The ISS coding manual

159 Pages·2003·0.46 MB·English

THE INJURY SURVEILLANCE
SYSTEM AT EMERGENCY
DEPARTMENTS:
THE ISS CODING MANUAL
DATA DICTIONARY
VERSION 1.0 – SEPTEMBER 2003
Published by:
Consumer Safety Institute
P.O. Box 75169
1070 AD Amsterdam
The Netherlands
Telephone: [phone]
Fax: [phone]
E-mail: [e-mail]
Website: www.consafe.nl
Funding:
European Commission, Directorate General for Health and Consumer Protection
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CONTENTS
PART A
Introduction 7
Background 7
Basic sources for developing the manual 7
Guide for use 8
Update of Information 8
References 9
Annex 1 Data elements included in the ISS coding manual and their source 10
PART B
Data Elements
Country code 11
Hospital number 16
Case number 17
Age of patient 18
Sex of patient 19
Date of birth 20
Date of injury 21
Time of injury 22
Date of attendance 23
Time of attendance 24
Date of discharge 25
Treatment and follow up 26
Intent 28
Place of occurrence 31
Mechanism of injury 47
Activity when injured 64
Type of sport/exercise activity 72
Type of injury 81
Part of the body injured 84
Narrative 89
Object/substance producing injury 90
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INTRODUCTION
Background
Surveillance of injuries is essential for priority setting and for preventive interventions. The European
Union has a long history of Emergency Department based injury surveillance. These data are the
basis for several actions concerning injury prevention.
This new Injury Surveillance System (ISS) is meant to record information at (a selection of)
Emergency Departments within the European Union on all accidents/injuries attending this
department: an all injury coding manual. Therefore, the ISS coding manual contributes to the
standardisation of injury and accident surveillance in the European Union: it is the basis for
comparability of injury data from different member states.
For the future of Emergency Department injury surveillance it is essential to link as much as possible
with relevant standard classifications in health care. The International Statistical Classification of
Diseases and Related Health Problems (ICD) is the basic classification within health care, but does
not provide enough detail for injury prevention.1,2 The International Classification of External Causes of
Injuries (ICECI) is linked to the ICD and acknowledged by the World Health Organization (WHO) as
special classification complementary to ICD. Therefore, ICECI was the major guideline for developing
the ISS coding manual.
Basic sources for developing the manual
The ISS coding manual is based on data elements and codes from three sources:
- ICECI,3 a WHO classification for the external causes of injuries with an alpha status, subject to
formal procedures for acceptance as related classification within the WHO Family of International
Classifications (www.iceci.org).
- the Home and Leisure Accidents V2000 coding manual,4 used for recording home and leisure
accident data for the former European Home and Leisure Accident Surveillance System (EHLASS)
(http://servinfo.citi2.fr/ehlid).
- the Minimum Data Sets on Injuries (MDS-Is),5 developed under the auspices of the European
Commission and meant to record information on accidents/injuries in less resourced (as far as
information or money is concerned) settings (www.iceci.org/csi/iceci.nsf/pages/Ca?OpenDocument).
The data elements relevant for the ISS-coding manual on injuries were selected from all three
sources:
- ICECI version 1.1a: data elements related to the external causes
- HLA V2000: additional data elements needed for injury surveillance: patient data, follow-up,
administrative data, narrative
- MDS-Is: type of injury and body part
The selected data-elements and their source are described in Annex 1.
The permissible values (the actual codes including the description) were based on all three sources,
guided by the level of detail to be able to be collected at Emergency Departments (mainly based on
past experience with EHLASS). The common rule was that the source that was the basis for selecting
the data element was the basis for the codes to be included, but taking into account the possible level
of detail. The lay-out and the actual codes were based on ICECI 1.1a.
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Guide for use
The ISS manual is especially designed to record basic accident and injury data at Emergency
Departments (at a level of detail that is on average possible). If for more detailed information is
needed for specific accident or injury categories (like occupational accidents), one of the modules of
ICECI can be added to the coding manual.
The ISS coding manual contains 20 data elements and a narrative. In most of these data elements
there is hierarchy. The first part of the code corresponds to the information at the first level, while the
second and/or third part specifies the information given at the first and second part, respectively. This
hierarchy means that codes on a more detailed level can be aggregated to a lesser level of detail. This
means that the level of detail to be recorded for each data element can be selected to meet local
needs and resources. This hierarchical structure ensures consistency of all applications at the basic
level.
The guiding rules are explicitly mentioned in the text of the data elements. In general, these rules
follow the ICD coding rules. An important general guideline is to code the ‘direct’ cause instead of the
‘underlying’ cause. More information about this guidance can be found in the relevant sections of the
data elements.
Update of information
The ISS coding manual will be made available on the website of ICECI (www.iceci.org) and on the
website of the European Commission (http://europa.eu.int). The ISS coding manual can be regarded
as a derivative from ICECI with additional elements. That means that part of the maintenance of the
ISS coding manual will be carried out in conjunction with the ICECI maintenance procedures, together
with experts using the ISS coding manual.
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REFERENCES
1. WHO, World Health Organization. International Classification of Diseases, injuries and causes of
death: 9th revision. Geneva: World Health Organization; 1977.
2. WHO, World Health Organization. International Statistical Classification of Diseases and Related
Health Problems: Tenth Revision: Volume 1, tabular list (ICD-10). Geneva: World Health
Organization; 1992.
3. WHO Working Group on Injury Surveillance Methods. International Classification of External
Causes of Injuries (ICECI): Data Dictionary, version 1.1. Amsterdam: Consumer Safety Institute;
2002.
4. European Communities Commission. Coding Manual for Home and Leisure Accidents, including
product related accidents (HLA V2000); 2001.
5. Bloemhoff A, Hoyinck S, Dekker R, Mulder S. Data Dictionary for Minimum Data Sets on Injuries:
Developed within the Injury Prevention Programme of the European Commission. Amsterdam:
Consumer Safety Institute; 2001.
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ANNEX 1 Data elements included in the ISS coding manual and their source
Data-element Source
Country code HLA V2000
Hospital number HLA V2000
Case number HLA V2000
Age of the patient HLA V2000
Sex of patient HLA V2000
Date of birth HLA V2000
Date of injury HLA V2000
Time of injury HLA V2000
Date of attendance HLA V2000
Time of attendance HLA V2000
Date of discharge HLA V2000
Treatment and follow-up HLA V2000
Intent ICECI 1.1a
Place of occurrence HLA V2000 and ICECI 1.1a
Mechanism of injury HLA V2000 and ICECI 1.1a
Activity when injured HLA V2000 and ICECI 1.1a
Type of sport/exercise activity HLA V2000 and ICECI 1.1a
Type of injury HLA V2000 and MDS-Is
Part of the body injured HLA V2000 and MDS-Is
Object/substance producing injury HLA V2000 and ICECI 1.1a
Narrative HLA V2000
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