1. 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

2. 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

3. 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

4. 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

5. 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…..

6. ICD revisions and modifications in US International Classification of Diseases Classifies ALL health conditions 9 th and 10 th 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?

7. 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

8. 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

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

10. 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.

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

12. 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

13. 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

14. Number of Mentions: ‘Total’, ‘Any’ & ‘Weighted total’ by body region US, 2002 Body region

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

16. Total mentions Nature of injury US 2002 Nature of injury

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

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

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

21. Visit the injury website www.cdc.gov/nchs/injury.htm www.cdc.gov/nchs/injury.htm Email general injury questions nchsinjury@cdc.gov nchsinjury@cdc.gov Contact me directly MWarner@cdc.gov MWarner@cdc.gov THANK YOU !!!