Lois A. Fingerhut

An introduction to the Barell body region by nature of injury diagnosis matrix

Introduction: The Barell body region by nature of injury diagnosis matrix standardizes data selection and reports, using a two dimensional array (matrix) that includes all International Classification of Diseases (ICD)-9-CM codes describing trauma. Aim: To provide a standard format for reports from trauma registries, hospital discharge data systems, emergency department data systems, or other sources of non-fatal injury data. This tool could also be used to characterize the patterns of injury using a manageable number of clinically meaningful diagnostic categories and to serve as a standard for casemix comparison across time and place. Concept: The matrix displays 12 nature of injury columns and 36 body region rows placing each ICD-9-CM code in the range from 800 to 995 in a unique cell location in the matrix. Each cell includes the codes associated with a given injury. The matrix rows and columns can easily be collapsed to get broader groupings or expanded if more specific sites are required. The current matrix offers three standard levels of detail through predefined collapsing of body regions from 36 rows to nine rows to five rows. Matrix development: This paper presents stages in the development and the major concepts and properties of the matrix, using data from the Israeli national trauma registry, and from the US National Hospital Discharge Survey. The matrix introduces new ideas such as the separation of traumatic brain injury (TBI), into three types. Injuries to the eye have been separated from other facial injuries. Other head injuries such as open wounds and burns were categorized separately. Injuries to the spinal cord and spinal column were also separated as are the abdomen and pelvis. Extremities have been divided into upper and lower with a further subdivision into more specific regions. Hip fractures were separated from other lower extremity fractures. Forthcoming developments: The matrix will be used for the development of standard methods for the analysis of multiple injuries and the creation of patient injury profiles. To meet the growing use of ICD-10 and to be applicable to a wider range of countries, the matrix will be translated to ICD-10 and eventually to ICD-10-CM. Conclusion: The Barell injury diagnosis matrix has the potential to serve as a basic tool in epidemiological and clinical analyses of injury data.

Injuries at Work in the US Adult Population: Contributions to the Total Injury Burden

OBJECTIVES We estimated the contribution of nonfatal work-related injuries on the injury burden among working-age adults (aged 18-64 years) in the United States. METHODS We used the 1997-1999 National Health Interview Survey (NHIS) to estimate injury rates and proportions of work-related vs non-work-related injuries. RESULTS An estimated 19.4 million medically treated injuries occurred annually to working-age adults (11.7 episodes per 100 persons; 95% confidence interval [CI]=11.3, 12.1); 29%, or 5.5 million (4.5 per 100 persons; 95% CI=4.2, 4.7), occurred at work and varied by gender, age, and race/ethnicity. Among employed persons, 38% of injuries occurred at work, and among employed men aged 55-64 years, 49% of injuries occurred at work. CONCLUSIONS Injuries at work comprise a substantial part of the injury burden, accounting for nearly half of all injuries in some age groups. The NHIS provides an important source of population-based data with which to determine the work relatedness of injuries. Study estimates of days away from work after injury were 1.8 times higher than the Bureau of Labor Statistics (BLS) workplace-based estimates and 1.4 times as high as BLS estimates for private industry. The prominence of occupational injuries among injuries to working-age adults reinforces the need to examine workplace conditions in efforts to reduce the societal impact of injuries.

The effects of recall on reporting injury and poisoning episodes in the National Health Interview Survey

Objective: To examine effects of length of time between injury or poisoning and interview on the number of reported injury and poisoning episodes in the National Health Interview Survey (NHIS). (Hereinafter, both injuries and poisonings will be referred to as “injuries”.) Design: The NHIS collects data continuously on medically attended injuries occurring to family members during the three months before interview. Time between injury and interview was established by subtracting the reported injury date from the interview date. Values were multiply imputed for the 25% of the episodes for which dates were only partially reported. Main outcome measures: An analysis of mean square error (MSE) was used to quantify the extent of errors in estimated annual numbers of injuries and to compare the contributions of bias and variance to these errors. Results: The lowest estimated MSEs for annualized estimates for all injuries and for less severe injuries were attained when the annualized estimates were based on 3–6 elapsed cumulative weeks between injury and interview. The average weighted number of injuries reported per week per year was 8% lower in later weeks (weeks 6–13) than in earlier weeks (weeks 1–5) for all episodes, and 24% lower in later weeks than in earlier weeks for contusions/superficial injuries, with both differences being statistically significant. For fractures, however, the averages in the two periods were statistically similar. Conclusions: The error associated with the estimated annual number of injuries was large with a three month reference period for all injuries and for less severe injuries. Limiting analysis to episodes with up to five weeks between injury and interview has statistical, intuitive, and analytic appeal for all injuries and for less severe injuries.

