ICEHS ‘Data Wonks’ Roundtable

Lois A. Fingerhut

November 2004

Centers for Disease Control and PreventionNational Center for Health Statistics

What’s New from NCHS• International Collaborative Effort (ICE)

on Injury Statistics: 10 year review

• Injury Severity

• Multiple cause of death analyses– Barell Matrix for main injury death– Poisoning examples

• New Death Certificates

Injury ICE- 10 year review

• Injury Prevention, 10/04 • Injury Control and Safety Promotion

12/04 (to be published)

• History• Mission• Participants• Current projects• Other ICE related projects

Article Published

Current Projects

• Injury indicators ……… injury severity

• Selecting a main injury from among multiple diagnoses on death certificates

• Poisoning- how to define it?• Household survey comparisons of injury

questions (to be published by Injury Prevention)

• Occupational injuries• Multiple injury profiles

Other projects

• Frameworks for presenting injury mortality data

• Barell Injury Diagnosis Matrix

• ICECI technical assistance

• Definition of injury (ongoing??)

Injury Severity

Injury Severity• Outgrowth of:

– Injury Indicators work in the ICE activities– Desire for “public domain” severity measure

• Meeting held early September at NCHS to discuss with the “experts” how we can incorporate measure(s) of injury severity into administrative datasets

• Focus was on AIS related measures and ICISS (based on ICD codes) measures

What we know • National trends in injury-related

hospital discharges and emergency dept. visits reflects utilization, but not differences in injury severity

• ICD codes alone cannot distinguish severity among injuries

• ICD-10 has provided no real guidance on how to select a main injury among multiple cause of injury mortality data

The “practical problems”• ICD-9 CM is still being used for coding morbidity

data; annual updates to CM continue

• Most recent version of ‘ICDMAP’ [translates ICD-9 CM codes to AIS scores] doesn’t recognize new codes

• ICD-10 CM doesn’t yet have an implementation date and there is no new ICDMAP based on ICD-10

• ICD codes used for mortality data often lack specificity

What we discussed

• Strengths and weaknesses of different severity scales

• Solutions for administrative data acknowledging the limitations of the source data (e.g., non-specific coding, changes in admission practices)

• Can we measure threat to function as well as threat to life?

Severity scales

AIS• Based on anatomical

descriptors

• Used in trauma data

• Post-dot score ranges from 0-6

• Subjective

• Time consuming

• Proprietary

ICISS

• Based strictly on ICD codes

• ICISS score for a given patient =

Product of survival risk ratios (survivors with a given code/ all patients with that code) associated with each ICD dx

• Easy to apply to admin. data sets- free

What was accomplished

• Consensus paper is being drafted

• Recommend a standard measure to users of administrative databases (e.g., Statewide hospital discharge data sets)

• Incorporate a method to identify the “main injury” in mortality and add it to the mortality file– Multiple cause analyses

Optimism….

• Incorporate ICISS into administrative data

• Retain AIS for trauma and for measuring threat to function

• Add ?? to mortality file

Multiple cause mortality data from NCHS

National Vital Statistics System

• ICD-10: uses all digits; up to 20 listed diagnoses

• For 2001, range (0-15 injuries listed)– 1 injury listed 65% of deaths– 2 injuries 22%– 3 injuries 8%– 4 -15 injuries 4%

• Can we select the most severe injury?– Do we need to include underlying

cause of death?

Specificity in ICD-10 mortality coding: (1)Frequently occurring

pairs

Most frequent pair – occurs 3,327 times• S06.9 (Intracranial injury, unspecified) and

S09.9 (Unspecified injury of the head)

Second most frequent – occurs 2,671 times• S09.9 (Open wound of head, part

unspecified) and S29.9 (Unspecified injury of the thorax)

Specificity in mortality coding: (2) accounts for significant

numbers of deaths

• S09.9 Unspecified injury of head– Any mention 21,343

• S01.9 Open wound of head, part unspecified– Any mention 17,677

Analyzing multiple cause of death data

• Detailed explanations and SAS codes are provided in:Anderson RN, Miniño AM, Fingerhut LA, Warner M, Heinen MA. Deaths: Injuries, 2001. National vital statistics reports; vol 52 no 21. Hyattsville, Maryland: National Center for Health Statistics. 2004

Near final version of ICD -10 Barell Matrix (APHA Poster)

• I hope you got to see it!

• Lead authors are Paul Jones and Bruce Lawrence who work for Ted Miller

• Lois Fingerhut contributed draft ICD codes for matrix based on work done earlier in Australia by Richard Hockey

• Hope to finalize this in the next two months. NCHS 2002 Injury Mortality report will incorporate it!

Poisoning deaths• Must analyze multiple cause data to get

any substance-specific counts

• From the mc data, for example, in 2002 cocaine was the single leading substance mentioned followed by other opioids (includes, for example hydrocodone, oxycodone, morphine)

• Poster handouts available

New Death CertificatesTransportation questions

Injury Checkbox items on Revised Death Certificates

• 2 Standard certificate questions to be implemented by 1/1/05- not mandatory

43. DESCRIBE HOW INJURY OCCURRED [more space on certificate than before]

44. IF TRANSPORTATION INJURY, SPECIFY

□ Driver/Operator □ Passenger □ Pedestrian □ Other (Specify)

Idaho 200337. DESCRIBE HOW INJURY OCCURRED. IF TRANSPORTATION INJURY, STATE THE TYPE(S) OF VEHICLE(S) INVOLVED (Automobile, pickup, motorcycle, ATV, bicycle, etc),

SPECIFY WHICH VEHICLE DECEDENT OCCUPIED, if applicable

TRANSPORTATION INJURY ONLY38a. WAS DECEDENT: □ Driver/Operator □ Passenger □ Pedestrian □

Other (Specify)38b. WHAT SAFETY DEVICE(S) DID THE DECEDENT

USE/EMPLOY?□ Seat Belt □ Child Safety Seat □ Helmet □ Air bag□ None □ Unknown

South Dakota & Florida

• IF TRANSPORTATION INJURY, (Check all that apply)

• □ Driver/Operator □ Car/Minivan

• □ Passenger □ Pickup/Van• □ Pedestrian □ Heavy

transport• □ Other (Specify)□ Bus

□ Other (Specify)

Coming soon…

National Trendsin Injury Hospitalizations,1979-2001

www.cdc.gov/nchs/injury.htm