Injury Prevention Policy

Documenting the Cause of Injury

Background

How do we know if there is an injury problem?

Public health workers monitor the population for the occurrence of certain adverse health conditions and the risk factors for some of those conditions. In most states, injuries are among the fatal and non-fatal conditions that are monitored (1). This systematic, ongoing collection of data is termed surveillance. Surveillance data are useful for indicating the magnitude of the problem, identifying new problems, examining trends, and assessing the success of injury prevention efforts. These data are primarily gathered from information on death certificates and hospital discharge forms.

Information from these forms is classified by state vital records or hospital medical records professionals into standard categories. The nature of each injury (brain injury, fracture of a bone in the forearm, burn to the foot, etc.) and its cause (motor vehicle crash, fall, etc.) are assigned alphanumeric codes to allow efficient storage and retrieval of the information. As a rule, the system for classification of death records in the United States is the International Classification of Diseases (ICD), developed by the World Health Organization. The system for documenting non-fatal injuries is based upon the ICD but was enhanced and expanded by the National Center for Health Statistics.

Hospital physicians and medical examiners provide the information necessary to classify an injury's nature and cause. Documentation of the nature of injury is usually straightforward. Documentation of the information necessary to classify the cause and circumstances (e.g. activity and locale at the time of injury) of an injury-related incident is more problematic. Frequently, insufficient information is written into the hospital record or on the death certificate to properly classify the cause of injury. This limits the quality and specificity of the data on injury causes. Although these data are imperfect and can be improved, they are nonetheless quite useful (2, 3).

Policy & Details

Emergency physicians, nurses, and EMTs shall receive training in capturing information about the intent, causes, and circumstance of injury-related incidents and the appropriate documentation of such in the EMS report or medical record.

Physicians, nurses, and paramedics are required to attend continuing education courses in their specialty. Some of these courses contain information about the mechanism and biomechanics of motor vehicle trauma and how this may effect treatment. However, the applicability of this information to injury prevention is seldom discussed. It is important to ensure that health workers are made aware of the benefits of uniform and reliable recording of the circumstances of each injury on patient records so that this information may be properly coded. Only then will this information be useful for injury prevention.

Effectiveness

Surveillance systems are the primary means by which injury researchers and prevention specialists identify and monitor changes in the magnitude of injury problems. Surveillance data can help direct priorities to the areas in greatest need for attention. For example, a community could track the frequency of head injuries among children. The hospital records may reveal that many of these injuries were due to bicycle crashes. The availability of accurate and complete data would be needed to advocate effectively for the establishment of an injury-related policy or program to prevent these injuries. Promoting the training of health care professional in improved history-taking and record keeping will improve the quality of injury data and will further the development and evaluation of effective interventions.

Contacts

Lee Annest, Ph.D., Director
Office of Statistics and Programming
National Center for Injury Prevention and Control
Centers for Disease Control
Phone: (770) 488-4804
Fax: (770) 488-1665
Email: lannest@cdc.gov
WWW: http://www.cdc.gov/ncipc

David Lawrence, Director
Center for Injury Prevention Policy and Practice
Graduate School of Public Health
San Diego State University
Phone: (619) 594-3691
Fax: (619) 594-1995
Email: david.lawrence@sdsu.edu
WWW: http://www.cippp.org

References

1. Annest JL, Conn JM, McLaughlin E, Fingerhut LA, Pickett D, Gallagher SS. How States Are Collecting and Using Cause of Injury Data. Washington, DC: Injury Control and Emergency Health Services Section, American Public Health Association, 1998.

2. Sniezek JE, Finklea JF, Graicer PL. Injury coding and hospital discharge data. JAMA 262(16):2270-2272, 1989.

3. Berenholz G, Lawrence DW. Adequacy of hospital discharge data for determining trauma morbidity patterns. J Trauma 41(1):168-169, 1996.

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Last modified: 2-August-2000.