A Revised ICD-10-CM Surveillance Case Definition for Injury-related Emergency Department Visits.

Background-Administrative data from medical claims are often used for injury surveillance. Effective October 1, 2015, hospitals covered by the Health Insurance Portability and Accountability Act were required to use the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) to report medical information in administrative data. In 2017, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed ICD-10-CM surveillance case definition for injuryrelated emergency department (ED) visits. At the time, ICD-10-CM coded data were not available for testing. When data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists and epidemiologists from state and local health departments to test and update the proposed definition. This report summarizes the results and presents the 2021 revised ICD-10-CM surveillance case definition.

The 2020 International Classification of Diseases, 10th Revision, Clinical Modification Injury Diagnosis Framework for Categorizing Injuries by Body Region and Nature of Injury.

Background-Injury diagnosis frameworks, or matrices, based on the International Classification of Diseases (ICD) provide standardized categories for reporting injuries by body region and nature of injury. In 2016, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed injury diagnosis matrix for use with data coded using the ICD, 10th Revision, Clinical Modification (ICD-10-CM). At the time the proposed matrix was developed, ICD-10-CM coded data were not available to evaluate the performance of the proposed matrix. As data became available, NCHS and NCIPC received recommendations from clinicians and researchers to improve the consistency and clinical applicability of categorization of codes within the matrix. This report describes the modifications made to the 2016 proposed ICD-10-CM injury diagnosis matrix and presents the final 2020 ICD-10-CM injury diagnosis matrix. Methods-Comments on the 2016 proposed matrix were received from several federal agencies, military health centers, state health departments, researchers, and others. Additionally, subject matter experts from NCHS, NCIPC, the Council of State and Territorial Epidemiologists, and others reviewed code descriptions, coding guidelines, updates to the ICD-10-CM code set, and other materials to identify possible needed changes to the 2016 proposed ICD-10-CM injury diagnosis matrix. Results-Consideration of issues raised by clinicians and researchers and from the internal review resulted in relocation of approximately 3% of the 9,000 codes in the 2016 proposed ICD-10-CM injury diagnosis matrix. These relocations generally involved changes to the assigned nature-of-injury category. Additionally, approximately 200 new injury diagnosis codes not available at the time the 2016 proposed matrix was developed were added to create the final 2020 matrix. Conclusions-The 2020 final ICD-10-CM injury diagnosis matrix provides standard categories for reporting injuries by body region and nature of injury. Use of this tool promotes consistency for comparisons across populations and over time.

An Updated International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Surveillance Case Definition for Injury Hospitalizations.

The National Center for Health Statistics (NCHS) and National Center for Injury Prevention and Control (NCIPC) have routinely collaborated with injury epidemiology partners to develop standard injury surveillance case definitions based on the International Classification of Diseases (ICD). With the transition in October 2015 to the use of the ICD, 10th Revision, Clinical Modification (ICD-10-CM) for reporting medical information in administrative claims data, NCHS and NCIPC proposed an ICD-10-CM surveillance case definition for injury hospitalizations. At the time, ICD-10-CM coded data were not readily available, and the proposed surveillance definition could not be tested using real data. As ICD-10-CM coded data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists, injury epidemiologists from state and local health departments, and the Agency for Healthcare Research and Quality to test the proposed definition. This report summarizes the findings from the testing process and describes how the findings were used to update the proposed case definition. In the updated ICD-10-CM surveillance case definition, injury hospitalizations are identified as hospitalization records with a principal diagnosis of select ICD-10-CM S, T, O, and M codes. The codes must indicate an initial encounter for active treatment of an injury or be missing encounter type information. The selection criteria exclude hospitalization records with an injury as a secondary or subsequent diagnosis (not the principal diagnosis) or that have an external cause-of-injury code but do not have an injury code as the principal diagnosis. The updated ICD-10-CM surveillance case definition for injury hospitalizations provides standardized selection criteria for monitoring differences in hospitalization rates among populations and over time.

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) External Cause-of-injury Framework for Categorizing Mechanism and Intent of Injury.

