ICEHS Data Wonks Roundtable

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

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Injury ICE- 10 year review
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Article Published

• Injury Prevention, 10/04
• Injury Control and Safety Promotion 12/04 (to be
  published)
• History
• Mission
• Participants
• Current projects
• Other ICE related projects

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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

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Other projects

• Frameworks for presenting injury mortality data
• Barell Injury Diagnosis Matrix
• ICECI technical assistance
• Definition of injury (ongoing??)

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Injury Severity
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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

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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

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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 doesnt recognize new
  codes
• ICD-10 CM doesnt yet have an implementation date
  and there is no new ICDMAP based on ICD-10
• ICD codes used for mortality data often lack
  specificity

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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?

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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

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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

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Optimism.

• Incorporate ICISS into administrative data
• Retain AIS for trauma and for measuring threat
  to function
• Add ?? to mortality file

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Multiple cause mortality data from NCHSNational
Vital Statistics System
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• 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?

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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)

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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

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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

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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!

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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

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New Death CertificatesTransportation questions
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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)

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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 TRANSPOR
TATION 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
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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)

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Coming soon
National Trendsin Injury Hospitalizations,1979-2
001
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www.cdc.gov/nchs/injury.htm