Hospital Hospital SeparationsSeparationsIdentification of Identification of

records for use in records for use in tabulating of tabulating of

national injury national injury datadata

Susan G. Mackenzie

Presented at the ICE meeting in Washington, September 2006

QuestionsQuestions

What approaches to identifying injury hospital separation records for national tabulation are used in different countries?

What are the results of the different approaches?

Should ICE recommend an approach?

Methods – Survey of Methods – Survey of approaches to record approaches to record

selectionselection Survey of ICE membersSurvey of ICE members

Which version of ICD is used for hospital Which version of ICD is used for hospital

separation data?separation data? Record identificationRecord identification

By Diagnosis or External cause code? or By Diagnosis or External cause code? or both?both?

All or selected?All or selected?

Tabulation by External cause?Tabulation by External cause? If yes, all or selected?If yes, all or selected?

15 responses received15 responses received

Methods – Analysis Methods – Analysis overviewoverview

Identify the different approaches Identify the different approaches used to select hospital separation used to select hospital separation records for tabulationrecords for tabulation

Apply each of the approaches to the Apply each of the approaches to the same set of hospital separation datasame set of hospital separation data

Compare the groups of records Compare the groups of records retrieved using the different retrieved using the different approachesapproaches Total numbers of recordsTotal numbers of records Numbers of particular types of injuries, Numbers of particular types of injuries,

classified by external causeclassified by external cause

Thanks for the Thanks for the informationinformation

AustraliaAustralia James Harrison James Harrison CanadaCanada Susan Mackenzie Susan Mackenzie ColombiaColombia Andrés Fandiño-Losado Andrés Fandiño-Losado Victor Hugo Victor Hugo Álvarez CastañoÁlvarez Castaño DenmarkDenmark Birthe Frimodt-Moller, Birthe Frimodt-Moller,

Jens LauritsenJens Lauritsen El Salvador El Salvador Oscar Salinas, Gerardo De Cosio Oscar Salinas, Gerardo De Cosio IsraelIsrael Limor Aharonson-Daniel Limor Aharonson-Daniel JamaicaJamaica Yvette Holder Yvette Holder The NetherlandsThe Netherlands Saakje Mulder Saakje Mulder New ZealandNew Zealand Colin Cryer, John Langley Colin Cryer, John Langley Trinidad and Tobago Roanna Morton-Williams Trinidad and Tobago Roanna Morton-Williams

BynoeBynoe United StatesUnited States Lois Fingerhut Lois Fingerhut

More thanksMore thanks

AfricaAfrica Olive KobusingyeOlive Kobusingye South AfricaSouth Africa Richard Matzopoulos Richard Matzopoulos JapanJapan Tatsuhiro YamanakaTatsuhiro Yamanaka European Union European Union Maria Segui-GomezMaria Segui-Gomez

Information from 11 countries and the EU study available for analysis

ICD version used to classify ICD version used to classify hospital separationshospital separations

ICD-10 ICD-9 ICD-9-CM ICD-10 modificationNetherlands Israel Colombia Australia

1 other EU United States Denmark Canada

5 EU El Salvador New Zealand

Jamaica

Trinidad and Tobago

16 other EU

Approaches used to identify Approaches used to identify

injury records – Diagnosisinjury records – Diagnosis Based on the principal, primary, Based on the principal, primary,

or first-listed, diagnosis code on or first-listed, diagnosis code on the recordthe record Use Use All records with any diagnosis in records with any diagnosis in

the Injury and Poisoning chapterthe Injury and Poisoning chapter Use selected records with a diagnosis Use selected records with a diagnosis

in the Injury and Poisoning chapterin the Injury and Poisoning chapter Community injuriesinjuries Trauma

Approaches used to identify Approaches used to identify injury records –External injury records –External

causecause Based on the first-listed Based on the first-listed

External cause on the recordExternal cause on the record Use Use All records with an External cause records with an External cause Use selected records with an External Use selected records with an External

causecause Exclude adverse effects (AE) Trauma

ICD codes used to identify ICD codes used to identify records for injury records for injury

hospitalization tabulationhospitalization tabulation Diagnosis codes External cause codes

All Selected All Selected

DNK AUS – community NLD CAN – trauma

COL ISR – trauma NZL CAN – Exclude AE

SLV USA – community

JAM

EU study

Methods – DatasetMethods – Dataset

Used Hospital Morbidity Database Used Hospital Morbidity Database from the Canadian Institute for from the Canadian Institute for Health InformationHealth Information

Initial selection:Initial selection: All acute care separations from one All acute care separations from one

Canadian province for fiscal year Canadian province for fiscal year 2000-01.2000-01.

N=126,217.N=126,217.

Methods – Record Methods – Record selectionselection

From the 126,217 acute care records From the 126,217 acute care records

Considered the primary diagnosis and the Considered the primary diagnosis and the first listed external cause and selected first listed external cause and selected records where:records where:

The The primary diagnosis was an injury or poisoning or poisoning (in chapter XVII of ICD-9) (in chapter XVII of ICD-9)

oror

There was an There was an external cause on the record..

