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APHA Scientific Session and Event Listing

Margaret Warner, PhD¹, Lois Fingerhut, MA², and Li-Hui Chen, MS, PhD¹. (1) Office of Analysis and Epidemiology, National Center for Health Statistics (CDC), 3311 Toledo Rd., Room 6424, Hyattsville, MD 20782, 301 458 4556, MWarner@cdc.gov, (2) Office of Analysis and Epidemiology, National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782

This project addresses how to rank severity among the injuries listed in the mortality file -- a critical aspect of the proposed revisions to the ICD-10 guidelines for selecting a main fatal injury. The Barell Matrix and the Injury Mortality Diagnosis (IMD) matrix for categorizing diagnoses by body region and nature of injury were used as a bridge between morbidity data (ICD-9-CM) and mortality data (ICD-10) in determining survival risk ratios (SRR) by groups of ICD codes.

The Barell Matrix was modified to be comparable to the IMD matrix. All injury diagnoses from those with a first-listed injury diagnosis from the National Hospital Discharge Survey for 2000-2004 were assigned to the modified Barell. A SRR was calculated for each cell (i.e. body region by nature): SRRcell= Acell/(Acell + Dcell), where Acell = number discharged alive & Dcell = number of who died in the hospital. Other methods of calculating SRRs are discussed.

The body regions with the highest mortality (i.e. low SRR) were traumatic brain injuries (TBI, SRR=.92) and abdomen (SRR=.90). By nature of injury, blood vessels (SRR= .91) and internal injuries (SRR= .93) had the highest mortality. SRRs were lower for specific matrix cells (i.e. body region by nature).

Limitations: (1) deaths occurring outside the hospital are not considered; (2)in multiple trauma cases, the SRRs are contaminated by the presence of outcomes from other injuries and (3) severity refers only to the threat to life.

Learning Objectives:

• Participants should be able to describe how fatal injury diagnosis data are presented in the multiple cause of death file
• Participants should be able to describe current methods of assigning severity to injury diagnoses.
• Participants should be able to describe an Survival Risk Ratio and how it is calculated

Keywords: Methodology, Surveillance

Related Web page: www.cdc.gov/nchs/injury.htm

Presenting author's disclosure statement:

Any relevant financial relationships? No