# Presentation: 701179

## The role of NCHS in providing guidance for defining injuries in administrative data sets 

- Lois A. Fingerhut, MA
- Office of Analysis and Epidemiology
- National Center for Health Statistics
- CSTE, June 2007

## Presentation Overview

- What are the sources of national data for injury surveillance?
- Where are the national data used?
- What are the data issues for states?
- What is the role for a national agency?
- What is the role of collaborative efforts?

## NCHS data sources used for injury surveillance

**Mortality data**
- Underlying cause of death data
- Multiple cause of death data
**Survey data**
- National Hospital Discharge Survey
- National Hospital Ambulatory Medical Care Survey
- National Health Interview Survey*

## Where are the data used?

- Healthy People 2010
- Health, United States
- Online data:
- CDC WONDER
- Health Data for all Ages
- Trends in Health and Aging
- WISQARS

## What can States do with national data?

- Benchmark to national data
- Modify data according to standard operational definitions
- Conduct cross-state comparisons

## Benchmarking

- All States can replicate definitions from:
- National Vital Statistics System - Mortality
- Most States can replicate definitions from:
- National Hospital Discharge Survey (diagnoses)
- States may or may not be able to replicate definitions tracked by:
- National Hospital Ambulatory Care Survey
- National Ambulatory Care Survey

## Need for standards and operational definitions

- Standard definitions for injury definitions from health care survey data and from vital statistics are necessary for national benchmarks.
- Currently several standards exist, but are often not consistently applied.
**	**

## Examples of standards setting

- Definitions
- Mortality matrix
- Morbidity matrix
- Methodologies
- Age-adjustment
- Selecting a main injury in multiple cause of death data
- Severity measurement

## Examples of benchmarking tools

- Objective specifications for HP2010 Injury and Violence objectives provide information on:
- National data sources
- Target populations
- ICD-9 CM and ICD-10 codes
- Age groups/standard populations used for age adjustment
- Inclusion/exclusion criteria
- Updated specifications accessible in DATA2010

## Slide 10

## Slide 11

## Slide 12

## HP2010 Objectives with soon-to-be updated definitions

**Injury Prevention**
**   ****15-1   Nonfatal head injury hospitalizations (NHDS)****	**
**   ****15-12 Emergency department visits (NHAMCS)**
**      **

## “Current” 15-1. Reduce hospitalizations for nonfatal head injuries

**National Data Source **		National Hospital Discharge Survey 				(NHDS), CDC, NCHS.
**State Data Source **		State hospital discharge systems.
**Healthy People 2000 Objective **	9.9 (Unintentional Injuries).
**Changes since the 2000 **	              None.
**Publication**
**Measure **			Rate per 100,000 population (age 					adjusted).
**Baseline **			60.6 (1998)
**Target **				45.0
**Numerator **			**Number of hospitalizations for ****	****	****	****	****	****nonfatal head injuries (principal ****	****	****	****	****	****diagnosis of ICD-9-CM codes 800-****	****	****	****	****801, 803-804, 850-854, 870-873, 925).**** ****	**

- “Current” 15-1. Reduce hospitalizations for nonfatal head injuries

**Notes:**
Either TBI or all Head and Neck as per Barell Matrix.

## “To be revised” 15-1. Reduce hospitalizations for traumatic brain injuries

**National Data Source **		National Hospital Discharge Survey 				(NHDS), CDC, NCHS.
**State Data Source **		State hospital discharge systems.
**Healthy People 2000 Objective **	9.9 (Unintentional Injuries).
**Changes since the 2000 **	              None.
**Publication**
**Measure **			Rate per 100,000 population (age 					adjusted).
**Baseline **			**?? **
**Target **				 **??**
**Numerator **			**Number of hospitalizations for ****	****	****	****	****	****TBIs (principal diagnosis of ****	****	****	****	****	****ICD-9-CM codes: 800.0-801.9,**
**	****	****	****	**** ****803.0-804.9,850.0-854.1,950.1-950.3****	****	****	****	**** 995.55**** ****(Barell Matrix definition)****	**

