Nature and Site of Injury and Emergency Department Surveillance

Vita Barell
Ministry of Health, Israel

The nature and site of injury (ICD-9 800-999; ICD-10 S00-T98) are the clinical codes (consequences of external causes) for injury and poisoning. To date, ICE on Injury has not dealt with these diagnoses but at the September Planning Committee meeting, the issue was raised and tentative plans made to include them in a matrix of body parts by nature of injury for hospitalization data.

The sheer magnitude of hospitalized injuries, the large numbers and complex nature of multitrauma and the use of these diagnoses for assigning severity of injury make this a highly challenging task.

The number of persons visiting emergency departments for treatment of injuries is, in many countries, on the order of 10-fold the number hospitalized for injuries. Putting questions of cost aside, surveillance of injuries in the Emergency Department (ED) is a potentially rewarding activity, and many hospitals are including diagnostic codes in their computerized ED information systems. However, the character of diagnostic coding in the ED is problematic, and relates to the disposition of injured patients, i.e., whether hospitalized or sent home.

Many of those with injuries sufficiently severe to require hospitalization are not diagnosed at time of ED discharge at the level of detail required for ICD coding. While in the ED/Trauma Unit, the most severely injured are stabilized and moved on as fast as possible to definitive inpatient care units (OR, ICU, etc.). The appropriate diagnoses at that time, according to trauma surgeons, might be major chest (abdominal, head) trauma, as the specific organ(s) injured are often not yet known. These general diagnoses, of course, are not acceptable ICD codes.

Among these visiting the ED for injury and discharged home, there are many with either very minor or no signs of injury, other than pain or other minor symptoms, which are most often not ICD injury codes. [Perhaps these should be coded (ICD-10: Z04.1 - Z04.5, follow-up examination for injuries)].

ED discharge coding instructions would preferably be checked off a list by ED clerks or physicians and would therefore not necessarily be similar to instructions for inpatient discharge (coded by record room personnel).