14,77214,772 possible injury records were retrievedpossible injury records were retrieved

External cause on record

Present Not present

ICD

-9

ICD

-9 D

iag

no

sis

Dia

gn

os

is c

hap

ter

ch

apte

r

XV

II -

In

jury

& p

ois

on

ing

XV

II -

In

jury

& p

ois

on

ing

Oth

erO

ther

14,77214,772

04,499

(30%)

8,254

(56%)

2,019

(14%)

12,753 2,019

10,2

734,

499

14,77214,772

A B

C DC

Total records retained, by Total records retained, by approachapproach

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

DX AllDX CommunDX TraumaEC AllEC No adv effEC Trauma

Percentage of records Percentage of records retained where diagnosis is retained where diagnosis is not from the injury chapternot from the injury chapter

0

5

10

15

20

25

30

35

40

DX AllDX CommunDX TraumaEC AllEC No adv effEC Trauma

0 0 0

Distribution of non-injury Distribution of non-injury diagnoses when identification diagnoses when identification is based on external cause, by is based on external cause, by

approachapproach

0

5

10

15

20

25

30

35

40

V-cod

e

Circula

tory

Men

tal

GI

Mus

cske

l

Sympt

om

Neopl

asm

EC AllEC No AEEC Trauma

Pe

rce

nta

ge

of n

on

-inju

ry d

iagn

ose

s

ICD- 9 chapter

Numbers of all records and all Numbers of all records and all records with external causes, records with external causes,

by approachby approach

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

All records All records with externalcauses

DX AllDX CommunDX TraumaEC AllEC No adv effEC Trauma

Selected unintentional Selected unintentional external causes:external causes:Adverse effectsAdverse effects

0

500

1,000

1,500

2,000

2,500

Adverse effects

DX AllDX CommunDX TraumaEC AllEC No adv effEC Trauma

0 0

Selected external causes:Selected external causes:All records, Unintentional All records, Unintentional

injuries, fallsinjuries, falls

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

All externalcauses

All unintentional

Falls

DX AllDX CommunDX TraumaEC AllEC No adv effEC Trauma

Selected unintentional Selected unintentional external causes:external causes:

Motor vehicle traffic crashes, Motor vehicle traffic crashes, Other transport, Fire/flamesOther transport, Fire/flames

0

100

200

300

400

500

600

700

800

900

1,000

MVTC Other transport Fire/ flames

DX AllDX CommunDX TraumaEC AllEC No adv effEC Trauma

Selected unintentional Selected unintentional external causes: external causes:

Poisoning, Natural & Poisoning, Natural & environmental, (near) environmental, (near)

DrowningDrowning

0

50

100

150

200

250

300

Poisoning Natural &environmental

(near) Drowning

DX AllDX CommunDX TraumaEC AllEC No adv effEC Trauma

0

Selected unintentional Selected unintentional external causes:external causes:

Suffocation, Other foreign Suffocation, Other foreign bodiesbodies

0

20

40

60

80

100

120

140

Suffocation Other Foreign bodies

DX AllDX CommunDX TraumaEC AllEC No adv effEC Trauma

0 0

Selected external causes:Selected external causes:Other intentsOther intents

0

100

200

300

400

500

600

700

800

900

Self-inflicted Assault Undetermined

DX AllDX CommunDX Trauma EC AllEC No adv effEC Trauma

ConclusionsConclusions

There is variation between and within There is variation between and within countries in capacity to classify injury countries in capacity to classify injury diagnoses and external causes for hospital diagnoses and external causes for hospital separation recordsseparation records

Where the information is available, the Where the information is available, the selection approach used can make an selection approach used can make an important difference in the number and important difference in the number and nature of injury records retrievednature of injury records retrieved

External cause approaches generally yield External cause approaches generally yield more records than the injury diagnosis more records than the injury diagnosis approachesapproaches

QuestionsQuestions Is there a preferred selection approach?Is there a preferred selection approach? Is there value in using different selection Is there value in using different selection

approaches for different purposes approaches for different purposes Acute injury occurrenceAcute injury occurrence Total burden of injuryTotal burden of injury

IssuesIssues Diagnosis vs. external cause as primary selection?Diagnosis vs. external cause as primary selection?

or possibly a combination of diagnosis and external or possibly a combination of diagnosis and external cause?cause?

If diagnosis: All, Community, Trauma, (Other)?If diagnosis: All, Community, Trauma, (Other)? If external cause: All, All but adverse effects, Trauma, If external cause: All, All but adverse effects, Trauma,

(Other)?(Other)? If other: what?If other: what?

References References Injury Surveillance Workgroup. Consensus Injury Surveillance Workgroup. Consensus

recommendations for using hospital discharge recommendations for using hospital discharge data for injury surveillance. Marietta (GA): data for injury surveillance. Marietta (GA): State and Territorial Injury Prevention State and Territorial Injury Prevention Directors Association; 2003.Directors Association; 2003.

Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Recommended framework for presenting Recommended framework for presenting injury mortality data . MMWR 1997;46 (No. injury mortality data . MMWR 1997;46 (No. RR-14)RR-14)

Hospital separations due to injury and Hospital separations due to injury and poisoning, Australia 2001-02. Jesia Berry, poisoning, Australia 2001-02. Jesia Berry, James E. Harrison, March 2006, Australian James E. Harrison, March 2006, Australian Institute of Health and Welfare, Canberra.Institute of Health and Welfare, Canberra.