Mortality among children and youth.

All of the US mortality data in this report are for the 50 States and the District of Columbia and are based on data from death certificates provided by State and city vital statistics offices to the National Center for Health Statistics (NCHS) (or to its predecessor agencies). Data for eight other industrialized nations are also included, based on tabulations provided by the World Health Organization individual country reports, and selected detailed studies

Classifying External Causes of Injury: History, Current Approaches, and Future Directions

The International Classification of Diseases (ICD) is used to categorize diseases, injuries, and external causes of injury, and it is a key epidemiologic tool enabling storage and retrieval of data from health and vital records to produce core international mortality and morbidity statistics. The ICD is updated periodically to ensure the classification system remains current, and work is now under way to develop the next revision, ICD-11. It has been almost 20 years since the last ICD edition was published and over 60 years since the last substantial structural revision of the external causes chapter. Revision of such a critical tool requires transparency and documentation to ensure that changes made to the classification system are recorded comprehensively for future reference. In this paper, the authors provide a history of the development of external causes classification and outline the external cause structure. They discuss approaches to manage ICD-10 deficiencies and outline the ICD-11 revision approach regarding the development of, rationale for, and implications of proposed changes to the chapter. Through improved capture of external cause concepts in ICD-11, a stronger evidence base will be available to inform injury prevention, treatment, rehabilitation, and policy initiatives to ultimately contribute to a reduction in injury morbidity and mortality.

ADDRESSING THE GROWING BURDEN OF TRAUMA AND INJURY IN LOW- AND MIDDLE-INCOME COUNTRIES

In “Addressing the Growing Burden of Trauma and Injury in Low- and Middle-Income Countries,” Hofman et al. report on a meeting sponsored by the National Institutes of Health (NIH).1 The article acknowledges some work by the Centers for Disease Control and Prevention (CDC) but neglects to acknowledge an international activity sponsored by the CDC’s National Center for Health Statistics and cofunded by NIH’s National Institute of Child Health and Human Development.

Injury mortality indicators: recommendations from the International Collaborative Effort on Injury Statistics

Background The International Collaborative Effort (ICE) on Injury Statistics called for an effort ‘to reach consensus on what are the 10 most important indicators of injury incidence that offer the potential for international comparisons and for regional or global monitoring.’ Objectives To describe the process of developing the ICE indicators and to present the specifications of selected injury mortality indicators, along with comparisons between selected countries for those specified indicators. Methods Participants on the ICE list had been asked to send to one of the authors what they considered the most important five indicators of injury incidence. These were synthesised and presented under six themes: mortality indicators (general); mortality indicators (motor vehicle); mortality indicators (other); hospital data-based (overall); hospital data-based (traumatic brain injury (TBI)); long-term disability (overall). Following two work group discussions and after drafting and revising indicator specifications, agreement was reached on mortality indicators and specifications. Specifications for those mortality indicators are presented. Morbidity indicators are still to be agreed. Results The mortality indicators proposed were age-adjusted rates of injury death; motor vehicle traffic crash-related death; self-harm/suicide; assault/homicide; and TBI death. The empirical work highlighted difficulties in identifying TBI in countries where mortality data do not capture multiple injuries, prompting us to drop the mortality indicator related to TBI and moving us instead to introduce an indicator to monitor the use of undetermined intent in the classification of injury mortality. Conclusion The ICE has reached a consensus on what injury mortality indicators should be used for comparison between countries. Specifications for each of these have been applied successfully to the mortality data of seven countries.

The global injury mortality data collection of the Global Burden of Disease Injury Expert Group: a publicly accessible research tool

a publicly accessible research tool Kavi Bhalla*, James E. Harrison, Lois A. Fingerhut, Saeid Shahraz, Jerry Abraham and Pon-Hsiu Yeh; on behalf of the Global Burden of Disease Injury Expert Group Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; Research Center for Injury Studies, Flinders University, Adelaide, Australia; Independent Researcher, Washington, USA