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The ICD-10 injury diagnosis matrix: Grouping S and T codes by body region and nature of injury

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1The ICD-10 injury diagnosis matrix: 10effects.
Grouping S and T codes by body region and 11Top 10 Injury Diagnosis Categories as
nature of injury. Paul R. Jones and Bruce a function of Nature of Injury and Body
A. Lawrence Pacific Institute for Research Region. 9.1.
and Evaluation Lois A. Fingerhut National 12Incidence of Most Common Fatal Injury
Center for Health Statistics November, Diagnoses by Age and Sex. . 1. 2. 3. 4.
2004. 5. 6. 7. 8. 9. 10. 11. 12. . 50 or
2Background. ICD-10, like its younger. 50 or younger. 50 or younger.
predecessor ICD-9, contains so many Older than 50. Older than 50. Older than
detailed codes that it is often difficult 50. All ages. All ages. All ages. .
to see the forest for the trees. Female. Male. Total. Female. Male. Total.
Researchers, epidemiologists, and public Female. Male. Total. Poisoning. 20.4%.
health administrators, therefore, often 14.8%. 16.2%. 4.9%. 4.6%. 4.8%. 11.0%.
rely on various methods for grouping codes 10.9%. 10.9%. Other external effects @.
into more manageable categories. For 10.4%. 12.8%. 12.2%. 4.1%. 6.8%. 5.6%.
injury research, one of the most useful 6.5%. 10.5%. 9.1%. Unspecified injury of
tools has been the Barell Matrix (Barell head. 10.8%. 9.9%. 10.1%. 5.3%. 7.7%.
et al., 2001), which categorizes ICD-9-CM 6.6%. 7.4%. 9.0%. 8.5%. Unspecified injury
injury morbidity codes by body region and of multiple regions. 12.2%. 10.2%. 10.7%.
nature of injury. Since 1999, mortality 5.1%. 6.5%. 5.9%. 7.8%. 8.8%. 8.5%.
data have been coded in ICD-10. A Foreign body in trunk, other #. 2.5%.
successor to the Barell Matrix for use 1.4%. 1.7%. 17.5%. 14.1%. 15.7%. 11.7%.
with ICD-10 injury mortality diagnosis 6.3%. 8.1%. Open wound of head. 6.2%.
codes would be a new tool to aid 10.7%. 9.6%. 1.6%. 9.0%. 5.7%. 3.4%.
researchers and policymakers. 10.0%. 7.8%. Hip fracture. 0.1%. 0.0%.
3Background. Body Sites. Body Sites. 0.0%. 22.1%. 10.1%. 15.6%. 13.6%. 3.9%.
Body Sites. Body Sites. Body Sites. Body 7.2%. Internal injury of head & 3.6%.
Sites. Body Sites. Nature of Injury. 3.7%. 3.7%. 7.6%. 8.4%. 8.1%. 6.1%. 5.5%.
Nature of Injury. 1. Amputation. 2. Burn. 5.7%. Unspecified injury of unspecified
3. Blood Vessel. 4. Crush. 5. Dislocation. region. 6.4%. 5.4%. 5.6%. 3.6%. 4.6%.
6. Foreign Body. 7. Fracture. 8. Internal 4.2%. 4.7%. 5.1%. 5.0%. Toxic effects.
Injury. 9. Multiple. 10. Muscle/Tendon. 4.6%. 4.0%. 4.2%. 2.1%. 3.0%. 2.6%. 3.1%.
11. Nerve. 12. Open Wound. 13. Other Ext 3.6%. 3.4%. Open wound of thorax. 2.4%.
Eff. 14. Other Spec. 15. Poisoning. 16. 4.4%. 3.9%. 0.5%. 2.0%. 1.3%. 1.2%. 3.5%.
Sprain/strain. 17. Super/cont. 18. Toxic 2.7%. Unspecified injury of thorax. 2.4%.
effect. 19. Unspecified. 1. 1. Head. 20. 2.5%. 2.4%. 1.7%. 2.4%. 2.1%. 1.9%. 2.4%.
Abd+ low bk + pelv. 39. Lower ext other. 2.3%. Other. 18.1%. 20.3%. 19.8%. 23.8%.
