CDC's Short Version of
the ICECI
International
Classification of External Causes of Injury - A Pilot Test
Executive Summary
This report summarizes the findings of a pilot study to assess the
usefulness of the Centers for Disease Control and Prevention's (CDC)
short version of the International Classification of External Causes
of Injury (ICECI) in capturing external-cause-of-injury data from
hospital emergency department (ED) records. CDC's short ICECI was
designed to capture major mechanisms of injury (e.g., fall, motor
vehicle traffic crash, struck by/against, cut/pierce, fire/burn,
poisoning, firearm, and others), intent of injury, locale of the
injury incident, activity at the time of the injury, work-relatedness,
safety equipment use, consumer products involved, and a narrative
describing the circumstances of the injury incident. For this pilot
study, coders used the short ICECI data collection form to code
external-cause-of-injury data from a standard set of case scenarios
and from hospital ED records. Coded data based on the case scenarios
were then analyzed for percent agreement with a gold standard code set
(i.e., test of validity), percent agreement among coders (i.e., test
of inter-coder reliability), and percent agreement for repeated cases
for individual coders (i.e., test of intra-coder reliability). Coded
data based on hospital ED records were used to assess inter-coder
reliability, timeliness, and completeness of coded data. The study
used two independent ED surveillance systems: the Massachusetts (MA)
Department of Public Health's Emergency Department Surveillance and
Coordinated Injury Prevention Program (ED-SCIP) and the U.S. Consumer
Product Safety Commission's National Electronic Injury Surveillance
System (NEISS). The findings from this study suggest that CDC's short
ICECI can be a useful and efficient injury surveillance tool for
coding valid and reliable external-cause-of-injury data. The pilot
study also helped identify some limitations of the current version;
therefore, we plan to revise and develop a version 2.0 of CDC's short
ICECI for further testing and refinement.
We identified some important aspects of this classification system
that have implications for the further development and implementation
of the full ICECI and various short versions of the ICECI for use in
injury morbidity data systems. These aspects, which are discussed
later in the report, are listed below:
1. Protocols and instruction manuals for orientation and training
of coders and for ongoing quality assurance activities are essential
for ensuring complete and valid coding of external-cause-of-injury
data.
2. A detailed, user-friendly coding manual is necessary for
specifying the case definition, coding rules and definitions, and
guiding principles for coding.
3. The data collection instrument should make collecting and
processing short ICECI data from medical records more efficient;
electronic versions of the data collection form are needed.
4. Coding of mechanism of injury should be limited to two
mechanisms: the precipitating cause (i.e., the cause that
initiated the chain of events leading to the injury) and the
immediate cause of injury (i.e. the direct cause of the most
severe injury being treated).
5. A narrative description of the injury incident should be
included as an essential ICECI data element. Narratives can be very
helpful in conducting quality assurance reviews of assigned codes and
for capturing further details about injury-related circumstances.
6.
Training and orientation of hospital medical staff is critical to
improve the quality of information on intent of injury, mechanism of
injury, and other injury-related circumstances contained in the
medical record.
7. Proposed short ICECI data elements and code sets
should be cross-walked to the full ICECI, ICD-10, and ICD-10-CM code
sets as a measure of compatibility and cross-reference. The full ICECI
should serve as a standard coding system for all proposed short ICECIs.
Development of an injury surveillance tool like CDC's short ICECI
can provide a useful instrument for routinely capturing and coding
population-based data on external causes of injury for the large
number of injury-related cases treated in hospital emergency
departments. However, if this tool is to be useful and appropriate, it
must be consistent with existing international classification
standards for morbidity data systems. With careful planning and
development, pilot testing, and implementation efforts, this type of
surveillance tool can open new avenues for obtaining detailed data
important for both clinical practice and injury prevention efforts.
Clearly, we need to step beyond the limits of data captured using
ICD-10 external cause codes and derive compatible coding systems and
software that will allow for routine and timely capture of more
detailed data about the injury incident. Timely access to
population-based, injury-related data is critical in designing and
evaluating injury prevention programs. Because of advances in
information technology, now is the time for a concerted effort to
develop injury surveillance standards and tools.
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CDC's Short Version of the ICECI
Data Collection Form
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