1. ICEHS ‘Data Wonks’ Roundtable Lois A. Fingerhut November 2004 Centers for Disease Control and Prevention National Center for Health Statistics

2. 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

3. Injury ICE- 10 year review

4. 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

5. 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

6. Other projects Frameworks for presenting injury mortality data Barell Injury Diagnosis Matrix ICECI technical assistance Definition of injury (ongoing??)

7. Injury Severity

8. 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

9. 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

10. 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

11. 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?

12. 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

13. 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

14. Optimism…. Incorporate ICISS into administrative data Retain AIS for trauma and for measuring threat to function Add ?? to mortality file

15. Multiple cause mortality data from NCHS National Vital Statistics System

16. ICD-10: uses all digits; up to 20 listed diagnoses For 2001, range (0-15 injuries listed) –1 injury listed65% of deaths –2 injuries22% –3 injuries8% –4 -15 injuries4% Can we select the most severe injury? –Do we need to include underlying cause of death?

17. 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)

18. 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

19. 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

20. 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!

21. 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

22. New Death Certificates Transportation questions

23. 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)

24. Idaho 2003 37. 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 ONLY 38a. 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

25. 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)

26. Coming soon… National Trends in Injury Hospitalizations, 1979-2001

27. www.cdc.gov/nchs/injury.htm