Lower ext other. 2. 2. Face. 21. Trunk 20.6%. 22.1%. 21.6%. 20.4%. 20.8%. Total.
other. 40. Unspecified. Unspecified. 3. 3. 100.0%. 100.0%. 100.0%. 100.0%. 100.0%.
Eye. 22. Shouldr/upp arm. 41. Multi 100.0%. 100.0%. 100.0%. 100.0%. @. Mostly
regions. Multi regions. 4. 4. Neck. 23. asphyxiation and drowning. #. Mostly
Elbow. 42. Systemic. Systemic. 5. 5. associated with choking. & Brain
Head+Neck. 24. Forearm. Forearm. Forearm. injury.
Forearm. 6. 6. SC-neck. 25. Wrist/hand. 13Some injury categories were
Wrist/hand. Wrist/hand. Wrist/hand. 7. 7. concentrated in people over 50: Fractures
SC-upper back. 26. Fingers. Fingers. of the hip were especially prevalent among
Fingers. Fingers. 8. 8. SC-lower back. 27. women over 50, accounting for 22.1% of all
Upper ext mult. Upper ext mult. Upper ext injury-related deaths - the highest
mult. Upper ext mult. 9. 9. SC-other. 28. ranking category for this demographic
Upper ext other. Upper ext other. Upper group. For men over 50, hip fractures
ext other. Upper ext other. 10. 10. accounted for 10.2% of injury deaths. For
SC-Multiple. 29. Hip. Hip. Hip. 11. 11. people under 50, however, hip fracture
VC-neck. 30. Thigh. Thigh. Thigh. 12. 12. deaths were almost nonexistent. Foreign
VC-upper back. 31. Hip + thigh. Hip + body in the trunk accounted for 15.7% of
thigh. Hip + thigh. Hip + thigh. 13. 13. all injury deaths of people over 50, but
VC-lower back. 32. Upp leg + thigh. Upp only 1.7% for those 50 or under. These are
leg + thigh. Upp leg + thigh. Upp leg + mostly choking deaths. Internal injuries
thigh. 14. 14. VC-lower back + pelv. 33. of the head (brain injuries) accounted for
Knee. Knee. Knee. 15. 15. VC-other. 34. 8.1% of injury deaths of people over 50,
Lower leg. Lower leg. Lower leg. Lower but only 3.7% for ages 50 and under.
leg. 16. 16. Thorax. 35. Foot. Foot. Foot. 14Other fatal injury categories were
17. 17. Abdomen. 36. Ankle. Ankle. Ankle. more common among people 50 and under:
18. 18. Pelvis. 37. Ankle + foot. Ankle + Among people age 50 or less, the biggest
foot. Ankle + foot. Ankle + foot. 19. 19. fatal injury category was poisoning,
Lower back + pelv. 38. Toes. Toes. Toes. which, together with toxic effects,
4Coding and Validating the Algorithm. A accounted for 20.3% of all injury deaths.
draft of the ICD-10 injury diagnosis Poisoning and toxic effects were more
matrix was first provided by Lois A. prevalent among women (25.0%) than among
Fingerhut (NCHS). That draft was based on men (18.8%). They were less common among
earlier work by Richard Hockey in people over 50 (7.4%). Other external
Australia. The matrix classifies all effects (mostly drowning and asphyxiation)
injury ‘S’ and ‘T’ codes by body region accounted for 12.2% of injury deaths among
and nature of injury. With 19 those 50 or under, but only 5.6% among
nature-of-injury categories and 42 those over 50. Unspecified injuries of
body-region categories, it is somewhat multiple regions accounted for 10.7% of
more detailed than the original Barell injury deaths among those 50 or less, but
Matrix. Like the original, it also only 5.9% among those over 50.
