Multiple Cause of Injury Deaths Presented Using the ICD-10
Injury Mortality Diagnosis Matrix
Margaret Warner, PhDLois A Fingerhut, MA
NCIPC Denver 2005
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics
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
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
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…..
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?
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
Nature of injury Fractures Dislocations Internal Open Amputation Blood wound Vessels
Body region of injuryHead and NeckTraumatic Brain Injury
specific sites
Spine and upper backspecific sites
Torsospecific sites
Extremitiesspecific sites
Unclassifiablespecific sites
ICD-10 Injury Mortality Diagnosis Matrix
ICD-10 ‘S’ or ‘T’ code
Head&Neck allTBIOther headNeckHead and neck, other
Spine and upper backSpinal cordVertebral column
TorsoThorax AbdomenPelvis and lower backAbdomen, lower back & pelvisOther trunk
ExtremitiesUpper extremitiesHipOther lower extremities
Unclassifiable by body regionMultiple body regionsSystem wideUnspecified
ICD-10 Body regionof injury Categoriesappropriatefor mortality
Full matrix43 categories
More detailTo make it comparable to morbidity. Level of detail not available in mortality data.
Fracture
Dislocation
Internal organ injuries
Open wound
Amputation
Blood vessel
Superficial & contusions
Crushing
Burn
Effects of Foreign Bodies entering orifice
Other effects of external causes
Poisoning
Toxic effects
Multiple injuries
Other specified
Unspecified
ICD-10 mortalityNature of injurycategories
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
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
0
20
40
60
80
100
120
Head andNeck
Spine andupper back
Torso Extremities Unclassifiable
Thousand
Nu
mb
er
of
me
nti
on
s
Total mentionAny mentionWeighted total
Body region
Total mentions Body region
US, 2002
0
10
20
30
40
50
60
70
80
TBI
Other
hea
dNec
k
Head/
neck
Spinal
cord
Verteb
ral c
olum
n
Thora
x
Abdom
en
Pelvis/
Low b
ack
Abd/L
ow b
ack/p
elvis
Trunk
othe
r
Upper
ext Hip
Other
lower
ext
Mult
iple
regio
n
Syste
m wide
Unspe
cified
Thousand
Nu
mb
er
of
me
nti
on
s
Body region
Head & Neck
Spine & Back
Torso Extremities
Not classifiable
Total mentions Nature of injury
US 2002
0
10
20
30
40
50
60
70
80
Open W
ound
Poiso
ning
Inte
rnal
Fract
ure
Other
ext
ernal
Toxic
effe
ct
Foreig
n body
Burn
Blood
vess
el
Multi
ple
Crush
Super
/con
t
Dislo
catio
n
Amput
atio
n
Other
spec
Unspec
ified
Thousands
Nu
mb
er o
f m
enti
on
s
Nature of injury
Percent of all injuries mentioned by body region and nature of injury
US, 2002
0 10 20 30 40 50
Head & Neck
Spine & Back
Torso
Extremities
Not classifiable byregion
Percent of all injuries mentioned
Open wounds
Poisoning
Internal
Fracture
Other (residual)
Unspecified
0
5
10
15
20
25
30
35
MVT Firearm Poisoning Fall Other (residual)
Unclassifiable
Extremities
Torso
Spine & back
Head & Neck
Percent
Percent of all injuries mentioned by external cause and body region
US, 2002
0
5
10
15
20
25
30
35
MVT Firearm Poisoning Fall Other (residual)
Unspecified
Other(residual)
Fractures
Internal
Poisoning
Open wounds
Percent
Percent of all injuries mentioned by external cause and nature of injury
US, 2002
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