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