provides for collapsing the body regions 15Other fatal injury categories were
into broader categories. PIRE translated more common among people 50 and under
the matrix into a SAS algorithm, which can (continued): Unspecified head injuries
operate on any valid ICD-10 S or T code. accounted for 10.1% of injury deaths among
5In order to validate the algorithm, we those 50 or less, but only 6.6% among
first tested it against the ICD-10 coded those over 50. Open wounds were more
Multiple Cause of Death (MCOD) data for common among males than females. Open
2000. For records containing an injury wounds of the head accounted for 10.0% of
diagnosis (i.e., an S or T code), we injury deaths among men and 3.4% among
selected the injury diagnosis from the women. Open wounds of the thorax accounted
entity axis assigned by the death for 3.5% of injury deaths among men and
certificate as the earliest injury 1.2% among women.
diagnosis in the chain of causes leading 165.4% of injury death certificates
to death. We ran this classifying lacked any injury diagnoses. Some coroners
diagnosis (Dx0) through our algorithm. The and MEs follow the convention (which is
algorithm successfully assigned permitted by coding rules) of letting a
nature-of-injury and body-region codes to cause code represent the injury without
each case. any accompanying injury diagnosis code. Of
6Data & Methods. We next applied the cases with at least one injury
the algorithm to the 1999-2001 MCOD data. diagnosis code (the sub-sample used
We selected all cases with at least one elsewhere in this study), 70.3% had a
injury diagnosis on the record axis. This single injury diagnosis 19.6% had two
gave us 540,748 cases, which broke down by injury diagnoses 6.4% had three injury
age and sex as follows: AGE. AGE. SEX. diagnoses, and 3.6% had four or more
SEX. SEX. Female. Male. Total. 50 or injury diagnoses. Internal organ injuries
younger. 71,959 (13.3%). 218,909 (40.5%). of the head (i.e., brain injuries) and
290,868 (53.8%). Over 50. 113,097 (20.9%). unspecified injuries of the thorax were
136,783 (25.3%). 249,880 (46.2%). Total. especially likely to be accompanied by at
185,056 (34.2%). 355,692 (65.8%). 540,748 least one other injury diagnosis (51.1%
(100.0%). and 56.5%, respectively).
7For every injury death, we applied the 17Discussion. This exercise gave a
algorithm to each injury diagnosis on the clearer picture of a known weakness of
record axis (except superficial injuries, ICD-10 coded data - the heavy reliance on
which were judged to be unlikely to cause “multiple” and “unspecified” categories
death). In order to avoid double counting that are of little use to researchers. In
deaths with multiple injury diagnoses, we our injury-coded data, 31.5% of deaths
gave each diagnosis a weight equal to the with injury diagnoses have a multiple or
reciprocal of the number of injury unspecified code for either the nature of
diagnoses on the record. Example: a death injury or the body region, and 13.6% have
that involved a head fracture and a both.
crushed thorax would be counted as half a 18Conclusion. The SAS algorithm
death from head fracture and half a death successfully assigned body region and
from crushed thorax. By diagnosis matrix nature of injury classifications to a
cell, we then computed the weighted multi-year ICD-10 coded mortality dataset.
numbers of cases across all injury deaths. This new injury diagnosis matrix and the
8Results. Top 5 Nature of Injury SAS algorithm that embodies it will
Categories Top 5 Body Region Categories constitute a useful tool for the
Top 10 Injury Diagnosis Categories as a description and analysis of fatal injury
function of Nature of Injury and Body data. The matrix will serve as an initial
Region. injury classification benchmark for ICD-10
9Top 5 Nature of Injury Categories. (and, later, during the transition to
Remaining Categories 24.3%. Unspecified ICD-10-CM coding for medical data).
Injury 26.1%. Other External Effects1 19The algorithm proved robust against a
9.1%. Open Wound 15.8%. Poisoning 10.9%. large mortality dataset that could
Fracture 13.8%. Note. 1 = E.g., reasonably be expected to provide a
asphyxiation, drowning. sufficient test, but it should be
10Top 5 Body Region Categories. Multiple validated against other datasets before
Regions 10.2%. Remaining Categories 24.9%. being widely circulated. The heavy use of
Systemic1 23.5%. Unspecified Region 8.3%. “multiple” and “unspecified” diagnoses
Head 23.7%. Trunk, Other 9.4%. Note. 1 = will be a challenge to those using these
E.g., foreign body, poisoning, external ICD-10 coded data for injury research.
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The ICD-10 injury diagnosis matrix: Grouping S and T codes by body region and nature of injury

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