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Classification of death and injury due to terrorism. Lois A. Fingerhut & NCHS Colleagues…. May, 2002 National Center for Health Statistics, CDC. NCHS Colleagues…. Donna Pickett Donna Hoyert Donna Glenn Harry Rosenberg Bob Anderson Cathy Burt, Bob Pokras, Amy Blum
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Classification of death and injury due to terrorism Lois A. Fingerhut & NCHS Colleagues…. May, 2002 National Center for Health Statistics, CDC
NCHS Colleagues…. • Donna Pickett • Donna Hoyert • Donna Glenn • Harry Rosenberg • Bob Anderson • Cathy Burt, Bob Pokras, Amy Blum • Mary Anne Freedman,Marjorie Greenberg, Ed Hunter • Office of the Center Director, NCHS
Proposal circulated to: • Department of Justice- FBI • Department of Justice- Bureau of Justice Statistics • Centers within CDC • WHO: • Mortality Reference Group • WHO Update Reference Committee • Heads of WHO Collaborating Centres for the Classification of Diseases • Individuals developing the National Violent Death Reporting System • Injury Control and Emergency Health Services Section of the American Public Health Association • President of the National Association of Medical Examiners
FBI definition of terrorism • “…the unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objectives.” • Code of Federal Regulations (28 C.F.R. Section 0.85)
Classification guidance.. • Neither medical examiners nor medical record coders will be responsible for determining whether or not a death or injury resulted from terrorism. • All decisions will be made by ‘the federal government’ (FBI). • This will be more difficult for morbidity data if an “event” is labeled “terrorist” after the fact.
Guidelines for Mortality • Classify terrorism with new ICD-10 codes for mortality and tabulate as an underlying cause of death within the categories of homicide or suicide, as appropriate. • Place terrorism-related ICD-10 codes for mortality in the “U” Chapter of ICD-10, which has been reserved for “future additions and changes and for possible interim classifications to solve difficulties arising at the national and international levels between revisions.”
Guidelines for Mortality • New ICD-10 terrorism codes for mortality are to be tabulated for statistical purposes within the category of homicide, thus expanding the current codes from X85-Y09, Y87.1 to include *U01 and *U02. • ICD-10 Codes *U03.1 and *U03.9 are to be tabulated for statistical purposes within the category of suicide, expanding the current codes from X60-X84, Y87.0 to include *U03.
Guidelines for Mortality • Use ICD-10 code(s) Y08- Assault by other specified means, or Y09- Assault (homicide) by unspecified means, or X83 or X84, Intentional self-harm (suicide) by other specified or unspecified means, respectively for deaths for which terrorism has not been established at the time the death certificate is initially filed.
New terrorism ICD-10 codes for mortality • *U01 Terrorism • *U01.0 Terrorism involving explosion of marine weapons • *U01.1 Terrorism involving destruction of aircraft • *U01.2 Terrorism involving other explosions and fragments • *U01.3 Terrorism involving fires, conflagration and hot substances • *U01.4 Terrorism involving firearms • *U01.5 Terrorism involving nuclear weapons • *U01.6 Terrorism involving biological weapons • *U01.7 Terrorism involving chemical weapons • *U01.8 Terrorism, other specified • *U01.9 Terrorism, unspecified
New terrorism codes… • *U02 Sequelae of terrorism • *U03 Terrorism • *U03.0 Terrorism involving explosions and fragments • *U03.9 Terrorism by other and unspecified means
Illustration of inclusion terms • *U01.7 Terrorism involving chemical weapons • Gases, fumes and chemicals • Hydrogen cyanide • Phosgene • Sarin
Current Accidents (unintentional injuries) (V01-X59, Y85-Y86) Transport accidents (V01-V99, Y85) “ “ “ Intentional self-harm (suicide) (X60-X84, Y87.0) Intentional self-harm (suicide) by discharge of firearms (X72-X74) Intentional self-harm (suicide) by other and unspecified means and their sequelae (X60-X71, X75-X85, Y87.0) Assault (homicide) (X85-Y09, Y87.1) Assault (homicide) by discharge of firearms ( X93-X95) Assault (homicide) by other and unspecified means and their sequelae (X85-X92, X96-Y09, Y87.1) Legal intervention (Y35, Y89.0) Plus terrorism codes Accidents (unintentional injuries) (V01-X59, Y85-Y86) Transport accidents (V01-V99, Y85) “ “ “ Intentional self-harm (suicide) (X60-X84, Y87.0, *U03) Intentional self-harm (suicide) by discharge of firearms (X72-X74) Intentional self-harm (suicide) by other and unspecified means and their sequelae (X60-X71, X75-X85, Y87.0, *U03) Assault (homicide)(X85-Y09, Y87.1, *U01-*U02) Assault (homicide) by discharge of firearms (X93-X95) Assault (homicide) by other and unspecified means and their sequelae(X85- X92, X96-Y09, Y87.1, *U01-*U02) Legal intervention (Y35, Y89.0) Selected part of 113-cause list
Implementation-Mortality • Through the Division of Vital Statistics • To State vital statistics offices for immediate implementation through an addendum to its vital statistics instruction manuals • Beginning with September 11 deaths • NCHS will recode those deaths that have not been classified using new codes • Amended tabulation lists will appear in NCHS reports for 2001 data year
Guidelines for Morbidity • Place terrorism codes for morbidity within the framework of ICD-9-CM. • Unlike the placement of the mortality codes, which are in a new chapter (“U”), the codes for morbidity are within the existing chapter for External Causes of Morbidity.
Guidelines for Morbidity • Use the new ICD-9-CM codes E979.0-E979.9 and E999.0-E999.1 for nonfatal injuries resulting from terrorism. • For statistical purposes these codes will be tabulated within the category for assault, expanding the current category from E960-E969 to include E979 and E999. • At this time, NCHS is not recommending a parallel category for self-inflicted injury.
Terrorism Codes ICD-9 CM E979, E999 • E979.0 Terrorism involving explosion of marine weapons • E979.1 Terrorism involving destruction of aircraft • E979.2 Terrorism involving other explosions and fragments • E979.3 Terrorism involving fires, conflagration, and hot substances • E979.4 Terrorism involving firearms • E979.5 Terrorism involving nuclear weapons • E979.6 Terrorism involving biological weapons • E979.7 Terrorism involving chemical weapons • E979.8 Terrorism involving other means • E979.9 Terrorism, secondary effects • E999 Late effect of injury due to war operations and terrorism • E999.0 Late effect of injury due to war operations • E999.1 Late effect of injury due to terrorism
Implementation-Morbidity • Through its Data Policy and Standards Staff • Notice to be published in the Federal Register to announce the availability of the new codes to the health care community. • Codes become effective Oct.1, 2002 • Dissemination to the American Hospital Association, the American Health Information Management Association, State health information professional organizations, book publishers, and data system vendors.
Complete documentation can be found: NCHS web site Disease Classification http://www.cdc.gov/nchs/about/otheract/icd9/terrorism_code.htm