# Presentation: 834618

## The Barell 

**Body Region by Nature of Injury **
**Diagnosis Matrix**

**Aharonson-Daniel L **
- Presenting the work of the late
**Vita Barell**
- in conjunction with
- Avitzour M, Boyko V, Ziv A, Heruti R, Abargel A, ISRAEL
- Mackenzie E, Fingerhut L, USA
- And many dear friends from the
**ICE on Injury**

- The Center for Trauma and Emergency Medicine Research,
- Gertner Institute for Epidemiology and Health Policy Research, Israel

- May 2002

**Notes:**
My name is Limor Daniel and I am here to present... The matrix is named after Vita Barell.
Vita was a dear person and a brilliant researcher to whom injury prevention and analysis was a mission.
Vita passed away last May, leaving an almost finished project named “the israeli body region by nature of injury diagnostic matrix”, preliminary versions of which she presented in Amsterdam in 1998 and in India two years ago. Since then, to her last day she worked to make it perfect. Many people were involved in the process as you can see by the list of names on this slide.
When Vita died, it seemed only natural to name the matrix after her.
My presentation describes the major concepts and applications of the matrix.

## What is the Matrix?

- The Matrix is a tool for classifying injury ICD-9-CM codes by body region and nature of injury.
- It is useful for standardized retrieval of injury cases for epidemiological, clinical and management oriented analyses.

**What is the Matrix?**

- May 2002

**Notes:**
First, what is the matrix? (read)
The objectives (enter)

## Matrix objectives

** ****To characterize the patterns of injury**** **

**Matrix objectives**

** ****To serve as a standard for casemix comparison**** **

** ****To simplify the process of classifying injuries**

** ****To provide a standard format for reports**

- May 2002

**Notes:**
Were to
To simplify the process of classifying injuries using ICD-9 CM in a trauma setting.
To provide a standard format for reports from trauma registries, hospital discharge data systems, emergency department data systems or other sources of nonfatal injury data. .
Serve as a standard for case-mix comparison across time and place 
Characterize the patterns of injury resulting from diverse circumstances using a manageable number of clinically meaningful diagnostic categories

## Motivation for building the matrix

- Sorted by **nature of injury**

- Detecting injuries by **body region**
- requires collating codes across
- chapters

**ICD 9-CM CODES**** **
**800-995**

- May 2002

**Notes:**
The motivation for building the matrix rose from the fact that ICD9 cm codes 800-995 which describe traumatic injuries appear in a thick book sorted by nature of injury.(enter)
Detecting all injuries to the same body region requires collating codes across chapters, leaving room for variation and error.  
For example, if I want to look at lower leg, I may or may not include the knee, while others may choose to do otherwise, resulting in a different population.
This becomes more of a problem when we attempt to do comparative or international studies.

## ICD 9-CM CODES 800-995

**Motivation for building the matrix**

**nature of injury**

**body region**

- May 2002

**Notes:**
So we were looking for a way to present codes in a way which would define in a standard fashion both the nature of injury and the body region of the injury. These are the two axes of the matrix.

## The Matrix structure

** **

**Nature of injury**

**Body Region**

- ICD-9-CM injury codes

- May 2002

**Notes:**
Matrix columns include the nature of injury 
Matrix rows detail body regions,
and matrix cells (enter) contain ICD-9-CM injury codes

## Nature of injury (Columns) are based on

**Sequence**** ****of codes in ICD-9-CM codebook**

**12 Nature of Injury Columns**** **
**Fractures, dislocations, sprains & strains, internal, open wounds, amputations, blood vessels, contusions/superficial, crush, burn, nerves unspecified**

- May 2002

**Notes:**
Nature of injury is described in the  columns based on the sequence of codes in ICD9CM.  (enter) 
There are 12 nature of injury columns. These include...