Background-External cause-of-injury frameworks, or matrices, based on the International Classification of Diseases (ICD) provide standardized categories for reporting injuries by mechanism and intent of injury. In 2014, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed external cause-of-injury matrix for use with data coded using the ICD, 10th Revision, Clinical Modification (ICD-10-CM). At the time the proposed matrix was developed, ICD-10-CM coded data were not available to evaluate the performance of the proposed matrix. When data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists and state and local health departments to evaluate the proposed matrix to identify any changes needed before finalization. This report describes the results of that evaluation. Methods-With guidance from NCHS and NCIPC, state and local injury epidemiologists from five jurisdictions analyzed their hospital discharge and emergency department administrative claims data. The epidemiologists applied the ICD-9-CM matrix to ICD-9-CM coded data and the 2014 proposed ICD-10-CM matrix to ICD-10-CM coded data for similar time periods (e.g., January through December). The numbers for each mechanism and intent category in each of the two matrices were calculated and compared, and major differences were explored. Results-Based on the findings, several adjustments were made to the original placement of codes in the 2014 proposed ICD-10-CM external cause-of-injury matrix. These changes involved codes related to Drowning/submersion, Firearm, Motor vehicle-Traffic, Overexertion, and Unspecified mechanisms. In addition, new external cause codes not available at the time the 2014 proposed matrix was developed were added to create the 2019 final matrix. Conclusions-The 2019 final ICD-10-CM external cause-of-injury matrix provides standard categories for reporting injuries by mechanism and intent of injury. Use of this tool promotes consistency for comparisons across populations and over time.

Proposed ICD-10-CM Surveillance Case Definitions for Injury Hospitalizations and Emergency Department Visits.

This report describes a collaboration between the National Center for Health Statistics and the National Center for Injury Prevention and Control to develop proposed surveillance case definitions for injury hospitalizations and emergency department (ED) visits for use with administrative data sets coded using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). The proposed ICD-10-CM surveillance case definitions were developed by applying General Equivalence Mappings to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) definitions. As with the ICD-9-CM definitions, there are slight differences between the proposed ICD-10-CM surveillance case definition for injury hospitalizations and the one for ED visits. The inclusion criteria for an injury hospitalization requires a case to have a principal diagnosis of one of the included nature-of-injury (injury diagnosis) codes. The inclusion criteria for an injury ED visit requires the case to have either a principal diagnosis of one of the included nature-of-injury codes or the presence of selected external-cause codes. The ICD-10-CM nature-of-injury and external-cause codes included in the proposed definitions are presented and caveats for use of the proposed definitions are described.

Proposed Framework for Presenting Injury Data Using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Diagnosis Codes.

Frameworks based on the International Classification of Diseases (ICD) provide injury researchers and epidemiologists with standard approaches for presenting and analyzing injury-related mortality and morbidity data. Injury diagnosis frameworks, such as the Barell Matrix for the ICD Ninth Revision, Clinical Modification (ICD-9-CM) and the Injury Mortality Diagnosis Matrix for the ICD Tenth Revision (ICD-10), categorize ICD codes into major body region (e.g., head, chest, abdomen, or extremity) by nature-of-injury (e.g., fracture, laceration, organ injury, or vascular injury) categories. In the United States, morbidity coding transitioned from ICD-9- CM to ICD-10-CM on October 1, 2015. In preparation for the use of ICD-10-CMcoded morbidity data for injury surveillance and data analysis, the National Center for Health Statistics and the National Center for Injury Prevention and Control propose an ICD-10-CM Injury Diagnosis Matrix to provide a standard approach for categorizing injuries by body region and nature of injury. This report provides a brief description of the differences between ICD-9-CM and ICD-10-CM injury diagnosis codes, introduces the proposed framework and the methods used to create it, and provides a list of additional considerations for review and comment by researchers and subjectmatter experts in injury data and surveillance.

Strategies to improve external cause-of-injury coding in state-based hospital discharge and emergency department data systems: recommendations of the CDC Workgroup for Improvement of External Cause-of-Injury Coding.

Each year, an estimated 50 million persons in the United States experience injuries that require medical attention. A substantial number of these persons are treated in an emergency department (ED) or a hospital, which collects their health-care data for administrative purposes. State-based morbidity data systems permit analysis of information on the mechanism and intent of injury through the use of external cause-of-injury coding (Ecoding). Ecoded state morbidity data can be used to monitor temporal changes and patterns in causes of unintentional injuries, assaults, and self-harm injuries and to set priorities for planning, implementing, and evaluating the effectiveness of injury-prevention programs. However, the quality of Ecoding varies substantially from state to state, which limits the usefulness of these data in certain states. This report discusses the value of using high-quality Ecoding to collect data in state-based morbidity data systems. Recommendations are provided to improve communication regarding Ecoding among stakeholders, enhance the completeness and accuracy of Ecoding, and make Ecoded data more useful for injury surveillance and prevention activities at the local, state, and federal levels. Implementing the recommendations outlined in this report should result in substantial improvements in the quality of external cause-of-injury data collected in hospital discharge and ED data systems in the United States and its territories.

