1. What’s New from NCHS International Collaborative Effort (ICE) on Injury Statistics-Cuernavaca, June ‘05 Measuring injury severity Injury Mortality Diagnosis Matrix Death certificate updates –Transportation questions Brief ICD-10 CM update Coding of hurricane-related deaths

2. Injury Surveillance issues were the focus of meeting All of the power point presentations are on the ICE web pages… Audio and video presentations will be made available [I hope!] http://www.cdc.gov/nchs/about/otheract/ ice/agenda_cuernavaca.htm

3. Injury ICE Collaborations Pan American Health Organization European Union/Commission ICECI (International Classification of External Causes of Injury) WHO Center Heads for Classification Washington City Group (focus is on measurement of disability)

4. Injury Severity

5. Injury Severity- Background (at last year’s meeting) Outgrowth of: – Injury Indicators work based on ICE activities –Desire for “public domain” severity measure Focus was on AIS related measures and ICISS (based on ICD codes) measures

6. Some characteristics of severity scales AIS Based on anatomical descriptors Used in trauma data Subjective Time consuming Proprietary ICISS Based strictly on ICD codes ICISS score for a given patient = Product of survival risk ratios (survivors with a given code/ all patients with that code) associated with each ICD dx Easy to apply to administrative data Free

7. Accomplishments since last year Report written and on NCHS website http://www.cdc.gov/nchs/data/injury/DicussionDocu.pdf Yet to accomplish Recommendation on a standard measure to users of administrative databases (e.g., Statewide hospital discharge data sets) Incorporation of a method to identify the “main injury” in mortality and add it to the mortality file –Multiple cause analyses

8. Recent updates AIS will remain proprietary. AIS2005 is apparently not available yet. No official plans have been announced regarding update of ICDMAP. NCHS is pursuing ICISS as a method for estimating injury severity in national and state-wide administrative data sets.

9. Forthcoming data request to States Calculate Survival Risk Ratios [ # alive at discharge / (# alive+# dead) ] –1 st listed injury diagnoses –All listed injury diagnoses SRR’s based on U.S. National Hospital Discharge Survey data will be posted on web

10. ICD-10 Injury Mortality Diagnosis (IMD) Matrix

11. IMD Matrix Cross-classifies nature of injury by body region of injury –Diagnoses from multiple cause of death data Similar structure to Barell matrix for morbidity Mortality measurement issues: –Any mention vs total mention vs weighted number of mentions of an injury vs multiple injury profiles Article accepted for publication in Injury Prevention - Feb. ‘06 issue See NCHS Injury website for matrix and data

12. IMD Matrix presentation categories Body region (rows) Head & neck Traumatic brain injury (TBI) Other head Neck Head and neck, other Spine and upper back Spinal cord Vertebral column Torso Thorax Abdomen Pelvis and lower back Abdomen, lower back & pelvis Other trunk Extremities Upper extremities Hip Other lower extremities Unclassifiable by body region Multiple body regions System wide Unspecified Nature of injury (columns) 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 by Intersection of row and column includes relevant ICD-10 S&T codes

13. Injury mortality: fractures and unspecified injuries by body region of injury: 2002 total mentions of deaths

14. New Death Certificates

15. States with new transportation items on death certificates 2003-2006 2003 –Calif –Idaho –Montana –NY & NYC 2004 –Connecticut –Michigan –New Hampshire –New Jersey –Oklahoma 2005 –DC –Florida –Kansas –Nebraska –South Carolina –Utah 2006 –Az, Ga, Hi, La, Me, –NM, Or, Tx –RI- no plan to implement All other states- no plans before 2007 Handouts with new questions are available.

16. ICD-10-CM update

17. Health Information Technology Promotion Act of 2005 Oct 27, 2005: Nancy Johnson HR 4157 SEC. 5. RULEMAKING TO UPGRADE ICD CODES (among other items) –HR4157 directs the Secretary to adopt a final rule by April 1, 2007 for implementation of ICD-10-CM –The final rule shall apply to transactions occurring on or after October 1, 2009. Status: Referred to Subcommittee on Health (11/04/05)

18. www.cdc.gov/nchs/injury.htm