International Classification of the External Causes of Injury: ICECI

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International Classification of the External Causes of Injury: ICECI

How can injuries best bedescribed? Need set of classifications for injurysurveillance Precisely define the domain of injuries Answer questions on the circumstancesof injuries Provide more information on specificinjury categories, such as occupationalinjuries or scald burns


What has been used? International Classification of DiseasesExternal Codes (ICD E codes)• Versions 9 and 10• Lack scope and specificity ICECI can be used to complement ICD10 E codes• Comparability for cause (mechanism) andintent of injury


What is the history of ICECI? WHO coordinated efforts of injuryprevention specialists worldwide• Scandinavia and Western Europe• Australia• United States First draft (ICECI 1.0) released in 1999 Current version (1.2) released July 2004


Guide to Use ICECI is “pick and choose” multiaxialclassification system Series of recommended data elements• Collect info about variety of external causerelated topics• Varying detail Number of data elements, modules anddetails can be tailored to each site


How does ICECI work? Interface with NTRACS• Demographics• Severity and outcome of injury Six major modules• Seven core modules Burden of collection• Reduced case collection• Reduced record completion• Reduced reliability of data & codes


Module Codes C – Core Module V – Violence Module T – Transport Module P – Place Module S – Sports Module O – Occupational Module


Contents of Core Module C1 Intent C2 Mechanism (full)• M1 Mechanism (short) C3 Object/Substance C4 Place C5 Activity C6 Alcohol Use C7 Drug Use


Core Set of Data Elements Code designations for modules and dataelements provide unique identifiers forelements of ICECI Intent and Mechanism of Injury arecritical elements for injury matrix(CDC) and comparability with ICD-10• Place of Occurrence and Activity whileInjured are next level


Contents of Core Module C1 Intent C2 Mechanism (full)• M1 Mechanism (short) C3 Object/Substance C4 Place C5 Activity C6 Alcohol Use C7 Drug Use


Additional Modules Violence ( (supplementsC1 Intent) Transport ( (supp.C2/M1 Mechanism) Place ( (supp.C4 Place) Sports ( (supp.C5 Activity) Occupational ( (supp.C5Activity)


Intent C11. Unintentional, including accidental2. Intentional self-harm3. Assault4. Other violence, including legal intervention and war5. Undetermined intent6. Medical/surgical complications7. Euthenasia8. Injury from unknown mechanismMore details in Violence module.


Mechanism of Injury C2 Defined as the way in which the injurywas sustained. Physical injury results when tissue isacutely exposed to some form of energyand sustains some form of damage.• Also results from insufficiency of vitalelements (drowning, freezing) More details in Transport module.


Types of Mechanisms C2 Injuries are often the result of a sequence ofevents.• Underlying mechanism occurs at the start of theevent.• Direct mechanism produces the harm to tissues.• Intermediate mechanisms are involved in-between. Direct and underlying may be the same• Laceration on finger from knife while preparingfood. Underlying is coded first, direct second.• Transport module allows for 4 more elements.


Thermal Mechanisms C24.1 Heating4.1.1 hot liquids, steam, or gas4.1.2 contact with hot object4.1.3. contact with fire or flame4.1.5 man-made made overheating4.1.6 inhalation of smoke from burning objector substance4.2 Cooling4.2.1 Natural source4.2.2 Man-made source


Thermal Mechanisms M14.1 Contact with hot object/subtanceorhot liquid/gas4.2 Contact with fire or flame (includingsmoke inhalation)4.3 Other thermal


98.2 Exposure to Electricity andRadiation98.2.1 exposure to electric current98.2.2 exposure to welding arc/light98.2.3 exposure to man-made made visible andUV light98.2.4 exposure to sun-light98.2.5 exposure to non-ionizing radiation


Object/SubstanceProducing Injury C3 Defined as matter, material or thing beinginvolved in the injury event An object (e.g. car, heater, knife) orsubstance (hot water, flames) conveys themechanism of an injury• Underlying object/substance—starts starts sequence• Direct object/substance—produces physical harm• Intermediate object(s)/substance(s) Again, underlying and direct may be identical Similar to mechanism, can code up to three:underlying, direct and intermediate


Object/SubstanceProducing Injury C3 Complicated mechanisms/objects• Woman trips on appliance cord in kitchen,dislodging hot grease in frying pan onto floor, slipson grease and strikes head against counter,sustaining SDH• Underlying mechanism/object is tripping onappliance cord• Direct mechanism/object is striking head oncounter• Intermediates include frying pan with grease (maybe responsible for a separate set of injuries)


Object/Substance ProducingInjury C3----codes1. Land vehicle2. Mobile machinery3. Watercraft4. Aircraft5. Furniture6. Infant/child product7. Household appliance8. Utensil or container9. Personal items10. Sports items11. Work tools & machines12. Weapons13. Animal, plant, person14. Building15. Ground surface16. Material NEC17. Fire, flame or smoke18. Hot object/substance19. Food or drink20. Drugs & medicine21. Non-pharmdrugs40. Med/surgdevice98. Other specified99. unspecified


Object/Substance ProducingInjury C3----codes5 Furniture/furnishing5.01 Bed, bedding or bedding acces.5.02 Chair, sofa5.03 Table, stand, cupboard, shelf5.04 Decoration5.98 Other specified furniture5.99 Other unspecified furniture


Object/Substance ProducingInjury C3----codes17 Fire, flame, or smoke17.01 fire or flame17.02 smoke17.99 unspecified18 Hot object/substance18.01 hot liquid18.02 hot air or gas18.98 other specified18.99 unspecified


Place of Occurrence C4 Defined as where the injured personwas when the injury event started• Selected as whole rather than part ofentity (city park vs. swimming pool)• Includes attached grounds and outbuildings(garden, garage, storage shed, parking lot) More details in Place module.


Place of Occurrence C41. Home2. Residentialinstitution3. Medical service4. School5. Sports area6. Street, hwy, rd7. Other transportarea8. Industrial orconstruction area9. Farm or ranch10. Recreational area11. Commercial area12. Countryside98. Other specified99. unspecified


Activity When Injured C5 Defined as the type of activity in whichthe injured person was engaged at thetime of injury• Determine area of responsibility and mainpurpose of activity Educational vs. sports Occupational vs. traffic Sports vs. leisure More details in Sports and Occupationalmodules.


Activity When Injured C5----codes1. Paid work2. Unpaid work3. Education4. Sports/exercise during leisure5. Leisure or play6. Vital activity7. Being taken care of8. Traveling98. Other specified99. unspecified


Activity When Injured C5----codes2 Unpaid work2.1 traveling to/from work2.2 traveling during work2.8 other specified• Food preparation2.9 unspecified


Alcohol Use C6 Defined as suspicion or evidence ofalcohol use preceding the injury eventby the injured person and by othersinvolved• Suspicion (e.g. AOB) is sufficient


Alcohol Use C61. No information available2. No suspicion/evidence of alcohol use3. Suspicion/evidence of alcohol use byinjured person4. Suspicion/evidence of alcohol use byother persons5. Suspicion/evidence of alcohol use byboth parties


Psychoactive Drug orSubstance Use C7 Definition, context, and codes identicalto alcohol use C6


Proposed Project Complete database tool Submit to testing at alpha site (UNC) Submit to testing at beta sites—process evaluation• Collaborative effort within ABA• Collaboration with UNC IPRC Incorporation into National BurnRegistry of ABA


Contact Information Michael Peck• mpeck@med.unc.edu• 919-260260-4017

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