From: International Classification of External Causes of Injuries (ICECI), Version 1.2, July 2004, pp 10-14
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1 From: International Classification of External Causes of Injuries (ICECI), Version 1.2, July 2004, pp Relationship between ICECI and ICD-10 The ICECI is desig to have a role complementary to the ICD-10 external causes classification. The ICD, including its external causes classification, is the reference classification for international reporting of mortality. The ICD often in a clinical modification is widely used to classify hospital in-patient cases. As a specialised system focusing on external causes of injury, the ICECI enables more detailed and flexible classification in its subject area. The ICECI can be used in many settings, including emergency departments, clinics, in-patient hospital settings; in ad hoc studies and surveys; and specialised mortality registration systems. The relationship between the ICECI and the ICD is shown schematically in Figure 2. Most parts of the ICD (ie. Chapters I to XIX and Chapter XXI) do not deal with external causes of injury and poisoning. Hence, most of the ICD is beyond the scope of the ICECI, and issues of comparability do not arise. Some parts of the ICECI fall beyond the scope of the ICD-10 External Causes chapter. This applies, for example, to items in some of the ICECI special modules (eg. Proximal risk factors for intentional self-harm; previous suicide attempt; sex of perpetrator; context of assault; phase of [sports] activity). Issues of comparability do not normally arise for these. However, the conceptual scope of several items in the Core module of the ICECI overlaps with the scope of ICD-10 Chapter XX. The ICECI items for which this is most clearly so are: Intent, Mechanism, Place, Activity and the Transport module. Issues of comparability arise for these parts of the ICECI. Figure 2: Schematic diagram of relationship between ICECI and ICD ICECI Bridge Intent ICD Intent Mechanism Transport module Mechanism Chapter XX (External causes) Place Activity Place Activity Rest of ICECI Rest of ICD (Chapters I to XIX and XXI) The Place and Activity items in the ICECI were desig to be comparable to categories in the ICD-10 Place and Activity classifications. The relationship is shown in Tables 3 and 4. ICECI Level 1 Place and Activity categories map directly to ICD Place and Activity categories, apart from minor differences in scope for two Place categories. The Intent, Mechanism and Transport module items in the ICECI have a more complex relationship with ICD-10 Chapter XX (Table 5). A major factor underlying the development of the ICECI has been dissatisfaction with some aspects of the ICD External Causes chapter for certain purposes related to injury prevention. It was not possible to develop a version of ICECI which mapped directly to categories in the External Causes chapter at 1
2 fine level without forcing the ICECI to take on characteristics of the External Causes chapter which had prompted development of the new approach. However, it was recognised by the ICECI development group that maximal comparability with ICD was a necessary design criterion. The solution arrived at was to specify mapping between ICECI and ICD at the level of a previously published reporting standard for injury data. This is shown in Figure 2 as the 'bridge' between ICECI and ICD. The MMWR reference cited above specified the 'Intent' and 'Mechanism/Cause' categories of the Framework in terms of ICD-9 External Cause codes. Subsequent work has adapted the Framework for use with ICD-10 [ The Framework has also been specified in terms of ICECI. ICECI version 1.2 and ICD-10 External Causes are both mapped onto the Framework in Table 5. ICD-10 values are shown within cells of the matrix. ICECI-coded cases corresponding to a cell in the Framework are those having the Intent (C1) code value below the cell (in the last row of the table) and the Mechanism (C2), and sometimes Transport (T) module, code values to the right of the cell (in the last column of the table). Table 3: Table of ICD-10 External Cause and ICECI version 1.2 code equivalents: Place ICD-10 Place ICECI 1.2 Notes Categories Codes Codes Home 0 C4=1 Residential