound Vessels

Body region of injuryHead and NeckTraumatic Brain Injury

specific sites

Spine and upper backspecific sites

Torsospecific sites

Extremitiesspecific sites

Unclassifiablespecific sites

ICD-10 Injury Mortality Diagnosis Matrix

ICD-10 ‘S’ or ‘T’ code

Head&Neck allTBIOther headNeckHead and neck, other

Spine and upper backSpinal cordVertebral column

TorsoThorax AbdomenPelvis and lower backAbdomen, lower back & pelvisOther trunk

ExtremitiesUpper extremitiesHipOther lower extremities

Unclassifiable by body regionMultiple body regionsSystem wideUnspecified

ICD-10 Body regionof injury Categoriesappropriatefor mortality

Full matrix43 categories

More detailTo make it comparable to morbidity. Level of detail not available in mortality data.

Fracture

Dislocation

Internal organ injuries

Open wound

Amputation

Blood vessel

Superficial & contusions

Crushing

Burn

Effects of Foreign Bodies entering orifice

Other effects of external causes

Poisoning

Toxic effects

Multiple injuries

Other specified

Unspecified

ICD-10 mortalityNature of injurycategories

Sprain or strain

Muscle and tendon injuries

Nerve injuries

Injury deaths, US, 2002

•161,269 deaths with underlying cause injury

•246,065 injuries mentioned on death certificate

•1.5 injury diagnoses per death

•Ratio varied by cause & intent

Multiple injury deaths

Many methods to analyze. For example:

•Total mentions of injury diagnoses

•Any mention in a category (selected)

•Main injury or first listed injury

•Weighted total mention –

weight = 1/total number of injuries per death

Number of Mentions: ‘Total’, ‘Any’ & ‘Weighted total’

by body region US, 2002

0

20

40

60

80

100

120

Head andNeck

Spine andupper back

Torso Extremities Unclassifiable

Thousand

Nu

mb

er

of

me

nti

on

s

Total mentionAny mentionWeighted total

Body region

Total mentions Body region

US, 2002

0

10

20

30

40

50

60

70

80

TBI

Other

hea

dNec

k

Head/

neck

Spinal

cord

Verteb

ral c

olum

n

Thora

x

Abdom

en

Pelvis/

Low b

ack

Abd/L

ow b

ack/p

elvis

Trunk

othe

r

Upper

ext Hip

Other

lower

ext

Mult

iple

regio

n

Syste

m wide

Unspe

cified

Thousand

Nu

mb

er

of

me

nti

on

s

Body region

Head & Neck

Spine & Back

Torso Extremities

Not classifiable

Total mentions Nature of injury

US 2002

0

10

20

30

40

50

60

70

80

Open W

ound

Poiso

ning

Inte

rnal

Fract

ure

Other

ext

ernal

Toxic

effe

ct

Foreig

n body

Burn

Blood

vess

el

Multi

ple

Crush

Super

/con

t

Dislo

catio

n

Amput

atio

n

Other

spec

Unspec

ified

Thousands

Nu

mb

er o

f m

enti

on

s

Nature of injury

Percent of all injuries mentioned by body region and nature of injury

US, 2002

0 10 20 30 40 50

Head & Neck

Spine & Back

Torso

Extremities

Not classifiable byregion

Percent of all injuries mentioned

Open wounds

Poisoning

Internal

Fracture

Other (residual)

Unspecified

0

5

10

15

20

25

30

35

MVT Firearm Poisoning Fall Other (residual)

Unclassifiable

Extremities

Torso

Spine & back

Head & Neck

Percent

Percent of all injuries mentioned by external cause and body region

US, 2002

0

5

10

15

20

25

30

35

MVT Firearm Poisoning Fall Other (residual)

Unspecified

Other(residual)

Fractures

Internal

Poisoning

Open wounds

Percent

Percent of all injuries mentioned by external cause and nature of injury

US, 2002

Visit the injury website www.cdc.gov/nchs/injury.htm

Email general injury questions nchsinjury@cdc.gov

Contact me directly MWarner@cdc.gov

THANK YOU !!!