Multiple Cause of Injury Deaths Presented Using the ICD-10 Injury Mortality Diagnosis Matrix Margaret Warner, PhD Lois A Fingerhut, MA NCIPC Denver 2005 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National 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 UnintentionalSuicideHomicideUndeter -mined Oth er 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 9 th and 10 th revisions ICD-9 Mortality: ICD-10 Mortality: 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

ICD-10 Injury Mortality Diagnosis Matrix ICD-10 ‘S’ or ‘T’ code

ICD-10 Body region of injury Categories appropriate for mortality Full matrix 43 categories More detail To make it comparable to morbidity. Level of detail not available in mortality data.

ICD-10 mortality Nature of injury categories Sprain or strain Muscle and tendon injuries Nerve injuries

Injury deaths, US, ,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 Body region

Total mentions Body region US, 2002 Body region Head & Neck Spine & Back Torso Extremities Not classifiable

Total mentions Nature of injury US 2002 Nature of injury

Percent of all injuries mentioned by body region and nature of injury US, 2002

Percent Percent of all injuries mentioned by external cause and body region US, 2002

Percent Percent of all injuries mentioned by external cause and nature of injury US, 2002

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