## Body Region (Rows) are based on :

**3 standard levels of detail**
**5 rows**
**10 rows**
**36 rows**

**Body Region (Rows) are based on :**
**Anatomic subgroups**
**High Incidence**
**Variability in Outcome**
**Difference in health care utilization**

- May 2002

**Notes:**
The subdivision of the rows was based on 
anatomic subgroups, high incidence, variability in outcome, difference in utilization
There are 3 standard levels of details
The most general includes 5 rows, the second level, 10 rows and the most detailed, 36 rows.
For example if we take the most general level of head , the second level is TBI and other head and the third includes TBI, face, eye, neck and other and unspecified head face and neck.

## matrix

- *

|   |
| --- |

| The Matrix is available on the net at www.cdc.gov/nchs/about/otheract/ice/barellmatrix.htm |
| --- |

**matrix**

- May 2002

**Notes:**
This is an overview of what the actual matrix (or what could fit on the screen) looks like

## Zoom on matrix

- *

|   |
| --- |

| The Matrix is available on the net at www.cdc.gov/nchs/about/otheract/ice/barellmatrix.htm |
| --- |

**Zoom on matrix**

- May 2002

**Notes:**
If we zoom in a bit into the extremities we can see the three levels
At the 5 row level we will have extremities, at the 10 row level we will have upper ext and lower ext and at the 36 row level we will have the small categories

## Example

- 800.4
- Skull fracture

- 850
- Concussion

**Head**

-  860
- Flail chest

** **824
- Fractured ankle

**Fractures**

**Internal**

**Blood Vessels**

**Lower**** **
**extremity**

**Spinal**
**Cord**

**Chest**

- Jack – skull #
- Jill - concussion
- John – Flail chest
- Peter - # ankle

- May 2002

**Notes:**
This is an example of how it works. We have four patients: Jack Jill John and Peter
Jack has...
Patient injury diagnostic codes are entered into the cells  (examples)

## Summary Report 

**(50)**

**Head**

**0**

**(0)**

**1**

** (****25****)**

** ****1**

**(****25****)**

**Number**

**%**

**Lower**** **
**extremity**

**Spinal**
**Cord**

**Chest**

**Summary Report**** **

**N**

**2**

**4**

**Total**

**100**

- May 2002

**Notes:**
A summary report Is then produced, presenting the distribution of  injuries by body region or by nature or by other groupings
Taking a real example

## Summary report in practice

- May 2002

**Notes:**
This table presents data from the Israeli National Trauma registry for two years, summarized by broad matrix rows (5 groups). We see that ... (describe)
The same analysis was conducted on US NHDS data. A comparison (enter)

## Using report for comparisons

- May 2002

**Notes:**
is presented in this graph. 
Blue bars present distribution of Israeli Trauma registry data for three years from 1997-1999 and
Red bars US national hospital discharge survey data for two years from 1998 to 1999.
As populations are different, there are evident differences in distribution of diagnoses. For example 36% of all injuries in Israel were Head and neck injuries compared to only 17% in the US data.

## Forthcoming developments

**Collaboration with CDC NCIPC, academic and other Neurological organizations about the structure and interpretation of Severity of TBI rows**** **
**Develop standard methods for summarizing multiple injuries**
**Translate into ICD-10**

- May 2002

**Notes:**
During the building of the matrix, it evolved that CDC widely accepted and used TBI definition actuallly consists of two groups.So forthcoming developments in the matrix include (enter)
Collaboration with CDC NCIPC, academic and other Neurological organizations about the structure and interpretation of Severity of TBI rows 

The matrix, when used with multiple diagnoses can be the basis for the development of (enter)
standard methodologies for the analysis of multiple injuries. This analysis of multiple injuries is therefore seen as a central issue in the matrix concept and will be at the core of the next phase of matrix utilization. 
I will give a presentation on it’s first application for this use after we finish the questions about the matrix
Finally,
With the growing use of ICD-10 and in order to be applicable to a wider range of countries, some of which use ICD-10 already, there is need for the translation of this matrix to ICD-10 and eventually to ICD 10 CM

## Thanks for your attention

- The matrix is also on the net at: www.cdc.gov/nchs/projects/barellmatrix.htm

- A handout of the matrix is available

- May 2002