Selecting main Injury- Discussion

1. Selecting main Injury- Discussion Cleo Rooney Office of National Statistics England

2. Main injury coding /selection • For ROUTINE mortality statistics only • From vital registration • Death certificates – • Limited information and quality • All countries with VR systems • with /out multiple cause coding

3. Main injury in routine statistics • 70 countries published main injury as well as underlying cause in ICD-9 • None did when implemented ICD-10 • US does not • Data users demand main injury statistics

4. Main injury is not the limit- • Multiple cause of death codes where available • Special / research analyses • CF underlying cause of death tabulations • And multiple cause analyses

5. Issues • Data on death certificates limited • 2/3 only 1 injury mentioned • But, more detailed information can give less useful code eg stab wound to heart, open wound of anterior chest, heamhorrage, laceration of left ventricle > other specified chest injury

6. International comparability • Time trends • Consistency • ‘Public health’ • Prevention of deaths

7. Now and future • ICD-10 – • Mend problems • ‘quick and dirty’ • ICD-11 • Evidence based • Thought through • Piloted > feasible, relevant, useful data

8. Main injury coding for mortality • Automated or manual coding • Clear, unambiguous • Certifier training • Coder training • allocation of single codes, index entries • Selection rules • Modification rules – trivial conditions, linkage, specificity, Severity or precedence

9. Severity or precedence? • Use existing rules better • coder training & materials from WHO FIC • More comprehensive measure of severity? • Data on hospital admissions and deaths before reaching hospital? • Combination codes? • Define a FEW important, relevant combinations