Multiple Cause of Injury Deaths Presented Using the ICD-10 Injury Mortality Diagnosis Matrix

1. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Multiple Cause of Injury Deaths Presented Using the ICD-10 Injury Mortality Diagnosis Matrix Margaret Warner, PhD Lois A Fingerhut, MA NCIPC Denver 2005

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

6. 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?

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

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 Head & Neck Not classifiable Spine & Back Torso Extremities Body region

16. Total mentions Nature of injuryUS 2002 Nature of injury

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

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

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

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