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Injury classification: balancing continuity and utility

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The approach to classifying injury and its causes in the International Classification of Diseases changed radically between ICD5 and ICD6. It has changed relatively little in the subsequent four revisions and fifty years. ICD6 introduced separate chapters for “injury and poisoning” and “external causes”, and the main groups in each of those chapters. Injury research has emerged as a discipline in the period since ICD6 was developed. Major themes are conceptual frameworks of aetiology and prevention, the empirical measurement of injury severity, and population-based and community injury prevention techniques. ICD-10 (in common with ICD-9) reflects these developments to a very limited extent. A response to limitations of the ICD for purposes of injury prevention and control was the development, particularly in the 1980s and 1990s, of special-purpose classifications of characteristics of events that result in injury. Recognition of strong commonality among several of these ‘multi-axial' systems led to a view that an international system embodying shared characteristics was achievable and worthwhile. The draft ICECI is the latest outcome of this work. Compatibility with ICD-10 is a design criterion for ICECI because of the continuing central importance of the ICD for health classification. The precise meaning of “compatibility” in this context has not been resolved. At one extreme, “compatibility” could mean limiting ICECI simply to the ICD-10 external cause codes with subdivision of existing categories, and perhaps some additional data items that do not overlap conceptually with ICD-10. At other extremes, ICECI could be developed without specific reference to categories in ICD-10, or ICECI could replace the existing ICD external cause classification. It is not practicable to map every ICD-10 three-character external cause category to a unique equivalent combination of codes in a multi-axial system, mainly due to conceptual inconsistencies in the ICD-10 external cause classification. More limited mapping is possible and could be designed to ensure that data coded to ICECI could be grouped to be equivalent to important ICD external cause categories. The way chosen for classification of external causes should be one that recognises contemporary information requirements in the fields of injury prevention and control as well as the desirability of continuity in long-term monitoring of important categories of injury. Field-testing and consultation with data users will determine whether ICECI meets these criteria well enough to warrant its adoption as a member of the ICD family of classifications.

Document Type: Research Article


Publication date: March 1, 2000

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