- “To be revised” 15-1. Reduce hospitalizations for traumatic brain injuries

**Notes:**
Either TBI or all Head and Neck as per Barell Matrix.

## Age-adjusted hospital discharge rates for different measures of head injury: 1997-2005

**0**

**50**

**100**

**150**

**200**

**250**

**1997**

**1998**

**1999**

**2000**

**2001**

**2002**

**2003**

**2004**

**2005**

**per 100,000 population**

##  “Current” 15-12. Reduce hospital ED visits caused by injuries

**State Data Source **			Not identified.
**Healthy People 2000 Objective **		Not applicable.
**Changes since the 2000 Publication **	None.
**Measure **				Rate per 1,000 population (age 						adjusted)
**Baseline **				131 (1997)
**Target****	**				126
**Numerator **	      			**Number of emergency department ****	****	****	****	****	****visits due to injury or poisoning****	****	****	****                             (defined by ICD-9-CM dx codes or E-****	****	****	****	****	****codes or reason for visit codes**).

-  “Current” 15-12. Reduce hospital ED visits caused by injuries

## “To be revised” 15-12. Reduce initial hospital ED visits caused by injuries

**State Data Source **			Not identified.
**Healthy People 2000 Objective **		Not applicable.
**Changes since the 2000 Publication **	None.
**Measure **				Rate per 1,000 population (age 						adjusted)
**Baseline **				**??**
**Target****	**				**??**
**Numerator **	      			**Number of initial emergency ****	****	****	****	****	****	****department visits due to ****	****	****	****	****	****	****	****injury or poisoning (defined by first-****	****	****	****	****	****listed ICD-9-CM injury codes or E-****	****	****	****	****	****codes ****                                  **

- “To be revised” 15-12. Reduce initial hospital ED visits caused by injuries

## Age-adjusted injury visit rates to emergency departments based on alternative definitions: United States, 1995-2005

**Age-adjusted injury visit rates to emergency departments based on alternative definitions: United States, 1995-2005**

**SOURCES: CDC/NCHS, NHAMCS-ED, 1995-2005 data files and NEISS-AIP data from WISQARS**.

**900.0**

**1,000.0**

**1,100.0**

**1,200.0**

**1,300.0**

**1,400.0**

**1,500.0**

**1995**

**1996**

**1997**

**1998**

**1999**

**2000**

**2001**

**2002**

**2003**

**2004**

**2005**

**Visits per 10,000 population**

## Other sources of injury data

- Health United States
- Standard annual tables
- Time trends
- Health Data for all Ages and Trends in Health and Aging
- Online resource of NCHS mortality and morbidity data with standard definitions for injury measures
- NCIPC’s WISQARS and CDC WONDER
- NCHS mortality data

## Health, United States

- Trend tables using matrix definitions
- Homicide rates
- Suicide rate
- Firearm death rates
- Trend tables using non-matrix definitions
- Motor vehicle death rates
- ED injury visit rates (to be changed)
- Hospital discharge rates for injury (to be changed)
- _[www.cdc.gov/nchs/hus.htm](http://www.cdc.gov/nchs/hus.htm)_

## Health Data for all Ages & Trends in Health and Aging

- Online data retrieval resources based on NCHS data
- Injury mortality
- Injury ED visits
- Injury hospital discharge rates
- _[www.cdc.gov/nchs/health_data_for_all_ages.htm](http://www.cdc.gov/nchs/health_data_for_all_ages.htm)_
- _[www.cdc.gov/nchs/agingact.htm](http://www.cdc.gov/nchs/agingact.htm)_

## NCHS and collaborative work

- _None_ of the standard setting or definition changes are done without collaborations with our partners:
- CSTE
- ICE on Injury Statistics
- ICEHS
- NCIPC
- PHDSC
- STIPDA

## NCHS and collaborative work

- CSTE
- Workgroup on External Cause Coding for Injuries (WECCI)
- ICE on Injury Statistics
- External cause code matrices
- Diagnoses matrices
- WHO Technical committee for ICD-11 injury chapters
- ICEHS
- First external cause of injury matrix
- NCIPC
- Indicators
- Matrices
- PHDSC
- External cause of injury workgroup
- STIPDA
- Injury Surveillance Workgroups (ISW)

## We want to hear from youWe can’t do this alone!

## NCHS Injury resources on the web

- _[http://www.cdc.gov/nchs/injury.htm](http://www.cdc.gov/nchs/injury.htm)_

## Slide 27

## Contact Information

**Lois A. Fingerhut**
- Special Assistant for Injury Epidemiology
- CDC/National Center for Health Statistics
- 3311 Toledo Road
- Hyattsville, MD 20782
- _laf4@cdc.gov_