Tracking the silent epidemic and educating the public: CDC's traumatic brain injury-associated activities under the TBI Act of 1996 and the Children's Health Act of 2000.

The Traumatic Brain Injury Act of 1996 and the Children's Health Act of 2000 authorized the Centers for Disease Control and Prevention to conduct several activities associated with traumatic brain injury. This article describes how the Centers for Disease Control and Prevention responded to the legislation in 2 key areas: traumatic brain injury surveillance, and education and awareness.

The CDC traumatic brain injury surveillance system: characteristics of persons aged 65 years and older hospitalized with a TBI.

OBJECTIVE: To examine the epidemiologic and clinical characteristics of older persons (ie, those aged 65-74, 75-84, and > or = 85 years) hospitalized with traumatic brain injury (TBI). METHODS: Data from the 1999 CDC 15-state TBI surveillance system were analyzed. RESULTS: In 1999, there were 17,657 persons 65 years and older hospitalized with TBI in the 15 states for an age-adjusted rate of 155.9 per 100,000 population. Rates among persons aged 65 years or older increased with age and were higher for males. Most TBIs resulted from fall- or motor vehicle (MV)-traffic-related incidents. Most older persons with TBI had an initial TBI severity of mild (73.4%); however, the proportions of both moderate and severe disability for those discharged alive and of in-hospital mortality were relatively high (23.5%, 9.7%, and 12%, respectively). Persons who fell were also more likely to have had 3 or more comorbid conditions than were those who sustained a TBI from an MV-traffic incident. CONCLUSIONS: TBI is a substantial public health problem among older persons. As the population of older persons continues to increase in the United States, the need to design and implement proven and cost-effective prevention measures that focus on the leading causes of TBI (unintentional falls and MV-traffic incidents) becomes more urgent.

Traumatic brain injury-related hospital discharges. Results from a 14-state surveillance system, 1997.

PROBLEM/CONDITION: Previous studies indicate that each year in the United States, approximately 1.5 million Americans sustain a traumatic brain injury (TBI). Of those injured, approximately one quarter million are hospitalized. Approximately one third of adults hospitalized with TBI still need help with daily activities 1 year after their discharge. REPORTING PERIOD: This report summarizes surveillance data for TBI in the United States for January-December 1997. DESCRIPTION OF THE SYSTEM: Data are from 14 states that participated in an ongoing CDC-funded TBI surveillance system. State health departments used CDC guidelines to identify TBI cases from hospital discharge data or from other statewide injury data systems. Supplementary information was abstracted from medical records. RESULTS: The overall age-adjusted TBI-related live hospital discharge rate was 69.7/100,000 population. Rates were highest for American Indians and Alaska Natives (75.3/100,000) and Blacks (74.4/100,000). The age-adjusted rate for males was approximately twice as high as for females (91.9 versus 47.7/100,000 respectively). For both sexes, the rates were highest among those aged 15-19 years and >/= 65 years. Motor-vehicle crashes, falls, and assaults were the leading causes of injury for TBI-related discharges (27.9, 22.5, and 7.3/100,000 respectively). TBI-related discharge rates for falls were highest among those aged >/= 65 years (82.3/100,000). Black males and American Indian/Alaska Native males had the highest rates of TBI attributable to assault (31.3 and 29.5 per 100,000, respectively), approximately 4 times the rate for white males. An estimated 46% of injured motor-vehicle occupants, 53% of motorcyclists, and 41% of pedal cyclists reportedly were not using personal protective equipment (PPE) (e.g., seat belts or helmets) at the time of their TBI. With regard to outcome assessed before discharge from the hospital, approximately 17% of persons hospitalized with TBI had moderate to severe disability. INTERPRETATION: Data in this report, the most extensive to date from a multistate population-based TBI surveillance system, indicate the importance of TBI as a public health problem. Population-based information regarding TBI hospitalizations can be useful in assessing the effect of prevention efforts and planning for the service needs of persons with TBI.