institution 1 C4=2 School, other institution and public administrative area 2 C4=3, 4 Sports and athletics area 3 C4=5 Street and highway 4 C4=6 Trade and service area 5 C4=7, 11 Industrial and construction area 6 C4=8 Farm 7 C4=9 Other specified places 8 C4=10, 12, 98 Unspecified place 9 C4=99 C4.4 excludes Sports and athletics areas at schools and educational areas C4.10 excludes Public religious places, and Public buildings, non-cultural Table 4: Table of ICD-10 External Cause and ICECI version 1.2 code equivalents: Activity ICD-10 Activity ICECI 1.2 Categories Codes Codes While engaged in sports activity 0 C5=3.1, 4 While engaged in leisure activity 1 C5=5 While working for income 2 C5=1 While engaged in other types of work 3 C5=2, 3.8, 3.9 While resting, sleeping, eating or engaging in other vital 4 C5=6 activities While engaged in other specified activities 8 C5=7, 8, 98 During unspecified activity 9 C5=99 2
3 Table 5 Framework for presenting injury data: table of ICD-10 External Cause and ICECI version 1.2 code equivalents: Mechanism and Intent Manner/intent ICECI 1.2 All injury V01-X59, Y85, Y86 X60- X84, Y87.0 X85-Y09, Y87.1 Y10-Y34, Y87.2, Y89.9 Y35, Y36, Y89 (0,1) C2=1 to 8; 98; 99 Cut/ pierce W25-W29, W45 X78 X99 Y28 Y35.4 C2=2 (except 2.2.2) Drowning/ W65-W74 X71 X92 Y21 - C2=5.2 submersion Fall W00-W19 X80 Y01 Y30 - C2=1.5 Fire/ burn X00-X19 X76, X77 X97, X98 Y26, Y27 Y36.3 C2=4.1 Fire flame X00-X09 X76 X97 Y26 - C2=4.1.3 Hot object/substance X10-X19 X77 X98 Y27 - C2=4.1.1;4.1.2; to Firearm W32-W34 X72- X74 X93-X95 Y22-Y24 Y35.0 C2=2.2.2 Machinery W24, W30-W C2=3.2 All transport V01-V99 X82 Y03 Y32 Y36.1 C2=1.1 MV traffic Any of the 6 categories below X82 Y03 Y32 - C2=1.1 AND any of the Transport module statements for the subordinate MV traffic rows. Occupant V30-V39 (4-9) V40-V49 (4-9) V50-V59 (4-9) V60-V69 (4-9) V70-V79 (4-9) V83-V86 (0-3) C2=1.1 AND T1=(5 to 7) AND T2<>1 AND T4=(1 or 3) Motorcyclist V20-V28 (3-9) V29 (4-9) C2=1.1 AND T1=4 AND T2<>1 AND T4=(1 or 3) 3
4 Manner/intent ICECI 1.2 Pedal cyclist V12-V14 (3-9) V19 (4-6) C2=1.1 AND T1=2 AND T2<>1 AND T3=(4 to 7) AND T4=(1 or 3) Pedestrian V02-V04 (1,9) V09 (2) C2=1.1 AND T1=1 AND T2<>(2 to 6) AND T3=(4 to 7) AND T4=(1 or 3) Other V80 (3-5) V81-V82 (1) C2=1.1 AND T1=3 AND T2<>1 AND T3=(4 to 7) AND T4=(1 or 3) Unspecified V87 (0-8), V89 (2) C2=1.1 AND T1=99 AND T2<>1 AND T4=(1 or 3) Pedal cyclist, other V10, V11, V12-V14 (0-2) V15-V18, V19 (0-3,8,9) Pedestrian, other V01, V02-V04 (0) V05, V06, V09 (0,1,3,9) Other land transport V20-V28 (0-2), V29 (0-3) V30-V39 (0-3),V40-V49 (0-3) V50-V59 (0-3), V60-V69 (0-3) V70-V79 (0-3), V80 (0-2, 6-9) V81-V82 (0,2-9), V83-V86 (4-9) V87.9, V88 (0-9), V89 (0,1,3,9) C2=1.1 AND T1=2 AND T4<>(1 or 3) OR C2=1.1 AND T1=2 AND T2<>1 AND T3<>(4 to 7) AND T4=(1 or 3) OR C2=1.1 AND T1=2 AND T2=1 AND T4=(1 or 3) C2=1.1 AND T1=1 AND T4<>(1 or 3) OR C2=1.1 AND T1=1 AND T2<>1 AND T3<>(4 to 7) AND T4=(1 or 3) OR C2=1.1 AND T1=1 AND T2=1 AND T4=(1 or 3) Y82 Y03 Y32 C2=1.1 AND T1=(8 to 10) OR C2=1.1 AND T1=3 AND T4=(1 or 3) OR C2=1.1 AND T1=3 AND T3=(4 to 7) OR C2=1.1 AND T1=3 AND T2=1 Transport, other V90-V Y36.1 C2=1.1 AND T1=(11, 12, 98 or 99) Natural/ environmental W42, W43, W53-W64, W92- W99, X20-X39, X51-X C2=2.2 or 8 4
5 Manner/intent ICECI 1.2 Overexertion X C2=7 Poisoning X40-X49 X60- X85-X90 Y10-Y19 Y35.2 C2=6 X69 Struck by, against W20-W22, W50-W52 X79 Y00, Y04 Y29 Y35.3 C2=1.2 Suffocation W75-W84 X70 X91 Y20 - C2=5.1; 5.3 to 5.9 Other specified, classifiable W23, W35-W41, W44, W49, W85-W91, Y85 X75, X81 X96, Y02, Y05-Y07 Y25, Y31 Y35 (1,5), Y36 (0-2, 4-8) C2= 1.3 to 1.8; 3.1; 3.8; 4.2; 4.8 Other specified, not elsewhere classifiable X58, Y86 X83, Y87.0 Y08, Y87.1 Y33, Y87.2 Unspecified X59 X84 Y09 Y34, Y89.9 Adverse effects* Y40-Y84, Y88 Drugs Y40-Y59, Y88.0 Medical care Y60-Y84, Y88(1-3) All external causes Y35.6, Y89 (0,1) Y35.7, Y36.9 C2= 1.9; 3.9; 4.9; 98 C2= C2= C2= C2=20.3 to 20.9 V01-X59 X60- X84 X85-Y09 Y10-Y34 Y35-Y59 C2=1 to 99 ICECI 1.2 C.1=1 C.1=2 C.1=3 C.1=5 C.1=4.1 * Adverse effects and complications of medical and surgical care are included in ICD classification of external causes, but have controversial status as external causes of injury. 5
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