# Presentation: 512713

## Multiple Cause of Injury Deaths Presented Using the ICD-10 

**Injury Mortality Diagnosis Matrix**

**Margaret Warner, PhD**
**Lois A Fingerhut, MA**
**NCIPC Denver 2005**

## 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

**Notes:**
Mention versions used

## 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**

**Notes:**
Multiple cause of death data – vital statistics – comes from death certificate.  Wisqars comes from this data source. From NCHS.  All health conditions are coded.  Injury deaths defined by the underlying cause.  Underlying cause the chain of events that led to death.  Defined by ICD coding rules.  In ICD-10 the coding structure is alpha numeric.  More discussion of ICD in a bit

## 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

## External cause matrix-basic structure

|  | Intent of injury |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
| Mechanism | Unintentional | Suicide |  | Homicide | Undeter-mined | Other |
| MV-traffic |  |  |  |  |  |  |
| Cut |  |  |  |  |  |  |
| Firearm |  | External cause codes for ICD-9 & ICD-9 CM  & ICD-10 |  |  |  |  |
| Poisoning |  |  |  |  |  |  |
| Struck by/
against |  |  |  |  |  |  |
| Suffocation
Etc..... |  |  |  |  |  |  |

**Notes:**
This matrix is designed for all ICD versions in the US.
Lois says should drop if run out of time

## 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?**

**Notes:**
ICD without the CM in this country (emphasize) is used for mortality.  CM stands for clinical modifications and is more detailed. Substantative changes to injury diagnosis codes in ICD-10 – major group by body region and within body region --Nature of injury.  ICD -9 was the opposite.

## 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

## 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**

**Notes:**
Many codes in ICD-10.  Many groupings to make it as compatible as possible with the ICD-9-CM matrix and to accommodate all types of research.

## ICD-10 Injury Mortality Diagnosis Matrix

**ICD-10 ‘S’ or ‘T’ code**

**Notes:**
Basic structure is body region by nature

## ICD-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.**

**Notes:**
More detail available at the 43 level categories.  Make it mappable to morbidity but not necessarily appropriate.   E.g. extremities like fingers.  Eyes.  

## ICD-10 mortality

**ICD-10 mortality**
**Nature of injury**
**categories**

| Sprain or strain |  |
| --- | --- |
| Muscle and tendon injuries |  |
| Nerve injuries |  |

## 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

**Notes:**
Data source slide.

## 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

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

- Body region

**Notes:**
External causes, varies by intent, firearm & suffocation

## Total mentions Body region US, 2002

- Body region

- Head & Neck

- Spine &  Back

- Torso

- Extremities

- Not classifiable

**Notes:**
- Ordered by body region

## Total mentions Nature of injuryUS 2002

- Nature of injury

**Notes:**
Ordered by magnitude 

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

**Notes:**
Other (residual) is other causes not put in 

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

- Percent

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

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

- Percent

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

## Slide 20

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

- Visit the injury website  						_[www.cdc.gov/nchs/injury.htm](http://www.cdc.gov/nchs/injury.htm)_
- Email general injury questions    					_[nchsinjury@cdc.gov](mailto:nchsinjury@cdc.gov)_
- Contact me directly                         				_[MWarner@cdc.gov](mailto:MWarner@cdc.gov)_

**THANK YOU !!!**