The use of the international classification of disease (ICD) in its mortality and morbidity incarnations is standard across U.S. state health departments. Most state and national injury morbidity and mortality statistics are based on these rubrics and form the basis for comparisons among states and to national norms. However, state-by-state differences in case definitions (by omission or commission), bureaucratic inertia, and ignorance of the complexities of ICD classifications, have led to oversimplification, missed cases, and over-counting. The injury research and practitioner communities still lack standard ICD-based definitions of what is included and excluded as an injury event in vital statistics systems. Unless the problem is addressed, the use of newly adopted ICD-10 systems will propagate the same type of non-uniformity as that which marked the use of the ICD-9.
Injuries can be identified by 2 different major ICD sub-classifications pertaining to the nature of injury and the mechanism of injury. However, it is not well appreciated that within each both axes lie conditions that are not generally deemed as injuries, some ambiguous conditions, and that definable injuries occur outside ranges used in official reports. Furthermore, editing algorithms are applied by agencies with little or no standardization. While overall these differences may be deemed minor, in some circumstances, the process of cleaning data may unintentionally eliminate important cases of interest.
This roundtable will review ICD-based injury definitions from several states, show how data edits can change the comparability of data, and discuss how the situation might begin to be addressed on a national level.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to: 1. List three areas where the use of ICD based data systems may lead to over-reporting, under-reporting or confused reporting of injury conditions. 2. Articulate the procedures by which injury data goes from large mixed conditions databases to injury reports. 3. Identify what to look for in their own state data systems to better understand how injuries were defined there, either by commission or omission. 4. Assess the need for a national consensus on the definition of officially coded injury events
Keywords: Injury Prevention, Surveillance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.